Transcription:
Breast Cancer Awareness & Surgical Options

Deborah Howell (Host): A look at breast cancer awareness and surgical options on this episode of Curating Care, a podcast brought to you by St. Clair Health, expert care from people who care. I'm Deborah Howell. And joining me is Dr. Sarwat Ahmad, a board-certified surgical oncologist with St. Clair Medical Group Breast and General Surgery. Welcome, Dr. Ahmad.

Dr Sarwat Ahmad: Thank you. I'm so pleased to be here.

Deborah Howell (Host): Now, you recently joined St. Clair Health from Mayo Clinic in Scottsdale, Arizona, and had previously completed a fellowship at UPMC. What brought you back to Pittsburgh and to St. Clair Health?

Dr Sarwat Ahmad: I really enjoyed my time in Pittsburgh when I was here for my fellowship. And Mayo Clinic was just the perfect job right out of fellowship. I had a really great time there. I learned a lot about what's new and current in breast cancer. And what really brought me back was more personal reasons, my significant other lives in Pittsburgh. And so, the time had just come for me to move back and sort of move that relationship along and things are going great from that perspective. And I really appreciate having had that experience at Mayo Clinic, so that I can sort of bring what I've learned back out here to the community that I already sort of knew and was familiar with and loved being part of. So, it was more personal reasons, but a lot of professional growth in between.

Deborah Howell (Host): What a bonus for the community. Now, I'm hoping you can tell our listeners about the services you offer as a surgical oncologist.

Dr Sarwat Ahmad: So as a surgical oncologist, I specialize in treating a variety of cancers from breast cancer to skin and soft tissue malignancies to abdominal cancers. And here at St. Clair, I'm mostly focusing on breast and skin disorders and malignancies.

Deborah Howell (Host): Now, St. Clair has a unique affiliation with UPMC Hillman Cancer Center for Radiation and Medical Oncology. How does that affiliation in having all the cancer services on one campus benefit patients?

Dr Sarwat Ahmad: So, this is a great affiliation. One, it allows patients that have UPMC insurance to have in-network care here. But really, the great benefit is that the patients at St. Clair have access to all the great science and clinical trials that's happening over at UPMC. So, we have medical oncologists and radiation-oncologist with that affiliation to UPMC. And they all work out of the Dunlap Center at the St. Clair Main Hospital where we operate. We also have all of our services with breast imaging and screening. And our consultations with breast surgeons as well as the high-risk breast program are all located on our campus in the South Hills Village. And so, that makes it really convenient for patients that are in the South Hills that may need access to resources that are provided by UPMC, but want to stay in the South Hills. And I think that that connection and relationship has really helped patients in this community.

Deborah Howell (Host): Yeah, for sure. They're not running here for the labs and here for their screenings and there for the medical appointments.

Dr Sarwat Ahmad: And the other benefit to it is that we can sort of coordinate their care behind the scenes because we're all connected. And so, it's easier for the patient to make sure that all of their doctors are on the same page and have communicated all the different things that go into their plan of care. So, I think having that coordination is really great and then, also having access to the most valuable resources to help the patients out.

Deborah Howell (Host): Yeah. One big silo, everyone together. I love it. Now, I wanted to ask you about something. Last year, St. Clair Health implemented a comprehensive screening tool called the Tyrer-Cuzick Risk Assessment Model. This tool, also used by Mayo Clinic, determines a patient's estimated risk of developing breast cancer. How does that tool work and who's going to benefit from it?

Dr Sarwat Ahmad: So, there's a handful of breast cancer risk models out there. We really believe that Tyrer-Cuzick is one of the best ones to use to determine what risk each individual has for breast cancer, and then how that might impact them with regards to how many times a year do they need to get imaging done or do they need to get genetic testing or do they need to have intervention such as starting medications or doing other kinds of surgery or other lifestyle interventions to reduce their risk for breast cancer.

The Tyrer-Cuzick model is one of the best ones out there because it includes over 15 risk factors that we know contribute to breast cancer development. And it's been validated many times over, and it updated every few years. So, we know that as the research progresses and we identify more and more risk factors for breast cancer, this model really takes into account the ones that we have seen to have an impact. And what I'm talking about is like family history, age, even the weight of the patient, any prior abnormal biopsies that might confer an increased risk for breast cancer in the future, breast density. So, all these risk factors go into the development of the Tyrer-Cuzick model.

