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Expert Care in the Community

April 2016

 

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Meghan Milburn, M.D., FACS, breast surgeon and medical director of the UM UCMC Breast Center

For any cancer patient, a support group of loved ones is vital to your emotional, mental and physical well-being. Whether it’s family members, close friends, neighbors, co-workers or members of your church, being able to lean on someone else for support and encouragement is extremely important and can aid in your recovery. Equally important is a close rapport with your medical team and the assurance that the doctors, surgeons, nurses and specialists are all working closely together. At the Kaufman Cancer Center at the University of Maryland Upper Chesapeake Medical Center (UM UCMC), patients benefit from the ideal combination of a community hospital atmosphere and the expertise and technological advancements of a university hospital setting.

Hope and Healing — Close to Home
Breast cancer patients at the Kaufman Cancer Center can tap into myriad services offered – without leaving Harford County. Screenings, digital mammograms, ultrasounds, surgery and reconstruction can all be done at UM UCMC. No more trips down I-95 South to Baltimore, as due to the partnership with the University of Maryland Medical System, UM UCMC can offer the high-tech services and physician expertise of a world-class research university in a community hospital setting. However, patient advantages go beyond simply having your physician close by.

“When we have the entire team here, we can provide more expertise to patients in real time. I can consult with all of my colleagues in radiation oncology, medical oncology, pathology and plastic surgery, and we can make immediate recommendations for the patient,” says Meghan Milburn, M.D., FACS, breast surgeon and medical director of the UM UCMC Breast Center. “We have a Tumor Board where we discuss the clinical care needed for our breast cancer patients prior to surgery. The team includes surgeons, medical oncologists, radiation oncologists, as well as pathologists, radiologists, social workers, research nurses, PT/OT, dieticians, and nurse navigators.”

In addition, breast cancer patients can consult with their team of medical professionals in one setting. “We have a multi-disciplinary breast cancer clinic every other week, and it allows the patients to come and see the entire team of specialists that day instead of going to separate offices at separate times and sometimes having to wait for their medical professionals to communicate with each other,” says Dr. Milburn.

For women who are considered high-risk patients for breast cancer, UM UCMC has the High-Risk Breast Cancer Clinic. “We offer this to any woman who has a higher risk of breast cancer – whether it’s family history of breast or ovarian cancer, men with breast cancer in the family, or those with Ashkenazi Jewish heritage and family history of cancer. We also look at whether the patient has a personal history of Atypical ductal hyperplasia (ADH), Atypical Lobular Hyperplasia (ALH), or Lobular carcinoma in situ (LCIS),” says Dr. Milburn. “We try to take the guesswork out of screening and help determine if they are at higher risk and tailor breast screening recommendations to the individual patient. We’ll also discuss lifestyle measures – staying active, having a healthy diet, not smoking and limiting alcohol. Early detection and screening is critical for these patients.”

She adds that the Breast Center’s services are not limited to breast cancer. “We handle all aspects of breast health – from benign breast disease, such as lumps, bumps, breast pain, clogged ducts during breastfeeding, to breast cancer screening, to the detection and treatment of breast cancer,” Dr, Milburn says.

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Meghan Milburn, M.D., FACS, consults with Mathew Thomas, M.D.

In addition to the convenience factor of having one setting for all your health care needs, patients also benefit from a having a close relationship with a hospital that is actively involved in the community. “When you know your physician lives close by and is raising a family in Harford County, just like you do, it creates a comfort level for the patients,” says Mathew Thomas, M.D., plastic and reconstruction surgeon at UM UCMC and the Bel Air Center for Plastic and Hand Surgery. (Thomas and his wife live in Harford County and are raising three children.) “By combining the University of Maryland and Upper Chesapeake Health, it’s really the best of both worlds for our patients – it’s the combination of a community atmosphere close to home where you have a relationship with your physicians, but also you understand that you are getting the most advanced care possible.”

