Thirty years ago, the only treatment for breast cancer was a mastectomy. Today, depending on the stage of breast disease, a woman may have many alternatives that don't require complete removal of the breast.
Dr. Theresa Schwartz and the all-female breast cancer treatment team provide a range of care, including ways to meet personal needs during treatment.
Selected Podcast
Considering Treatment Options After a Breast Cancer Diagnosis
Featuring:
Dr. Schwartz is an assistant professor in the Department of Surgery at Saint Louis University School of Medicine, where she is also associate director of the general surgery residency program. In addition, she chairs the Saint Louis University Cancer Committee.
Dr. Schwartz is a peer reviewer for the Annals of Surgical Oncology and Cancer Treatment Reviews.
She maintains a high level of positive energy both at work and outside of work, where she is an enthusiastic sports fan.
Theresa Schwartz, M.D.
Dr. Theresa Schwartz provides surgical care for women with breast cancer and benign breast disease. She is interested in research regarding breast cancer outcomes and reducing socioeconomic disparities in access to breast cancer care.Dr. Schwartz is an assistant professor in the Department of Surgery at Saint Louis University School of Medicine, where she is also associate director of the general surgery residency program. In addition, she chairs the Saint Louis University Cancer Committee.
Dr. Schwartz is a peer reviewer for the Annals of Surgical Oncology and Cancer Treatment Reviews.
She maintains a high level of positive energy both at work and outside of work, where she is an enthusiastic sports fan.
Transcription:
Melanie Cole (Host): After receiving a breast cancer diagnosis, the first step is to have a plan. At Saint Louis University Breast Cancer Center, they can help you develop a map, a direction, and a plan with their all-female team. My guest is Dr. Theresa Schwartz. She’s an Assistant Professor in the Department of Surgery at Saint Louis University School of Medicine. Welcome to the show, Dr. Schwartz. Tell us about the breast cancer team at SLUCare.
Dr. Theresa Schwartz (Guest): Mentioning that it’s a complete female team is actually a nice way to start because there are multiple people that are involved in the care of any breast cancer patient. But most of the time, it starts at the radiology level. We have a fantastic breast radiologist named Dr. Christie Doherty and then a new breast radiologist named Dr. Debbie Bennett, who just started here at SLU. They are both fantastic, both female radiologists that are the frontline that any woman who comes in with an abnormal mammogram or an abnormal finding on physical exam will see in terms of imaging. From a surgical side, it’s me. I’m the one breast surgeon here who’s able to take care of all of our breast cancer patients as well as all of those women who have benign and high-risk disease at the same time. Then once they get through the initial phase, the getting the imaging, the seeing a surgeon and determining what needs to be done in their overall treatment plan, we have multiple other ancillary staff and sub-specialists that get involved. We have a fantastic genetics counselor here, Dr. Suzanne Mahon, who sees a significant number of women around the city of Saint Louis to determine if they have a higher than normal risk of getting breast cancer in the future, or, if they’re already breast cancer patients, if a genetic mutation was responsible for the progression of their disease. Then we also have fantastic medical oncologists as well as radiation oncologists that assists in the treatment that we do once an operation is complete. We really do have a very well-rounded and very advanced team here that helps take care of women with breast cancer.
Melanie: Well, it certainly can be a devastating diagnosis for any woman, Dr. Schwartz. Scary, and you think about your family and mortality and all of these things. We’re women. These things run through our minds.
Dr. Schwartz: Absolutely.
Melanie: So what do you tell someone when they’ve been newly diagnosed to help them with that emotional aspect?
Dr. Schwartz: You’re exactly right about that as well because this is tough. Women are used to taking care of everyone else. They’re not used to being the ones that need to be taken care of. And unfortunately, your regular life doesn’t stop whenever you get this diagnosed. People still have jobs. They still have kids to get to soccer practice. They still have spouses. They still have regular lives that are going to have to be worked in as well. One of my biggest pieces of advice is that breast cancer doesn’t become an emergency. It’s not something where a decision has to be made immediately about what to do and when to do it. There’s time. There’s time to be able to think about what your treatment options are. There’s time to think about in what order, if that’s a possibility, what you would like to get different things done. You can also work it around your schedule. It’s not as if you get diagnosed on Monday and you have to have an operation by Tuesday afternoon. There’s ways that it can be worked in so it’s not as devastating of a punch, and it also gives you some time to actually process the information. We have great women in our Cancer Resource Center as well as within our Department of Social Work and Department of Psychology that can help with other things as well in terms of financial resources or educational resources and, definitely, from a psychological standpoint, to be able to give them an opportunity to get through the diagnosis as well as what it’s going to do to the rest of their lives. So it’s a tough diagnosis to be able to get, but it’s not something that you have to hurry up and make quick decisions about. So I try and encourage everyone at the time of diagnosis to be able to take that back and process all the information that they’re getting because this is all new. Breast cancer isn’t something that most women know a lot about. It’s something that most women fear. But the knowledge of what we have to offer in terms of treatment is not something anyone in the general population would have a good handle on. That is the one good thing is that you do have time. You have time to be able to process everything about the diagnosis as well as what options are available to you.
