Prakash Chandran (Host): Getting diagnosed with breast cancer is a shock that can understandably leave patients feeling vulnerable and unsure of what to expect. Today, we'll meet a team of dedicated breast cancer specialists from Bebee HealthCare who will shed some light on the treatment options available to patients facing breast cancer.

Joining us today are breast surgical oncologists, Dr. Diana Dickson-Witmer and Dr. Matthew Richards as well as family nurse practitioner, Amanda Biro, from the Beebe Center for Breast Health.

Thank you all so much for joining us today. I truly appreciate your time. Now, you're all breast cancer specialists with the Beebe Center for Breast Health. Dr. Richards, I wanted to maybe get started with you. I know a lot of patients that will be watching and listening to this will be wondering what type of treatment options are available. Is this something that you can speak to?

Dr. Matthew Richards: Sure. So, Dr. Dixon-Witmer and I, our goal with this program is to make Beebe not only an option, but a destination where patients can really travel the entire spectrum of the disease process. So from screening to diagnosis to biopsy through their surgery, if they need any followup chemotherapy-type treatments or radiation-type treatments. Our goal with this program is to make this a destination where they can get all of the state-of-the-art treatments that are available at further institutions.

Host: Yeah. That absolutely sounds fantastic, that you run the whole spectrum of treatment and care within that organization. Dr. Dixon-Witmer, is there anything that you would like to add just regarding some of the treatment options that are available at Beebe Center for Breast Health?

Dr. Diana Dickson-Witmer: I think one thing that's particularly important to patients and their families is not just that all these things are available, but we coordinate these things for them. We are a team. And our team members include not these three providers, but nurse navigators who are absolutely the most important part of the team much of the time. They help make sure that everybody's on the same page. They help the patients know where they're supposed to be, when, and without feeling stressed about needing to find that location or get that piece of paper. So, it is not just we have everything that's state-of-the-art that's available for treating patients with breast disease, be it benign or malignant, but we help coordinate a whole team to help the patient.

Host: Yeah, absolutely. I want to stay with that kind of line of discussion. You talked about navigation being so incredibly important. Amanda, if I can turn to you and just ask a little bit around what a patient can expect, especially when it comes to the pre-surgery routine and the team support.

Amanda Biro: Yeah. So, we have two nurse navigators here at Beebe, Donna Miskin and Kathy Cook, and they streamline the process of surgery focusing on education for our patients pre and post-op. They ensure that testing and other needed services happen within a timely fashion. They're available to answer questions after their surgical consult, before the surgery and after surgery to support the patient needs. They also address barriers to care and refer to resources to keep things moving smoothly for the patient in the continuum of care.

Host: Yeah. That sounds fantastic that you have that support team there. Now, I know that there is a new specialty surgical hospital and there's an experience that comes along with that. Dr. Richards, is this something that you can speak to?

Dr. Matthew Richards: So, the new specialty surgical hospital has been getting great feedback from patients. They love the facilities. It's really streamlined kind of the outpatient surgical experience for the patients. The fact that it's kind of within the same campus is where they're familiar with our office and where they're familiar with their radiology appointments, is also very helpful to them. The hospital itself has all kind of state-of-the-art equipment designed specifically to streamline our process during the day. So, the patients are very comfortable. They all have reported a great experience with the staff there, and they love the facilities and the people that they've met. So, I think it's been a great addition to the Beebe community.

Host: Now Dr. Dixon-Witmer, you kind of started to touch on this. But in the new Center for Breast Health, obviously, the patient feels supported in every bit of their journey, including the navigation piece. But more broadly speaking, can you just talk about the new Center for Breast Health and how that really goes to support the patient journey?

Dr. Diana Dickson-Witmer: Yes. We are going to be expanding the number of examining rooms that we have from four to seven, and that's going to permit us to bring in another breast surgical oncologist. You know, that Sussex County, where Beebe resides in Sussex County, is Beebe's specialty. Sussex County is growing about 6% per year population. It's exploding in population and we want people in Sussex County not to have to leave Sussex County to have the best possible care for breast issues. And we can do that, we are doing that. But we need another breast surgical oncologist in order adequately to accommodate this growing population. So, that's one of the advantages.

Another advantage is that in the new space, we will be co-located with the radiologists, and Beebe is actively recruiting a dedicated breast imager, a radiologist who specializes in nothing but breast imaging. So, that is coming soon. Now, the radiologists who do an excellent job at reading breast imaging will be able to be available to us immediately when we're seeing a patient. We, the providers on this call, see a patient that has maybe a complicated mammogram or MRI. When we're in the same building where the radiologists are, we can walk across the hall and be looking at those images with the radiologist at the same time, not just on the phone, each on a different computer, trying to explain what you see and see if they think they see the same thing. So, that's a big advantage for the patient; the proximity, being in the same building with the radiologist.

The third thing is that we will have, right in the offices where the breast surgical oncologists are housed, we'll have stereotactic core biopsy, a form of needle biopsy of things seen on the mammogram of the breast and ultrasound. And those will be right within our office space so that we will eventually be able to offer patients much more timely access to an indicated biopsy than we're able to do now. So, those are three very significant advantages of moving into the new Center for Breast Health.

