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To the wonderful women I have cared for at Montclair Breast Center,

Thirty years ago I joined Dr. Nancy Elliott as a breast surgeon at Montclair Breast Center. It is very difficult for me to say this, but it is now time for me to retire.  My last day will be March 1st.

I know you understand what I mean when I say we have been through a lot together. I am humbled by the way in which you let me into your lives.  I have had the honor of taking care of many of your daughters, and even your granddaughters. There are not many doctors who can say that.

I am sorry to leave you, but I know that you will be in excellent hands with the surgeons, radiologists, and physician’s assistant available to continue your care at Montclair Breast Center. 

I will miss all of you, and I will think about you. You are an amazing group of women and I’ve enjoyed the moments we spent together. Taking care of you has been a joy, a privilege, and an honor.

I wish all of you the very best.

Marcie Hertz

Understanding test results can be challenging

The 21st Century Cures Act is a new federal law that requires health care providers to give patients
access to their health information without delay. This means you may see results from a test or
pathology on an electronic medical records system as soon as it becomes available. Sometimes,
you may see your results before your health care provider has had a chance to review them.

We understand this new law may be unsettling but remember, your breast doctor is an expert in
the field and will be contacting you with the specific details as it pertain to your breast health. It
is important for a specialist at Montclair Breast Center to interpret any test results.

Remember:

• Some results may be marked as abnormal even though they are normal for you.
• Not all abnormal results are clinically relevant. Test results are combined with other information and medical history.
• Be aware that you may see results that are difficult to understand or indicative of serious illness.
• If you are concerned that your test results will make you nervous, consider waiting until your provider reaches out to you.

Rest assured your physician will always review your results and communicate the details as soon
as possible.

If you have any additional questions, please contact our office. We look forward to managing
your breast health.

By: Kruti McDonald, PA-C, M.S.

Breast specialists at Montclair Breast Center complete a thorough history on all patients to determine if they meet important national guidelines for genetic testing.

Determining if you need genetic testing is very important. With the guidance of your breast doctor, understanding your potential risk of disease can help you make educated decisions on how to best detect early abnormalities or prevent breast cancer. As genetic testing evolves, healthcare experts are evaluating differences in more genes and how they can impact future risk of disease. We’re now aware of more genetic variants that increase the risk for breast cancer, so some patients should consider a more modern and comprehensive test. An MS3 (Ashkenazi panel) or BRCA testing may not be enough.

Variant vs. Mutation
Mutation is a permanent change to the DNA or genetic sequence of a living organism. Changes in DNA do not always cause disease. A genetic variation is seen in groups or population and is observed in genes as well as in alleles.

What are BRCA Genes and How Do They Impact Our Health?

BRCA genetic variants can increase the risk of breast, ovarian, pancreatic and prostate cancer.

All males and females have two copies of BRCA genes. These genes play a critical role in DNA damage repair, which helps prevent cancer from occurring. Populations with a significant BRCA genetic variation have an increased risk of cancer. A BRCA1 variant increases the lifetime risk for breast cancer up to 87% and up to 84% with a BRCA2 variant.

According to the National Breast Cancer Foundation, 1/400 people in the U.S. have a BRCA genetic variant. Ashkenazi men and women have a 1/40 chance of having a BRCA mutation, a significant 10x increase in risk as compared to the general population.

Case Study

Recently a young female of Ashkenazi descent presented to Montclair Breast Center for a routine 3D mammogram. High-risk screening and breast evaluation were completed.

Her full family history was reviewed with a dedicated breast specialist, noting that her mother had a triple-negative breast cancer. Additionally, her maternal aunt and grandmother both had breast cancer. Her maternal grandfather had metastatic prostate cancer and paternal female cousin and paternal grandmother had breast cancer. We were immediately curious about her genetic testing status. She explained her mother had negative genetic testing and she was told she did not need testing. Our team inquired about the type of testing her mother had, but she was not certain. She was unable to get her mother’s results.

We determined that perhaps her mother did not have a full panel of testing and despite that, she still met the criteria for genetic testing from the family history on her paternal side. (Men and women can inherit a genetic mutation from either their maternal or paternal side.)