Melanie: When people are thinking about a plan and having their plan after receiving their cancer diagnosis and that they want to develop this map and direction and you’re helping them, Dr. Schwartz, to do that, when you speak about other options, they right away think, “Oh my, gosh. I gotta have a mastectomy.” But there are other options out there. Discuss a few of those for us.
Dr. Schwartz: You know, absolutely, because those were the options 30 years ago. There were no options. You walked in, you got a breast cancer diagnosis, and you were signed up to have your entire breast removed. Those days are gone. Fortunately, with the advances that we have in clinical exam as well as mammography techniques, we’re able to detect cancer at a much earlier stage, so hardly anybody needs a mastectomy anymore. There are ways that we can just remove part of the breast and then do radiation therapy to follow, and that gives them the exact same survival as if I would remove the entire breast. They do have options. However, some women, even if they have a small cancer, they would opt for that entire breast removal. So there is no wrong answer in terms of treatment. It comes down to how big is the tumor, can we take it out with a smaller operation instead of having the entire breast removed. But ultimately, what the patient wants, if they are interested in conserving the breast and I can make it happen, that’s always on the table. If their tumor does not allow that, then a mastectomy is something that can happen for anyone. But there’s immediate breast reconstruction, there’s delayed breast reconstruction. There’s ways that we can kind of get them back to a normal physical appearance sooner rather than later. So it’s not what people would have seen 35 years ago where you’re immediately signed up to losing your breast without reconstruction and just hoping everything works out okay. We have plenty of different surgical techniques in order to get people back to the way they felt before the diagnosis was placed.
Melanie: So speak about the individually focused treatment approach. You have this team of women and you’re doing all these things. There’s kind of this outside circle too. There’s music therapy, social work and journaling, and yoga. Speak about some of the other things that women can do after receiving this diagnosis besides just looking at treatment options.
Dr. Schwartz: That’s a great point, because the treatment ends up being the center. It’s what everyone’s focused on and then they kind of let their emotional health as well as their mental wellbeing, they make it take a backseat because they’re worried that the cancer needs to be at the front. But all of that is important because if you’re not emotionally comfortable with your decision and if your mental focus is not paying attention to the rest of you, it’s going to catch up. Whether it catches up with you in the middle of treatment or after treatment, that’s individualized as well. But it’s something that you can’t really get away from. What our Cancer Resource Center does here, is tremendously important, even for many other cancer sites. We have tons of educational materials, where men and women at the time of diagnosis are able to go in and talk to our specialty nurses that know how to direct them to find things to read, to find things in lay language that makes more sense. Because whenever they’re in the doctor’s office, it’s kind of hard to process and be able to understand everything that’s being said because it’s just such a huge diagnosis to receive. But in addition to the educational resources, we have the music therapy program here that’s gotten a significant amount of accolades because there is data to show that people going through chemotherapy or going through cancer treatment can have a lower level of anxiety and a higher comfort level during treatment if they’re receiving music therapy. We also have a certified oncology psychologist who is able to gear her assistance to cancer patients better than someone who does not normally treat cancer patients would. From a social work standpoint, the financial support, the insurance coverage, transportation to and from the hospital, making sure that everyone has the resources they need at home in order to get better, either after an operation or during treatment, those can be outside sources of stress that don’t tend to be something a patient would bring up to their physician. So that’s what our ancillary staff focuses on. What else we need to do to make sure that that woman is taken care of outside of the cancer diagnosis?
Melanie: Dr. Schwartz, in just the last minute, if you would, tell the listeners why they should come to see you at SLUCare for your breast health.
