Newswise — With a diagnosis of breast cancer, everything changes. The calendar becomes filled with scheduled tests and scans, perhaps daily infusions or weekly visits with medical and surgical experts. Depending on the type and stage of cancer, treatment can last months or years. To make the experience significantly easier for patients, UC San Diego Health has designed a state-of-the-art space to bring all team members and services into one convenient location.
The Comprehensive Breast Health Center is located within the Koman Family Outpatient Pavilion at UC San Diego Health. The pavilion opened in 2018 and represents part of a $1.3 billion investment in patient care on the La Jolla campus.
“While we treat all patients with any kind of breast issue, our primary focus is on the care of patients with cancer,” said Richard Schwab, MD, medical oncologist, Moores Cancer Center at UC San Diego Health. “We are personalizing therapies to the specific type of breast cancer and to the patient’s preferences for care.”
The Comprehensive Breast Health Center includes specialized suites for medical and surgical care of patients with breast conditions ranging from advanced cancer to benign cysts. Patients may also seek cosmetic surgery for breast enhancement or as part of gender reassignment.
New Infusion Center
Schwab noted that UC San Diego Health is the only local health system to offer an infusion center dedicated to patients with breast cancer.
“One of the biggest advantages of the spacious new infusion center is that it offers healing panoramic views of the La Jolla canyons,” said Schwab, who is also clinical director of the infusion center. “The 12-chair infusion center is a few steps away from our new clinics so that patients are always close to their doctors and nurses.”
Anne Wallace, MD, surgeon and director of the Comprehensive Breast Health Center, points out that, as an academic health center, patients may be eligible for clinical trial drugs that provide them with access to promising new treatments.
“The advantage of developing a treatment plan at a National Cancer Institute-designated comprehensive cancer center is that patients have early access to emerging drugs and therapies,” she said. “Patients who are part of a clinical trial or who are receiving standard treatment can receive their infusions here at the Koman Family Outpatient Pavilion.”
For example, Wallace is principal investigator of the national I-SPY2 clinical trial for women with newly diagnosed breast cancer. She and a team of university investigators are testing whether adding investigational drugs to standard chemotherapy is better than chemotherapy alone.
“The trial is trying to match particular investigational agents with patients who stand to benefit the most from them, based upon the biology of the patient’s disease,” said Wallace. “The trial uses serial MRI imaging to track the progress of the patient’s tumors. We hope the trial results accelerate the process of identifying drugs that are effective for specific breast cancer subtypes. Fortunately, what we are seeing is that incurable cancers are being moved toward curable.”
Patients who participate in a clinical trial have a special facilitator assigned to them to guide them through the study. Clinical trial coordinators are available to answer all questions, walk patients through the study process, help fill out paperwork, make appointments related to the trial and act as a liaison between the patient and medical team if needed.
Same-Day Surgical Options
Increasingly, breast cancer surgery is becoming less invasive and can be performed on an outpatient basis. Breast cancer surgery often can be accomplished through a lumpectomy or segmental mastectomy (removal of only the affected tissue), allowing breast conservation. Major surgeries requiring an overnight stay, such as double mastectomy, are performed at the adjacent Jacobs Medical Center.
“UC San Diego Health can take care of all of a patient’s surgical needs from biopsy to tumor removal to partial and full mastectomy to reconstruction,” said Wallace, who is double board certified in breast and plastic surgery. “Within the outpatient facility, we can perform a same-day lumpectomy, sentinel lymph node detection, and revision surgery. Our goal is clear surgical margins with beautiful cosmetic results as defined by the patient.”
One of the procedures performed at the Koman Family Outpatient Pavilion is sentinel lymph node mapping. This imaging procedure identifies lymph nodes that may harbor metastatic cancer cells, and guides surgeons in removing them. Wallace, in collaboration with the UC San Diego Molecular Imaging Team, developed a novel dye for the procedure. Now available worldwide, the agent is safer and more precise than older colored dyes and radiopharmaceuticals.