 

 

High-Tech Meets Welcoming Design
Walk into the Kaufman Cancer Center, and you are struck with just how bright and warm it is. Huge glass walls, modern design, comfortable, yet stylish furniture, a café and a garden complete with a labyrinth make you forget momentarily that you are in a hospital setting. Dr. Milburn was actively involved in the design and planning of the new Cancer Center. “One of the overriding goals was to have the real focus on hope and healing, and you can see that in the design and décor. It’s very warm and welcoming, and we were able to seamlessly merge this look with the fact that this is a state-of-the-art medical facility,” she says.

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Linda Pytel, administrative assistant in Oncology Services with volunteers Philomena Rubino and Donna Clark

Having the latest and best technology was also instrumental to eliminate the need for patients having to go to a specialist off campus for tests and certain procedures. “It allows us to offer patients everything – different types of radiation, different types of reconstruction, and access to clinical trials through our partnership with the University of Maryland,” says Dr. Milburn, who notes that the Cancer Center is both NAPBC (National Association Program for Breast Centers) and a Breast Imaging Center of Excellence (American College of Radiology) accredited, further illustrating the high level of care and expertise available in Harford County. As an assistant professor in the Division of Surgical Oncology at the University of Maryland School of Medicine, Dr. Milburn is able to provide patients in Harford County with access to clinical research trials from the Greenebaum Cancer Center.

One of the newest treatment options available to patients at UM UCMC is an advanced form of radiation therapy called brachytherapy, which treats cancer from the “inside-out” and is ideal for early-stage breast cancer. Accelerated partial breast irradiation for breast cancer treatment, which uses a SAVI catheter, is a five-day radiation treatment for early stage breast cancer that gives your physician the ability to precisely target the treatment to where it is needed most. The approach is very precise, spares the surrounding healthy tissue and produces excellent cosmetic results.

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Dr. Mathew Thomas (left) and Dr. Ramon DeJesus

Dr. Milburn explains that with SAVI, a small catheter can be used for partial breast radiation in some patients who are able to have a lumpectomy. “Traditional whole breast radiation is given from the “outside-in” to the patient. A small catheter is placed in breast after surgery where the cancer was and twice a day for five days, a radioactive seed is placed into that catheter for the highest dose of radiation where the cancer was,” says Dr. Milburn, who notes that SAVI is only for women who have an excellent prognosis and the Breast Center at UM UCMC is a Center of Excellence for this treatment.

“This is why it is so important to collaborate – I can text or call one of the radiation oncologists and let them know that I just saw a patient who may be an excellent candidate for SAVI and ask if they can see the patient in the next few days. There is a limited amount of time available for this type of treatment after surgery. Patients often rave about their experience and ask to be on a list to talk to other women considering this treatment,” she says.

Mammogram Screening Guidelines

One of the most highly contested topics regarding breast cancer is when women should begin getting mammograms and how frequently. Different opinions exist, creating confusion for patients. In 2009, the United States Preventive Services Task Force (USPSTF) released guidelines recommending biennial screening for women ages 50-74, while the American Cancer Society (ACS) published new guidelines in 2015, recommending annual screenings for women ages 45-54 and biennial screenings for women over age 55.

UM Upper Chesapeake Medical Center’s Dr. Meghan Milburn recommends the guidelines set forth by the American Society of Breast Surgeons (ASBrS) for asymptomatic average risk women:

1. Discussion with her physician to consider screening mammography at age 40-44 based on a balanced discussion of risks and benefits: a) Most studies show a decrease in breast cancer mortality from screening starting at age 40, but in the group 40-49 there is higher false positive rate; b) Patients should discuss screening with their physician including risk assessment to determine if they are average risk

2. Annual screening for women ages 45-54 as indicated by the ACS guidelines

3. Annual or biennial screening for women 55 and older based on a shared decision making discussion regarding risk and benefits of screening timing

4. Biennial screening for women over the age of 75 if an estimated life expectancy is greater than 10 years

5. Breast tomography may be considered for screening, which may increase detection rates and decrease false positive rates, especially in women with dense breast tissue

Another new technology for patients is the 3-D mammogram, which is not typically covered by insurance but only costs about $50-100 out of pocket. Studies have shown that 3-D mammograms can reduce the rate of callbacks; sometimes with a two-dimensional mammogram, dense breast tissue can line up and look like a mass, so patients must come back to do alternate magnified views.