Some women of Ashkenazi descent only have three genetic mutations evaluated and therefore not all the BRCA differences are assessed. Our patient received a full panel of genetic testing and was found to have a significant BRCA1 variant. This was not a founder mutation and would not be found on a limited Ashkenazi panel. It’s fortunate she specifically visited our Center! Instead of simply receiving an annual mammogram, our appointments entail a full breast health evaluation – including risk assessment and prevention strategy.

She was extremely thankful for her diagnosis and subsequently underwent a bilateral prophylactic mastectomy with reconstruction to prevent breast cancer. Elsewhere, she had an oophorectomy to prevent ovarian cancer. She will continue to follow our high-risk program, which will offer supplementary and non-invasive screening such as ultrasound and MRI to discover any abnormalities early.

When evaluating your own family history, please let us know if any of the following apply to your relatives. If so, you are likely a candidate for genetic testing.

• Breast cancer, especially multiple family members or diagnosis at a young age
• Male breast cancer
• Ovarian cancer
• Ashkenazi Jewish ancestry
• Personal history of a triple-negative breast cancer

The experts at Montclair Breast Center will develop an individualized plan of prevention and early detection that fits your unique circumstances, taking into account any genetic concerns.

By: Amy Kathryn (Katie) White, DO

After a breast cancer diagnosis, under certain circumstances, women may be presented with the opportunity to choose between mastectomy (removal of all the breast tissue) and lumpectomy (removal of the cancerous tissue with a margin of normal breast tissue). If lumpectomy is performed, treatment is usually followed by radiation therapy. The combination of lumpectomy plus radiation therapy is commonly referred to as breast-conservation therapy

When breast cancer is surgically removed, a rim of normal tissue surrounding the tumor is also removed. This rim is called a margin. Margins help show whether or not all of the tumor was removed. A negative margin means that extra tissue does not contain cancer cells and no additional surgery is needed. A positive margin has cancer cells in the rim of extra tissue. More surgery may be needed to get negative margins.

Over the years, data has shown both to be equally effective in regards to breast cancer prognosis.

Many deciding factors go into the decision of lumpectomy or mastectomy. In general, this is a shared decision between patient preference and breast surgeon recommendations.

The main advantages to lumpectomy include:

• a less invasive surgery
• preservation of appearance and sensation of the breast
• significantly shorter recovery time

The disadvantages include the need for adjuvant (post-operative) radiation therapy which usually lasts 3-6 weeks (depending on your cancer). Radiation therapy in certain patient populations can be deferred; however, is usually recommended to decrease the risk of the cancer coming back locally. There are incidences where someone may not be eligible for breast conservation surgery. You may not be eligible for a lumpectomy if there are multiple areas of cancer in your breast, large breast cancer size, prior radiation to the breast or have contraindications for radiation therapy.

So how did we get here?

In 1882, William Halsted, a surgical innovator and creator of surgical and medical residency training programs, performed his first radical mastectomy for the treatment of breast cancer at Roosevelt Hospital in New York (now part of the Mount Sinai system). Radical mastectomy included the removal of the breast tissue, the underlying pectoralis major and minor muscle, as well as removal of all the lymph nodes under the axilla. He published his data of 50 patients in 1894 which showed excellent clinical results and low local recurrence rates when compared to previous breast cancer treatments previously described. The radical mastectomy became the cornerstone for breast cancer treatment and was universally embraced for all stages of breast cancer. Unfortunately, this surgery resulted in significant chest wall deformity and postsurgical complications such as lymphedema. The use of chemotherapy and radiation had not played a role in breast cancer treatment at that time, so its adjunct use and benefit had not yet been demonstrated.

Around 1956, Bernard Fisher, medical doctor and surgeon, introduced the practice of clinical trials and questioned the need for such radical surgery in all stages of breast cancer. By this time, radiotherapy experiments and usage benefits had been successful in Europe. Fisher used this data and information to create clinical trials to test the hypothesis: “Does less invasive surgery offer the same prognosis in breast cancer treatment?” Over the next 30 years, Bernard Fisher led clinical trials that resulted in transformative changes in the treatment of breast cancer.

The results of multiple clinical trials comparing Halsted’s radical mastectomy to what we know today as a total mastectomy (removal of breast tissue and sentinel node biopsy), as well as comparing to lumpectomy with node biopsy and radiation, showed similar results when comparing overall survival, disease-free survival and local recurrence rate. These three decades of comparison between aggressive radical surgery and less invasive surgery allow breast surgical oncologists to offer the safe and successful option of breast conservation therapy.