Dr. Schwartz: Saint Louis University has a long history of providing a high level of care with an altruistic approach relatively unmatched. We have a well-educated, well-trained staff in addition to all of our sub-specialists that concentrate on the care of breast cancer patients. It’s definitely our focus. It’s what the majority of us have dedicated our career to. And there’s something that you get at Saint Louis University that you just don’t get at other institutions. It’s a smaller hospital. It’s definitely focused on the patient. It’s focused on respecting their personal values, and it’s a warmer environment than you will get at most bigger cancer centers. So in our institution, you can definitely feel like you are getting personal care by the best in the city.
Melanie: Thank you so much, Dr. Theresa Schwartz. You’re listening to For Your Health with the physicians of Saint Louis University, SLUCare Physician Group. SLUCare is the academic medical practice of Saint Louis University School of Medicine. For more information, you can go to slucare.edu. This is Melanie Cole. Thanks for listening.
Melanie Cole (Host): After receiving a breast cancer diagnosis, the first step is to have a plan. At Saint Louis University Breast Cancer Center, they can help you develop a map, a direction, and a plan with their all-female team. My guest is Dr. Theresa Schwartz. She’s an Assistant Professor in the Department of Surgery at Saint Louis University School of Medicine. Welcome to the show, Dr. Schwartz. Tell us about the breast cancer team at SLUCare.
Dr. Theresa Schwartz (Guest): Mentioning that it’s a complete female team is actually a nice way to start because there are multiple people that are involved in the care of any breast cancer patient. But most of the time, it starts at the radiology level. We have a fantastic breast radiologist named Dr. Christie Doherty and then a new breast radiologist named Dr. Debbie Bennett, who just started here at SLU. They are both fantastic, both female radiologists that are the frontline that any woman who comes in with an abnormal mammogram or an abnormal finding on physical exam will see in terms of imaging. From a surgical side, it’s me. I’m the one breast surgeon here who’s able to take care of all of our breast cancer patients as well as all of those women who have benign and high-risk disease at the same time. Then once they get through the initial phase, the getting the imaging, the seeing a surgeon and determining what needs to be done in their overall treatment plan, we have multiple other ancillary staff and sub-specialists that get involved. We have a fantastic genetics counselor here, Dr. Suzanne Mahon, who sees a significant number of women around the city of Saint Louis to determine if they have a higher than normal risk of getting breast cancer in the future, or, if they’re already breast cancer patients, if a genetic mutation was responsible for the progression of their disease. Then we also have fantastic medical oncologists as well as radiation oncologists that assists in the treatment that we do once an operation is complete. We really do have a very well-rounded and very advanced team here that helps take care of women with breast cancer.
Melanie: Well, it certainly can be a devastating diagnosis for any woman, Dr. Schwartz. Scary, and you think about your family and mortality and all of these things. We’re women. These things run through our minds.
Dr. Schwartz: Absolutely.
Melanie: So what do you tell someone when they’ve been newly diagnosed to help them with that emotional aspect?
Dr. Schwartz: You’re exactly right about that as well because this is tough. Women are used to taking care of everyone else. They’re not used to being the ones that need to be taken care of. And unfortunately, your regular life doesn’t stop whenever you get this diagnosed. People still have jobs. They still have kids to get to soccer practice. They still have spouses. They still have regular lives that are going to have to be worked in as well. One of my biggest pieces of advice is that breast cancer doesn’t become an emergency. It’s not something where a decision has to be made immediately about what to do and when to do it. There’s time. There’s time to be able to think about what your treatment options are. There’s time to think about in what order, if that’s a possibility, what you would like to get different things done. You can also work it around your schedule. It’s not as if you get diagnosed on Monday and you have to have an operation by Tuesday afternoon. There’s ways that it can be worked in so it’s not as devastating of a punch, and it also gives you some time to actually process the information. We have great women in our Cancer Resource Center as well as within our Department of Social Work and Department of Psychology that can help with other things as well in terms of financial resources or educational resources and, definitely, from a psychological standpoint, to be able to give them an opportunity to get through the diagnosis as well as what it’s going to do to the rest of their lives. So it’s a tough diagnosis to be able to get, but it’s not something that you have to hurry up and make quick decisions about. So I try and encourage everyone at the time of diagnosis to be able to take that back and process all the information that they’re getting because this is all new. Breast cancer isn’t something that most women know a lot about. It’s something that most women fear. But the knowledge of what we have to offer in terms of treatment is not something anyone in the general population would have a good handle on. That is the one good thing is that you do have time. You have time to be able to process everything about the diagnosis as well as what options are available to you.