Host: Yeah. It's absolutely incredible and it kind of leads me to also want to ask about the new tools and technologies that you're going to have access to. So, maybe Dr. Dixon-Witmer, just staying with you for a moment, you kind of mentioned imaging. I know there's 3D mammography technology now accessible to you. Is this something that you can speak to?

Dr. Diana Dickson-Witmer: Absolutely. And so, 3D mammography or tomosynthesis mammography has been shown to reduce callbacks by as much as 50%. What that means is when patients have a screening mammogram every year, maybe 7% of the time patients have to have some additional imaging. When the screening mammogram is done with tomosynthesis, and that's what's available at all the Beebe facilities that do mammography, there are 50% fewer times that patients have to come back and have extra imaging. So, tomosynthesis is better for patients.

The other things that are now becoming standard for evaluation of patients who are treated for breast cancer are MRI. And MRI is available with a dedicated what we call breast coil right in the building that the new Beebe Center for Breast Health will be in. We are going to have the capability of doing MRI-guided biopsies within the near future.

We are looking at contrast enhanced mammography as something that may be less expensive than MRI, with many of the advantages, and that's something we're exploring with our radiology colleagues for the near future and for happening in the same building where our new offices will be.

Host: It's just amazing some of the things you're talking about, even, the lack of requirement for that extra imaging with the tomosynthesis, just because I think it's so anxiety-inducing when you do get that cancer diagnosis, and the more you have to come in, the more steps that it takes, it just adds to that burden. I think I want to stay kind of along the same line of discussion. Amanda, you know, when we think about risk assessments or anything kind of within that regard that you want to talk about, can you kind of speak to risk assessments and how that is changing?

Amanda Biro: Yeah. So, every patient, before they get a mammogram done at Beebe, they are able to do their risk assessment for developing breast cancer using the Tyrer-Cuzick scale. And if any patient is over 20%, then they do recommend that patient see me because I do run the breast cancer prevention program and see patients that are at a high risk for developing breast cancer.

Dr. Diana Dickson-Witmer: Amanda, how many patients are you currently following in the Breast Cancer Prevention program?

Amanda Biro: I would probably say about 150 now.

Dr. Diana Dickson-Witmer: This is a gigantic, important thing for Sussex County. Because it's one thing to have Matt and me and our new colleague, Karen, who's going to be coming on, who can operate on patients if they have breast cancer, but it's a lot better to prevent breast cancers from happening.

And the first step in preventing breast cancer is for patients 25 years and older to identify what their actual personal risk of developing breast cancer is. So, Amanda has been traveling around from GYN and primary care office to office teaching providers how to do a kind of risk calculation, a computer-based algorithm called the Tyrer-Cuzick. And the National Cancer Center Network and American College of Radiology have both in their recent updates said how important it is for every individual at age 25 to have a risk assessment for breast cancer, so that we can identify those patients where risk reduction strategies like a pill for five years or in cases where there's actually a mutation making a really high risk, sometimes preventive surgery. And identifying those patients early on lets us put in place appropriate prevention strategies, and it lets us start to screen them. Some of them need screening from age 25 or 30 with MRI. But if we don't know what the risk is for each individual, we can't make those appropriate recommendations. And Amanda and her program are helping with that enormously.

Host: it's absolutely just amazing to hear that that is available. And I think for the people listening to this, just because the best thing to do is to be proactive and really prevent cancer before it expands. And just because there is the data now, you have algorithms and systems like this to where you can put in just a couple factors and information about yourself, your family history, and you're able to get a sense of, "Hey, am I high risk? What should be my course of action here?" So, I'm really glad that you drove that home there. Dr. Richards, there's other things and new technologies that are maybe worth talking about. I know, obviously, with the advent of AI and all of the coverage that's getting in the news, is there anything else that's worth kind of sharing with our audience around new technologies to discuss?

Dr. Matthew Richards: So, I think we've touched on a lot of the new technologies. We are using different localizing technologies in the operating room that are continuously evolving. So, those are moving in exciting directions that are becoming a little bit less stressful for the patients, because it doesn't burden them so much on the day of the surgery where they don't have to come in extra early and get procedures ahead of their procedure. So, it kind of uncouples that and lets the actual day of surgery would be a little bit calmer experience for them. So as these kind of technologies continue to evolve, we're continuing to trial and embrace them. And that's been, I think, very well received by our patients.

Dr. Diana Dickson-Witmer: And, Prakash, there's something that Dr. Richards and I as breast surgical oncologists have been very interested in, which is doing less to accomplish the same good result. So, not just looking for how much can a patient tolerate in treating a cancer. But looking at how much can we safely pull back. Can we do less radiation or not do radiation? Can we do less surgery or less aggressive surgery? And Matt and I are both very involved with the American Society of Breast Surgeons and the society's guidelines and initiatives around pulling back, doing less to achieve the same good results. And we are also involved with the Alliance for Clinical Trials in Oncology, so we are aware of what is at the forefront, of what's going to happen in the next 5, 10 years in terms of doing less to achieve the same excellent outcomes, but impacting the woman's body and her life less.

