A breast cancer diagnosis is always scary. At City of Hope, our dedicated team of breast cancer experts recognize that breast cancer is different for every patient, and that each woman needs her own personalized treatment plan.
Listen to City of Hope Radio as Dr. Joanne Mortimer, director of City of Hope's Women's Cancer Programs, discusses the compassionate, patient-centered, leading-edge care offered at City of Hope, including intraoperative radiation therapy, a procedure involving a single, concentrated dose of precise radiation that provides patients the exact same results as six to eight weeks of daily radiation.
Selected Podcast
Breast Cancer: Compassionate, Individualized Care
Featured Speaker:
Joanne Mortimer, M.D.
Joanne Mortimer, M.D., is a breast and gynecological cancers expert. She has participated in clinical trials for over 30 years. Her research has focused on assessing the effects of systemic therapies on cancer and normal tissues. Many of these trials have utilized functional imaging and other biomarkers. She is studying the impact of toxicity on breast cancer disease outcome and quality of life. She and her colleagues reported a favorable outcome for women treated with tamoxifen who experience hot flashes. Transcription:
Breast Cancer: Compassionate, Individualized Care
Melanie Cole (Host): A breast cancer diagnosis is life-altering. The breast cancer program at the City of Hope offers a unique approach for women diagnosed with breast cancer and a team of doctors and expert researchers are turning innovative laboratory breakthroughs into promising new therapies that can impact patients today and focusing on the patient as a whole. My guest is Dr. Joanne Mortimer. She’s the Vice Chair of the Department of Medical Oncology and Therapeutics Research and the Director of the Women’s Cancer Programs at City of Hope. Welcome to the show, Dr. Mortimer. Tell us a little bit about your treatment approaches at City of Hope for women with breast cancer.
Dr. Joanne Mortimer (Guest): Our approach is very much patient’s family-centered care. And when patients are initially seen in our clinic as a new patient, they are first seen by a team of social workers who sit down with the patient and their partner, whether it’s a husband, a life partner, a family, relative; and they talk to them about what the expectation of this particular visit is. The advantage of screening patients ahead of time is that it gives you an idea of where the patients and their partners are, and we also teach the patient and their partner to get the most out of their initial visit. So, all patients are seen in this partner’s clinic and the screening system so that we know where the patients’ concerns are before they ever even see a physician. So, all patients are really evaluated by a surgical oncologist, a medical oncologist and a radiation oncologist, with or without a plastic surgeon depending upon the patient’s decision regarding surgery. So we have a very holistic and multidisciplinary approach to patients with breast cancer.
Melanie: Tell us a little bit about the screening. What’s involved? Women get this diagnosis. They’re very scared. It can be very devastating. Tell us what you do to screen them and how you decide upon the treatment approach.
Dr. Mortimer: So, most women start with the surgeon and the reason they start with the surgeon is because we need to get a biopsy to know that this is cancer and, in general, the initial approach to breast cancer is surgical, whether it’s a lumpectomy or a mastectomy or mastectomy and reconstruction. And so the surgeon is usually the first point, but the surgeon then refers the patient to a medical oncologist, if that’s appropriate or a plastic surgeon or radiation oncologist, depending upon what the need of the patient is and how our plan is to go ahead with treatment. Often, we give chemotherapy before surgery. So the medical oncologist sees the patient with the surgeon, and we discuss giving chemotherapy first to shrink the cancer down so the patient is more likely to be able to get breast preservation therapy. So, it’s a very individualized therapy and it really is based on the cancer that the patient has, as well as what the patient’s desires are in terms of whether they want to preserve their breast or not, and whether they want reconstruction right away or not.
Melanie: As a select number of cancer centres to provide intraoperative radio therapy, tell us about that, Dr. Mortimer.
Dr. Mortimer: So, It’s operative radiation therapy. It’s exactly that, it’s radiation that is given in the operating room and this means that you don’t need to come in for six and a half weeks just for radiation therapy. But there really are select individuals that are candidates for this, so this is not a treatment for young women. This is not a treatment for women with large cancers. Patients that we offer this to are older women who have small cancers that we’re fairly comfortable that can be removed at the time of surgery, so that the margin around the cancer is clean. And then the patient receives radiation in the operating room, and it’s done – it’s over and done with.
Melanie: Tell us a little bit about the cancer genetics program. We’re hearing more and more in the media today, Dr. Mortimer, about, you know, genetics and your risk for breast cancer. Tell us about the program at City of Hope.