Lindsay Drubel, PA-C, M.S.

Would you sometimes describe your breasts as aching, tender or experiencing the occasional sharp, shooting pain? If so, you are in good company. Studies have shown 70% of women have felt breast pain in their life and up to 69% even have regular breast discomfort. Why does this happen? When should you worry?

Breast pain can be separated into two different categories— cyclical breast pain and non-cyclical breast pain. Cyclical pain is typically hormonal in nature, worsening before the menstrual cycle and relieved after. Many women experience this pain and for most women it is just a mild discomfort, however; this pain can sometimes be severe and detrimental to quality of life. In these rare cases we encourage you to talk to a breast specialist about your pain.

Non-cyclical breast pain can have many causes: trauma from an accidental bump or bruise, muscular pain from your chest or shoulder muscles, or breast disease (an inflamed cyst or infection). In very rare cases, breast pain may correspond to a breast cancer.

Women who are evaluated by a breast specialist for noncyclical pain and have normal breast imaging should be reassured there is no sign of breast cancer.

CAN BREAST PAIN BE A GOOD THING?

Having tender breasts can make you pay attention to them! Women who have felt breast discomfort may do a self-breast exam or self-massage when ordinarily they would not. Having breast pain may bring you to a breast specialist where you can be reassured your pain is not related to breast cancer. During this conversation, you may learn about your personal lifetime risk of breast cancer, strategies to reduce your risk, breast disease and how your family history may impact a recommendation for Genetic Testing.

In some women, breast pain can push them to have their first mammogram. Average-risk women (with no family history of breast cancer) are recommended to have their first mammogram at age 40 and continue every year. In our practice, we recommend a baseline between age 35-40, especially in women with a family history of breast cancer. This is typically covered by your insurance.

Breast pain, while bothersome and sometimes frustrating, keeps you mindful of your breast health.

On January 3, 2018, I went to Montclair Breast Center for my routine breast exam. My appointment included a 3D mammography and ultrasound, very common and effective breast cancer screening tests. The radiologist pulled up my films and we reviewed them together. I appreciate the one-on-one approach meeting with a physician and the opportunity to look at my own medical images with an expert who can explain exactly what we were viewing. Everything looked good, but at the end of the appointment, the radiologist recommended that due to my risk factors, I should have an MRI. My personal lifetime risk of breast cancer was above 20%, which is the standard line for an MRI recommendation.

Quite frankly, I was a little annoyed. Another test?! Was this truly necessary if there were no abnormalities shown on the mammogram? As all women do, I have a full and busy schedule, so I scheduled my appointment for the following week before I left the office to make sure potentially valuable time did not slip away from me.

The following Tuesday, I arrived at Montclair Breast Center and I had my MRI scan on the lower level. As soon as I heard Dr. Lee on the phone, I knew I had a problem. She asked me a couple of questions (such as, what medications do I take?) and then scheduled a biopsy.

The biopsy was completed the following week. They were true experts and professionals. During the biopsy, they knew the area of concern needed to be removed – cancer or not. Twenty-four hours later and only 13 days later from my original mammography appointment, I received the diagnosis of Cancer. When Dr. Elliott said it during the phone call, it forever changed my life.

Early diagnosis saved my life and has given me a chance to live a healthy life, free from cancer. My treatment included a lumpectomy (completed at the North Fullerton Surgery Center, located on the lower level of the MBC office), and then radiation. I have never been happier than at the last two checkups when I received the good news than my cancer had not returned.

Diagnosis has changed my perspective: Every day is a good day. I can’t help but think, if I had waited another year for my mammogram and it wasn’t caught as early, how much worse would my cancer have been? Would I have needed to undergo toxic, draining chemotherapy?

Montclair Breast Center looked after me from the very beginning. I cannot thank them enough.

Envisioning a World Without Breast Cancer
Lymphatic Breast Massage
To specifically effect lymph in massage, it is necessary to pump in a specific direction, at a specific pace. This mimics the natural action of the lymphatic system. Lymphatic Breast Massage is easy to learn. It is different than just massaging your breast because you will specifically move the breast in a way that mimics how lymph moves in the body. We will use a pumping movement where we move the breast using some light pressure and then release the breast gently, allowing it to return to it’s normal position. Each move and return counts as one pump. Using the lymphatic breast massage model, the most important idea is to keep the lymphatic fluid moving in this area.

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