Host: It really seems like a theme in this conversation with the new facility, with the new technology, and even the cultural approach, that doing less to accomplish the same result is really so apparent, right? That there is a culture where you're constantly looking at, "Hey, listen. A cancer diagnosis doesn't mean you don't have a team of supportive care that really looks to optimize how do we take care of this in the least invasive way possible."

An important piece that I wanted to bring up is just kind of the mental health component of things after a diagnosis is given to someone. There's obviously all this technology there, doing less to achieve the same result. But Amanda, I wanted to maybe ask, is there anything that is available to support the patient on their mental health journey after a cancer diagnosis is received?

Amanda Biro: So, our nurse navigators, they do a really good job of getting our patients in contact with social workers that can help with that.

Dr. Matthew Richards: The nurse navigators also have kind of contacts with a network of local support groups that are kind of tailored to the patient's demographics as well, which have been very well received as well. So, they can do things like connect them with survivors and have a survivorship-type conversation with women who have gone through similar diagnoses.

Dr. Diana Dickson-Witmer: We have close relationship with the Delaware Breast Cancer Coalition. We're very active in helping support. On that same idea of support for individuals going through treatment for breast cancer and into survivorship, one of the reasons that the Commission on Cancer exists and accredits 1,500 cancer programs in the country is that it is critically important for patients to be treated with high standards but close to home.

Because being where your dogs are, your cat, Matthew, your family, your neighbors coming over with a plate of brownies, being at home when you're going through treatment for cancer makes it more likely that you will in fact complete the treatments, and outcomes are actually better when patients have the psychological as well as physical support of not having to travel long distance for excellent care. So, it is very important that Sussex County have this breast program at Beebe Healthcare, because people from Sussex do not have to leave Sussex County to have the best possible care.

Host: You know, one thing that is apparent in this conversation is just how close you all are and how collaborative you all work together to provide the highest and best care for the patients. Dr. Richards, maybe starting with you, I'd love to just understand a little bit more about what you like most about kind of the team at Beebe Healthcare.

Dr. Matthew Richards: I think, like you said, we all work very well together. We have kind of a wide range of life experiences that we all bring to the table. So, each of us offers something different in the overall care of our patient community here. And it's all been meshing very well together.

Host: Amanda, what about yourself? Same question. What do you like most about the team?

Amanda Biro: Just how close we work together, especially with myself, Dr. Dixon-Witmer and Dr. Richards and our nurse navigators. Also, I think also we work very close with medical oncology and radiation oncology as well and the radiologist.

Host: And then finally, Dr. Dixon-Witmer, I'd love to hear from you as well.

Dr. Diana Dickson-Witmer: I can't get into political trouble by drawing distinctions between other places, but I have been in practice for decades and I've never worked anywhere where everybody was so supportive of one another. And where there's no backstabbing, there's no constant competing for moving up the ladder ahead of the next person. It's just a welcoming, warm, collaborative environment that is the perfect way for healthcare to be delivered.

Host: And the final question that I have really is, it is very clear that all of you had had a say and a hand in coming up with the future of what this new center represents for the future of patient care. So, I guess, a last word I'd love to hear is just what are you most excited about for this future, for the new center. And Dr. Richards, we'll start with you.

Dr. Matthew Richards: Sure. So, I'm excited that like Dr. Dixon-Witmer referenced earlier, that we'll be in closer proximity to radiologists. Having that ability to collaborate much closer with them is only a benefit to our patients and their care. So, I'm very excited that we'll be not only in the same building, but kind of in a shared space a little bit. They will have space in our office as well. So, it's exciting that we can move in that direction for our patients.

Host: Awesome. And Dr. Dixon-Witmer, what about yourself?

Dr. Diana Dickson-Witmer: Having a visual representation of the breast program. So, the program is what is important. The collaboration between the different disciplines, all of whom are important for the patient, and having a visual representation in the form of this physical new entrance, new offices. I think that helps the community understand that Beebe is really serious about this. We are building a state-of-the-art breast program, and these new offices are just the physical start. This is not the end product. This is a start, but it's a visual demonstration to this community that Beebe is very serious about building a state-of-the-art breast program, and it's only going to get better.

Host: Well said. And Amanda, I will give you the last word.

Amanda Biro: I agree. A new space for us, the providers and for our patients. And I agree with Dr. Richards about radiology being in the same space as us as well.

Host: Well, what an exciting future ahead. I appreciate the collaborative care that you all offer and your constant day to day work. Thank you so much for your time today.

Amanda Biro: Thank you.

Dr. Diana Dickson-Witmer: Thanks for the opportunity to get the message out.

Host: That was breast surgical oncologists, Dr. Diana Dixon-Witmer and Dr. Matthew Richards, and Family Nurse Practitioner, Amanda Biro, from the Beebe Center for Breast Health. For more information, please visit beebehealthcare.org/services/oncology and select breast cancer. If you found this podcast to be helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. I'm Prakash Chandran. Thanks for listening to Beebe Healthcare Podcast from Beebe Healthcare. Be well.