Dr. Mortimer: So we have a very well-established clinical cancer genetics program. And this program has been ongoing for years, counselling women who have a family history of breast cancer. So, about one in 20 women with breast cancer have an inherited genetic predisposition for breast cancer. It doesn’t mean that – you know, your family history may be very strongly positive for cancer, but we may not yet know a gene for that particular cancer. So we refer our patients to the Clinical Cancer Genetics Department and they’re evaluated by a physician and a genetics counsellor and they’re talked to about the pros and cons of doing genetic testing; how likely they are that they may have one of these predispositions for cancer. And their blood is kept, so as new cancer genes are identified, it allows us to go back and retest these women in case they did have a strong family history, but they tested negative for the genes that we currently know. So it’s a very active research program at keeping track of all the patients that we see, so that when new genes are identified, we can screen for those genes. The value in knowing that you have a genetic predisposition relates to what surgery women decide to have. So, if someone has a predisposition for developing breast cancer, often women will opt to have bilateral mastectomy at the time of their initial cancer surgery and there is data that shows that by doing prophylactic surgery, that you do decrease the likelihood that someone is going to get another cancer. So there is a rationale for doing the genetic testing as far as helping, especially young women make a decision about are they going to have a lumpectomy and radiation; are they going to have a mastectomy, or in the most extreme, to undergo bilateral mastectomy.
Melanie: Tell us a little bit about breast preservation. Women have – you know, it’s a big part of us and a big part of our self-esteem and self-confidence. When women are going through breast cancer care, they do want to think about aftercare and want recovery will be like. Talk about how they’re going to feel afterwards.
Dr. Mortimer: Breast preservation, I think, has a lot of different meanings right now. You know, years ago when we talked about breast preservation, we would talk about women who opted to have a lumpectomy and radiation afterwards. So the alternative to taking off the lump and getting radiation to the whole breast was to do a mastectomy. Now, we have so many wonderful surgical techniques that allow women to have preservation of a breast after surgery. So, there are new surgical techniques that allow us to save skin and save the nipple even in some cases. So the surgeon can go in and take out all the breast tissue, but leave the nipple and the skin associated with it. And why that’s so important is that that allows the surgeon to put an implant in at the time of the surgery, the plastic surgeon immediately reconstructs patient, so that even though they’ve had a mastectomy, the breast contour and appearance is preserved, because of the type of surgery that’s performed. So classically, when we talk about breast preservation, we’re talking about doing a lumpectomy, taking the lump out and giving radiation to the breast afterwards. But I think, with the newest surgical techniques and the combined surgery with plastic surgery at the same time, doing nipples-sparing mastectomy really does preserve the appearance of the breast, as well.
Melanie: Dr. Mortimer, tell patients why they should come to City of Hope for their breast cancer care.
Dr. Mortimer: I think that the number one unique aspect of City of Hope is really the attention to the patient and their family. This is a devastating disease to go through, it affects the entire family and we address the entire family. Secondly, all our treatments really are state of the art, cutting-edge treatments, with a multi-disciplinary approach that includes an incredible group of compassionate physicians in genetics, in surgery, in our supportive care services in medical oncology, surgery radiation oncology. So I think it’s a very unique group of individuals who are absolute leaders in the field, know all the recent therapies and they are available here, and we do it with compassion.
Melanie: Thank you so much, Dr. Joanne Mortimer. You’re listening to City of Hope Radio. For more information, you can go to cityofhope.org. That’s cityofhope.org. This is Melanie Cole. Thanks so much for listening.
Breast Cancer: Compassionate, Individualized Care
Melanie Cole (Host): A breast cancer diagnosis is life-altering. The breast cancer program at the City of Hope offers a unique approach for women diagnosed with breast cancer and a team of doctors and expert researchers are turning innovative laboratory breakthroughs into promising new therapies that can impact patients today and focusing on the patient as a whole. My guest is Dr. Joanne Mortimer. She’s the Vice Chair of the Department of Medical Oncology and Therapeutics Research and the Director of the Women’s Cancer Programs at City of Hope. Welcome to the show, Dr. Mortimer. Tell us a little bit about your treatment approaches at City of Hope for women with breast cancer.
Dr. Joanne Mortimer (Guest): Our approach is very much patient’s family-centered care. And when patients are initially seen in our clinic as a new patient, they are first seen by a team of social workers who sit down with the patient and their partner, whether it’s a husband, a life partner, a family, relative; and they talk to them about what the expectation of this particular visit is. The advantage of screening patients ahead of time is that it gives you an idea of where the patients and their partners are, and we also teach the patient and their partner to get the most out of their initial visit. So, all patients are seen in this partner’s clinic and the screening system so that we know where the patients’ concerns are before they ever even see a physician. So, all patients are really evaluated by a surgical oncologist, a medical oncologist and a radiation oncologist, with or without a plastic surgeon depending upon the patient’s decision regarding surgery. So we have a very holistic and multidisciplinary approach to patients with breast cancer.
Melanie: Tell us a little bit about the screening. What’s involved? Women get this diagnosis. They’re very scared. It can be very devastating. Tell us what you do to screen them and how you decide upon the treatment approach.