And the model will give us an individualized, very specific to that specific patient, a risk that we know what to do with afterwards as far as are they a candidate for risk-reducing medication or are they a candidate for an MRI to get a better look at the breast tissue to diagnose cancers earlier? So, this is a model that I was already used to using over at Mayo Clinic, especially in our high-risk breast cancer program, which is a program for patients who don't have breast cancer yet, but are deemed high risk for all the risk factors I just mentioned. And these can be used to come up with a validated risk estimate that can be used by the clinician to determine what needs to happen next. So, it's really about knowing where the patient stands at this point and where do they need to go next. And the risk model, Tyrer-Cuzick, really helps us determine that individual patient risk.

And so, this is something that patients, after they get their mammograms, they'll be asked a series of questions and some of those questions will go into figuring out what their individual risk is. And if it is above a certain threshold, they might get a referral to the high-risk breast program to see if they qualify for any of these interventions or enhanced surveillance techniques, so that we can make sure that patients who are at increased risk for breast cancer are getting it diagnosed sooner rather than later because the outcomes are so much better when it's diagnosed sooner.

Deborah Howell (Host): Oh, absolutely. Now, is there a certain stage of breast cancer or a certain size of breast tumor that an individual needs to meet to be qualified for breast surgery? And also, what surgery options are available at St. Clair Health?

Dr Sarwat Ahmad: Breast surgery for breast cancer is really done for anywhere from a stage 0 to a stage III. Stage 0 being ductal carcinoma in situ or non-invasive breast cancer. And then, stage I through III being breast cancer that doesn't involve other organs, so non-metastatic breast cancer. Some patients with stage IV breast cancer may also qualify for surgery, but that's really determined on a case by case basis.

Size of tumor and those kinds of factors, they really play into the stage. And so, all of that is taken into account whenever we meet a patient for the first time. We look at the size of the tumor, involvement of any lymph nodes and involvement of any organs before we determine whether they're a candidate for surgery. But that being said, there's also a number of patients who don't have a breast cancer who qualify for breast surgery. For example, if they have a genetic mutation that puts them at increased risk for breast cancer, they might qualify for prophylactic surgery. And so, it's important to know that breast surgery can be done for a lot of malignant causes as well as benign and just at risk patients as well.

As far as what types of surgery we offer, we really offer the whole gamut of breast surgeries from partial mastectomies or lumpectomies to total mastectomies. We do nipple-sparing mastectomies, tissue-sparing or skin-sparing mastectomies for patients that need reconstruction. We have plastic surgery services available for those who need implant-based reconstructions or tissue expanders. We also offer oncoplastic techniques for patients who need partial mastectomy, but would like a better aesthetic appearance or cosmetic outcome. We also do lymph node surgery for breast cancer, that kind of goes along with the treatment of breast cancer.

Deborah Howell (Host): Yeah. You're basically a one-stop shop. And you know, the thing we can't talk about enough is what should potential patients of yours know about the importance of regular mammography screenings and when to get started?

Dr Sarwat Ahmad: I definitely can't emphasize that enough. The standard is to get started around age 40. That's when I would get my first mammogram and then after that, once a year. And that really depends on what we see that first year. If there's something that the radiologist sees that they want a more frequent mammogram, they'll let us know. But usually, it's once a year starting at age 40 going until we feel that we still have a greater than 10-year life expectancy. So up until they're 80, these patients are still getting mammograms every year.

Between mammograms, it's important to maintain awareness of what your breasts normally feel like, so that if you do notice a change such as a new mass or a new lump, skin changes, nipple changes, these kinds of things, bring them to the attention of your doctor because those might indicate that something needs to be looked at with a different technology or a closer eye or a trained eye. And so, definitely starting mammograms at age 40.

Some patients may actually qualify to start earlier if they have a family member who had breast cancer diagnosed at a young age. And for those patients, what I mean by young age is before age 50 or so, those patients should start getting mammograms 10 years before the youngest age of diagnosis in their close family. So, that's why even though the age 40 is the national accepted standard to start screening, some patients may qualify for earlier screening based on their family history.

Deborah Howell (Host): Sure. And that's why it's important to keep records for your kids and grandkids as well, right?

Dr Sarwat Ahmad: Yes, it's important to sort of know whatever you can about your family histories medically.

Deborah Howell (Host): Well, it's certainly been enlightening. A lot of information shed today. Thanks so much for sharing your expertise and your advice with us. Just a true pleasure to have you on.

Dr Sarwat Ahmad: You're welcome. It was a pleasure to speak with you and the southwest community. Thank you.

Deborah Howell (Host): And to contact Dr. Ahmad, please call 412-942-7850 or visit st clair.org. And if you found this information helpful, please share it with others, especially on your social media. Thanks for listening to Curating Care, brought to you by St. Clair Health.