As a surgeon-scientist, Wallace has also advanced the use of novel agents to light up tumors for better cancer detection and removal. She has tested a fluorescent peptide to improve surgical precision. Her research is a translation of the work conducted by the late-Nobel Prize winner, Roger Tsien, also from UC San Diego.
3-D Outpatient Imaging
“The Comprehensive Breast Health Center has a fully integrated suite of advanced imaging technologies in one location,” said Haydee Ojeda-Fournier, MD, medical director of breast imaging. “The space is equipped with five new 3-D capable mammography units, ultrasound, molecular breast imaging and MRI suites that offer patients and their radiologists the most advanced technologies and software. Image-guided biopsies are performed onsite by fellowship-trained subspecialty radiologists.”
“The mammography machines we have invested in offer tomosynthesis, also known as 3-D imaging, which is superior to conventional 2-D mammography, particularly in dense breast tissue that may hide a malignant growth,” Ojeda-Fournier said. “This equipment has been shown to find 30 percent more cancers while reducing unnecessary recalls among women of all breast densities.”
Breast-specific gamma imaging (BSGI) is a molecular breast imaging option recommended for patients who are not best suited to MRI imaging. This technology allows the patient to be seated for the scan and offers a rapid interpretation of results.
“For patients coming for their annual screening mammogram, we are efficiently set up so that patients are in and out in six to ten minutes, “said Ojeda-Fournier. “Our goal is always to make the scans as easy as possible.”
An experienced and trained team of technologists is available to help guide patients through the imaging studies. And all UC San Diego Health radiologists who interpret the scans are fellowship-trained and explain the results to patients in nearby consultation rooms.
“Whatever the patient’s breast type,” said Ojeda-Fournier, “we have an incredible collection of technologies that can detect calcifications that are micron in size or tumors that are millimeters in size. Our technologists are not only expert in performing excellent imaging but in making the patient feel comfortable and at ease while doing so.”
Patients who may experience complications from cancer treatment are eligible for a breast cancer rehabilitation program where issues such as pain, lymphedema and hair loss are managed.
Comprehensive pain management of post-mastectomy pain is available using a multimodel and multidisciplinary approach to care that is tailored to each patient.
Certified lymphedema therapists are available to treat swelling in the arms, legs, and other areas which may be affected by lymph node removal or radiation treatment.
“Lymphedema, a form of severe swelling, can cause permanent tissue damage,” said Schwab. “The advantage of having services available onsite at the Comprehensive Breast Health Center is that patients can be treated as soon as symptoms appear. Rapid access is key.”
Therapists also address any post-operative issues such as range of motion, scarring, and lymphedema prevention. Complete decongestive therapy, manual lymphatic drainage techniques, compression therapy, and therapeutic exercise are offered.
In the future, the outpatient pavilion will offer a range of cooling techniques to treat neuropathic pain and to prevent hair loss that sometimes result from chemotherapy. These techniques involve cooling select parts of the body, such as the hands or feet, to prevent pain complications from anticancer drugs. In the case of the scalp, a cooling cap can reduce or prevent hair loss.
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“Breast cancer affects both men and women,” said Wallace. “Knowing your family history and risk factors could save your life. Have a discussion with your physician now about risks associated with your individual genes. If you need treatment, seek a comprehensive breast center where you’ll get customized treatment plans using a team-approach that cares for the whole patient.”
The Comprehensive Breast Health Center team includes radiation oncologists, cancer geneticists, nurse practitioners, pathologists, nurse case managers, dieticians and palliative care specialists.
“The team here is extraordinary,” said Wallace. “Case managers and social workers are here to help. In addition to your doctors, they can support you through your most vulnerable times. They can help translate the clinical information you receive and guide you through your emotions. Cancer is taxing on all family members. Our social workers recognize that and work with everyone in the family unit. They can also offer helpful guidance on how to address a cancer diagnosis with children.”
To learn more about comprehensive breast care services at UC San Diego Health, visit health.ucsd.edu/specialties/cancer/programs/breast or call 858-657-7000.