Dr. Mortimer: So, most women start with the surgeon and the reason they start with the surgeon is because we need to get a biopsy to know that this is cancer and, in general, the initial approach to breast cancer is surgical, whether it’s a lumpectomy or a mastectomy or mastectomy and reconstruction. And so the surgeon is usually the first point, but the surgeon then refers the patient to a medical oncologist, if that’s appropriate or a plastic surgeon or radiation oncologist, depending upon what the need of the patient is and how our plan is to go ahead with treatment. Often, we give chemotherapy before surgery. So the medical oncologist sees the patient with the surgeon, and we discuss giving chemotherapy first to shrink the cancer down so the patient is more likely to be able to get breast preservation therapy. So, it’s a very individualized therapy and it really is based on the cancer that the patient has, as well as what the patient’s desires are in terms of whether they want to preserve their breast or not, and whether they want reconstruction right away or not.
Melanie: As a select number of cancer centres to provide intraoperative radio therapy, tell us about that, Dr. Mortimer.
Dr. Mortimer: So, It’s operative radiation therapy. It’s exactly that, it’s radiation that is given in the operating room and this means that you don’t need to come in for six and a half weeks just for radiation therapy. But there really are select individuals that are candidates for this, so this is not a treatment for young women. This is not a treatment for women with large cancers. Patients that we offer this to are older women who have small cancers that we’re fairly comfortable that can be removed at the time of surgery, so that the margin around the cancer is clean. And then the patient receives radiation in the operating room, and it’s done – it’s over and done with.
Melanie: Tell us a little bit about the cancer genetics program. We’re hearing more and more in the media today, Dr. Mortimer, about, you know, genetics and your risk for breast cancer. Tell us about the program at City of Hope.
Dr. Mortimer: So we have a very well-established clinical cancer genetics program. And this program has been ongoing for years, counselling women who have a family history of breast cancer. So, about one in 20 women with breast cancer have an inherited genetic predisposition for breast cancer. It doesn’t mean that – you know, your family history may be very strongly positive for cancer, but we may not yet know a gene for that particular cancer. So we refer our patients to the Clinical Cancer Genetics Department and they’re evaluated by a physician and a genetics counsellor and they’re talked to about the pros and cons of doing genetic testing; how likely they are that they may have one of these predispositions for cancer. And their blood is kept, so as new cancer genes are identified, it allows us to go back and retest these women in case they did have a strong family history, but they tested negative for the genes that we currently know. So it’s a very active research program at keeping track of all the patients that we see, so that when new genes are identified, we can screen for those genes. The value in knowing that you have a genetic predisposition relates to what surgery women decide to have. So, if someone has a predisposition for developing breast cancer, often women will opt to have bilateral mastectomy at the time of their initial cancer surgery and there is data that shows that by doing prophylactic surgery, that you do decrease the likelihood that someone is going to get another cancer. So there is a rationale for doing the genetic testing as far as helping, especially young women make a decision about are they going to have a lumpectomy and radiation; are they going to have a mastectomy, or in the most extreme, to undergo bilateral mastectomy.
Melanie: Tell us a little bit about breast preservation. Women have – you know, it’s a big part of us and a big part of our self-esteem and self-confidence. When women are going through breast cancer care, they do want to think about aftercare and want recovery will be like. Talk about how they’re going to feel afterwards.
Dr. Mortimer: Breast preservation, I think, has a lot of different meanings right now. You know, years ago when we talked about breast preservation, we would talk about women who opted to have a lumpectomy and radiation afterwards. So the alternative to taking off the lump and getting radiation to the whole breast was to do a mastectomy. Now, we have so many wonderful surgical techniques that allow women to have preservation of a breast after surgery. So, there are new surgical techniques that allow us to save skin and save the nipple even in some cases. So the surgeon can go in and take out all the breast tissue, but leave the nipple and the skin associated with it. And why that’s so important is that that allows the surgeon to put an implant in at the time of the surgery, the plastic surgeon immediately reconstructs patient, so that even though they’ve had a mastectomy, the breast contour and appearance is preserved, because of the type of surgery that’s performed. So classically, when we talk about breast preservation, we’re talking about doing a lumpectomy, taking the lump out and giving radiation to the breast afterwards. But I think, with the newest surgical techniques and the combined surgery with plastic surgery at the same time, doing nipples-sparing mastectomy really does preserve the appearance of the breast, as well.
Melanie: Dr. Mortimer, tell patients why they should come to City of Hope for their breast cancer care.
Dr. Mortimer: I think that the number one unique aspect of City of Hope is really the attention to the patient and their family. This is a devastating disease to go through, it affects the entire family and we address the entire family. Secondly, all our treatments really are state of the art, cutting-edge treatments, with a multi-disciplinary approach that includes an incredible group of compassionate physicians in genetics, in surgery, in our supportive care services in medical oncology, surgery radiation oncology. So I think it’s a very unique group of individuals who are absolute leaders in the field, know all the recent therapies and they are available here, and we do it with compassion.
Melanie: Thank you so much, Dr. Joanne Mortimer. You’re listening to City of Hope Radio. For more information, you can go to cityofhope.org. That’s cityofhope.org. This is Melanie Cole. Thanks so much for listening.