Melanie: When people are thinking about a plan and having their plan after receiving their cancer diagnosis and that they want to develop this map and direction and you’re helping them, Dr. Schwartz, to do that, when you speak about other options, they right away think, “Oh my, gosh. I gotta have a mastectomy.” But there are other options out there. Discuss a few of those for us.
Dr. Schwartz: You know, absolutely, because those were the options 30 years ago. There were no options. You walked in, you got a breast cancer diagnosis, and you were signed up to have your entire breast removed. Those days are gone. Fortunately, with the advances that we have in clinical exam as well as mammography techniques, we’re able to detect cancer at a much earlier stage, so hardly anybody needs a mastectomy anymore. There are ways that we can just remove part of the breast and then do radiation therapy to follow, and that gives them the exact same survival as if I would remove the entire breast. They do have options. However, some women, even if they have a small cancer, they would opt for that entire breast removal. So there is no wrong answer in terms of treatment. It comes down to how big is the tumor, can we take it out with a smaller operation instead of having the entire breast removed. But ultimately, what the patient wants, if they are interested in conserving the breast and I can make it happen, that’s always on the table. If their tumor does not allow that, then a mastectomy is something that can happen for anyone. But there’s immediate breast reconstruction, there’s delayed breast reconstruction. There’s ways that we can kind of get them back to a normal physical appearance sooner rather than later. So it’s not what people would have seen 35 years ago where you’re immediately signed up to losing your breast without reconstruction and just hoping everything works out okay. We have plenty of different surgical techniques in order to get people back to the way they felt before the diagnosis was placed.
Melanie: So speak about the individually focused treatment approach. You have this team of women and you’re doing all these things. There’s kind of this outside circle too. There’s music therapy, social work and journaling, and yoga. Speak about some of the other things that women can do after receiving this diagnosis besides just looking at treatment options.
Dr. Schwartz: That’s a great point, because the treatment ends up being the center. It’s what everyone’s focused on and then they kind of let their emotional health as well as their mental wellbeing, they make it take a backseat because they’re worried that the cancer needs to be at the front. But all of that is important because if you’re not emotionally comfortable with your decision and if your mental focus is not paying attention to the rest of you, it’s going to catch up. Whether it catches up with you in the middle of treatment or after treatment, that’s individualized as well. But it’s something that you can’t really get away from. What our Cancer Resource Center does here, is tremendously important, even for many other cancer sites. We have tons of educational materials, where men and women at the time of diagnosis are able to go in and talk to our specialty nurses that know how to direct them to find things to read, to find things in lay language that makes more sense. Because whenever they’re in the doctor’s office, it’s kind of hard to process and be able to understand everything that’s being said because it’s just such a huge diagnosis to receive. But in addition to the educational resources, we have the music therapy program here that’s gotten a significant amount of accolades because there is data to show that people going through chemotherapy or going through cancer treatment can have a lower level of anxiety and a higher comfort level during treatment if they’re receiving music therapy. We also have a certified oncology psychologist who is able to gear her assistance to cancer patients better than someone who does not normally treat cancer patients would. From a social work standpoint, the financial support, the insurance coverage, transportation to and from the hospital, making sure that everyone has the resources they need at home in order to get better, either after an operation or during treatment, those can be outside sources of stress that don’t tend to be something a patient would bring up to their physician. So that’s what our ancillary staff focuses on. What else we need to do to make sure that that woman is taken care of outside of the cancer diagnosis?
Melanie: Dr. Schwartz, in just the last minute, if you would, tell the listeners why they should come to see you at SLUCare for your breast health.
Dr. Schwartz: Saint Louis University has a long history of providing a high level of care with an altruistic approach relatively unmatched. We have a well-educated, well-trained staff in addition to all of our sub-specialists that concentrate on the care of breast cancer patients. It’s definitely our focus. It’s what the majority of us have dedicated our career to. And there’s something that you get at Saint Louis University that you just don’t get at other institutions. It’s a smaller hospital. It’s definitely focused on the patient. It’s focused on respecting their personal values, and it’s a warmer environment than you will get at most bigger cancer centers. So in our institution, you can definitely feel like you are getting personal care by the best in the city.
Melanie: Thank you so much, Dr. Theresa Schwartz. You’re listening to For Your Health with the physicians of Saint Louis University, SLUCare Physician Group. SLUCare is the academic medical practice of Saint Louis University School of Medicine. For more information, you can go to slucare.edu. This is Melanie Cole. Thanks for listening.