For women who’ve had a mastectomy, there are two major types of reconstruction methods, each with their own advantages. Implant reconstruction is the most commonly chosen method by patients and involves using saline or silicone gel filled implants that are placed in a pocket created in the chest wall. Implant reconstruction procedures have the advantage of being shorter operations, and generally a fairly rapid recovery can be expected. When appropriate, many reconstructive surgeons often opt for autologous or “flap” techniques, which use an individual’s own tissue to create a more natural breast. Although these procedures generally require a longer operation and hospital stay, they result in a more natural look and feel to the breast.

No matter which procedure is chosen, the surgeons at UM UCMC offer a plan that is customized for each patient. “It’s definitely a collaborative effort with the patient. We can talk to them and let them know what option we think is best for them, but the patient has a lot of weight in the decision-making process,” says Ramon DeJesus, M.D., FACS, chief of hand surgery and plastic surgery at UM UCMC and the Bel Air Center for Plastic and Hand Surgery, who is also an assistant professor of plastic and reconstructive surgery at the University of Maryland and an adjunct professor of plastic and reconstructive surgery at Johns Hopkins University.

“We are here to help them, but ultimately the patient has full reign to make the decisions,” adds Dr. Thomas. “Reconstructive surgery is part of the process of hope and healing and is a combination of medicine and surgery, along with form and function. Cancer is a difficult experience for everyone – our role as surgeons is to ask the patient – ‘What can we do to help? What can we do to make you whole again?’ My goal is to listen, and what we do is really up to the patient.”

Breast reconstruction surgery that helps return a woman’s breast to near normal shape, size and appearance following a mastectomy can also help her regain her physique and confidence in her appearance.

“Having a normal shape and size with reconstructed breasts contributes significantly to the emotional health of the patient … it makes them feel whole again. You can see it with patients when you complete the reconstruction of the breast mound and then complete the reconstruction with the nipple and areola. It gives them a sense of completion, and the feeling of not having lost anything to cancer is so important. It’s a second chance on life,” says Dr. DeJesus.

Dr. Thomas agrees. “There have been a lot of studies that reflect the importance of having normal shape and size reconstructed breasts. With other very serious cancers – prostrate or colon cancer, for example – patients do not necessarily have the visual, aesthetic element that plays an important social role. This is somewhat unique to breast cancer patients,” he says.

Team Approach
The multidisciplinary approach at UM UCMC is a major factor for the quality of care delivered to patients. Physicians, surgeons and specialists can all collaborate on important health care decisions, and all rely on other members of the medical team – nurses, social workers, nurse practitioners and medical assistants.

“One of the most important persons on the team is the nurse navigator,” says Dr. Milburn. “She keeps track of everything and is a true patient liaison between the different specialists and the patient. Nurse navigators are there to help facilitate treatment plans, imaging and chemotherapy appointments, providing emotional support to patients and helping educate them.”

Dr. Thomas adds that he relies on the Image Recovery Center at UM UCMC, which provides a comprehensive and supportive environment to help survivors manage the appearance-related side effects of cancer and cancer treatments. Some of the services include post-breast surgery fittings, complimentary head shaves and scalp care instructions, wig fittings and styling, makeup application, and post-treatment appearance evaluation and recommendations.

“The Image Recovery Center has helped our practice tremendously. People are at various stages of reconstruction and they help with prosthetics, and the effects of chemotherapy … something as straight forward as how you get the right fit on a wig. Physicians and surgeons may not always be aware of all the ins and outs and social aspects that come with cancer, so these professionals are there to help the patients,” he says. I95

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