Cardio Oncology Enhances Breast Cancer Care

A Short History of Breast Cancer Surgery

There are papyrus records of breast cancer surgeries from 3,000 years ago. They reveal that while some long-ago patients were treated with magic, a more surgical approach of cauterizing tumors was also practiced. As time went on, other surgical attempts were made to remove cancerous tumors, but early surgeons lacked anesthesia and precision.

The grim truth is that significant progress in breast cancer treatment did not begin until the late 19 ^th century, with the adoption of the radical mastectomy — removal of the breast, the chest muscle and the lymph nodes. This procedure was the standard of care until the 1940s, when the safety and benefits of radiation therapy became evident and the practice of partial breast removal took hold.

The combination of radiation therapy and a modified radical mastectomy (sparing the chest muscles) or a simple mastectomy (further leaving some lymph nodes intact) was shown to have similar outcomes to those of a radical mastectomy. This began a move toward the de-escalation of surgical treatment and launched breast conservation surgery, where only the cancerous part of the breast is removed.

Breast conservation was further supported by mammography technology, which emerged in the mid-1960s and was officially recommended by the American Cancer Society in 1976. This tool allowed for earlier disease detection. And studies in the 1980s proved that when breast cancer was caught early, a partial breast removal – or lumpectomy ­– coupled with radiation was as effective as a mastectomy.

Doylestown Health’s Breast Care Services

“The major advances made with breast cancer treatment have resulted in a greater number of women surviving their disease. Our intention is to support them to live healthy, fuller lives,” says Donna Angotti, MD, Breast Surgeon and Medical Director of the Oncology Service Line at Doylestown Health.

Today, digital mammography is used to provide quality breast scans and catch cancer early. Three-D mammograms are also available to more thoroughly scan dense breast tissue. Doylestown Health’s Women’s Diagnostic Center , which specializes in the earliest possible detection of breast disease, will relocate to an expanded site within the hospital as the Clark Center for Breast Imaging in early 2022. This expansion will allow the center to provide an additional 2,500 patients per year with the latest in screening and diagnostic technologies.

When breast cancer is identified, the patient’s journey includes surgery, radiation and medication to prevent cancerous cells from growing in other areas of the body. For certain patients, breast-conservation surgery with a lumpectomy affords the same rate of cure as a mastectomy. The appropriate choices for a patient should be discussed with their Breast Surgeon who will evaluate all information in making a surgical plan with a patient.

Dr. Angotti explains how treatment plans are customized to each patient. “The types of cells in the tumor, the size of the tumor, whether the cancer has spread to lymph nodes, the presence of hormone and growth receptors, and any errors in the genetic code of the cancer cells are all taken into consideration when personalizing a patient’s treatment to defeat cancer.”

Breast surgeons at Doylestown Hospital use new technologies to locate and remove tumors with precision, conserving more healthy breast tissue. And Doylestown Health offers comprehensive breast reconstruction, including tissue transfer surgery such as DIEP flaps, that can be performed simultaneously with a mastectomy. The goal is to provide life-saving treatments while helping a woman retain positive self-image and quality of life.

In partnership with Penn Medicine Radiation Oncology, Doylestown is the only system in the region to offer cardio-protective radiation treatment modalities such as breath–hold and prone radiation. These techniques are particularly beneficial for left-sided breast lesions where vital structures such as the heart are in closer proximity to the treatment field.

Dr. Angotti shares Doylestown Health’s holistic philosophy of patient care. She focuses on the whole person, encouraging her patients to take advantage of the Integrative Medicine Program at Doylestown Health Cancer Institute. Through this program, patients can benefit from complementary nutritional counseling, psychological counseling, acupuncture, reiki and exercise programs. Dr. Angotti believes that all of these components are vital to overall wellness.

Cardio-Oncology for the Breast Cancer Patient

Another example of Doylestown Health’s integrative approach to medicine is Oncology’s collaboration with Cardiology to form the new Cardio-Oncology Program. This program, one of only a handful in the region, monitors a patient’s heart health before, during and after radiation and chemotherapy. While these anti-cancer therapies can be vital components of a patient’s care plan, they also have the potential for cardiovascular consequences. Cardio-Oncology Nurse Navigator Kassie Richman notes that 70% of the patients referred to the program are breast cancer patients. This is due to the cardiotoxicity of some of the primary chemotherapy drugs used to treat breast cancer.

Dr. Angotti says, “We must work proactively to preserve the health of all body systems, particularly the cardiovascular system, so that women and the families they love and for whom they care enjoy their presence for a full lifetime.” When she or her colleagues identify a patient as being at risk because of the type of cancer therapy they are receiving, or because they develop cardiovascular symptoms during treatment, they will refer them to the Cardio-Oncology Program. The program places patients under the care of a Cardiologist and provides them with health and lifestyle education.

“The evidence-based early monitoring techniques used here at Doylestown Health alert us to the patients in treatment who have early cardiac or vascular changes,” Dr. Angotti explains. “In collaboration with the treating Medical Oncologist and our expert Cardiology team led by Renee Sangrigoli, MD, interventions are made that permit treatment to continue and for the heart and cardiovascular system to reach full recovery. Patients feel safe and protected and many hesitations to treatment are relieved.”