The Clinical Breast Cancer Program at Columbia University is the clinical arm of the Herbert Irving Comprehensive Cancer Center's Breast Surgery Section. The program offers patients the resources of a major academic facility and comprehensive treatment of all forms of breast disease in one location.
Our clinicians are accomplished, caring specialists who have a long-standing commitment to women's health. They apply a multidisciplinary approach to breast health, which includes medical care, educational programs, and support groups. Ensuring that your experience at the Clinical Breast Cancer Program is private, comfortable and dignified is a primary concern of our staff.
Our specialists include breast surgeons, plastic and reconstructive surgeons, dedicated breast imagers, medical oncologists, pathologists, radiation oncologists, gynecologists, geneticists, psychiatrists, physical therapists and nutritionists, as well as physician assistants and specialized nurses. Their dedication, combined with academic and research capabilities and the full spectrum of diagnostic and therapeutic technology, result in the superior care that patients have come to expect from the program.
The program's high survival rate and low complication rate testify to the depth of this team's commitment; compared to national averages, patients treated at the Clinical Breast Cancer Program can expect consistently and significantly better results.
Surgery - Breast
New York University School Of Medicine
NYU Bellevue Hospital Medical Center
NYU Bellevue Hospital Medical Center
American Board of Surgery, Fellow American College of Surgeons, Fellow International College of Surgeons
Alpha Omega Alpha, New York State Society of Surgeons, American College of Surgeons, Society of Surgical Oncology, American Society of Clinical Oncology, The American Society of Breast Disease, The American Society of Breast Surgeons, New York Metropolitan Breast Cancer Group
Areas of expertise:
Oncoplastic surgery Nipple sparing mastectomy Minimally invasive breast cancer surgery Mammary ductoscopy High-risk patient surveillance Breast cancer prevention
Environmental factors and breast cancer Breast endoscopy and intraductal diagnostics and treatment Sentinel node biopsy Physician-patient communication Holistic patient-centered approaches to surgery
Awards and publications:
Compassionate Doctor Award 2009-2011 Best Doctors in America: New York 2009-10 America’s Top Surgeons, “Guide to America’s Top Surgeons”, 2004-2010 Top Doctors New York Metro Area, 2003-2010, Castle Connolly Medical Service Teacher of the Year Award, Family Practice Residency Program, June 1984 Sister Mary Charles Award, Benedictine Hospital, September 22, 1994 Award for Outstanding Service, American Cancer Society, September, 1998 Physician of Distinction Legacy of Hope 2004, American Cancer Society, Hudson Valley Region For publications, see: http://asp.cpmc.columbia.edu/facdb/profile_list.asp?uni=sf2388&DepAffil=Surgery
NewYork-Presbyterian - Columbia
Herbert Irving Pavilion Room 10th Fl., Suite 1005, 161 Fort Washington Avenue
New York, NY
An important emerging technology toward the goal of improving the local management of breast cancer is using RFA (radiofrequency ablation) intraoperatively during breast conservation (lumpectomy) surgery. In some centers up to 50% of patients who have a lumpectomy require return to the operating room for additional surgery to obtain clean margins. This is generally performed a few weeks after the initial surgery. The goal of using intraop RFA is to treat the breast tissue around the lumpectomy removal with heat (100 degrees centigrade) so that if the final pathology shows that a margin is not clean enough, it may not be necessary to perform and second surgery since additional margins have been “treated” with the RFA. Additionally this localized treatment may be comparable to a form of localized radiation therapy. If our studies show this to be equally effective it could allow many woman with early stage breast cancer to have successful breast conservation treatments even in areas of the world where radiation treatments are not readily available. The RFA equipment is not expensive and is small and portable and does not require lead lined radiation shielding. Several hundred patients have now undergone this procedure and the early results are very promising.
For women with ADH and family history of breast cancer, the risk for developing breast cancer is greatly increased. Serious consideration to take medications to reduce breast cancer development is prudent. These medication include; tamoxifen, raloxifene, torimifene and exemestane.
These lesions may be identified when a biopsy is performed for a palpable mass or abnormal breast imaging study. They include atypical ductal hyperplasia, atypical lobular hyperplasia, lobular carcinoma in situ, radial scar and papillary lesions. If they are diagnosed by a core needle biopsy, we generally recommend surgical excision of the area to be certain there is not an associated cancer that requires treatment. This lesions statistically increase a woman’s risk for developing breast cancer and depending on other risk factors it will be important to undergo careful breast surveillance and consideration of risk reducing therapies.
This is a FDA approved device which uses the difference in how healthy breast tissue versus cancerous breast tissue interact with an energy source called radiofrequency spectroscopy. The surgeon applies this probe to the surface of the lumpectomy specimen and gets a reading based on the signal generated by this device interacting with the breast tissue. If the signal suggests the margin is not adequate, the surgeon can remove additional tissue to achieve a clean margin. It is user friendly and does not add much time to the procedure. A recent study suggests this device may be an improvement in margin evaluation compared to standard methods.
The methods common used include; palpation, specimen radiograph, specimen ultrasound, frozen section and touch prep cytology. Specimen radiograph and ultrasound allow visualization of the distance from the tumor to the margin but not all disease is visible. Frozen section and touch prep can be challenging since they will not determine the margin distance and freezing fatty breast tissue is often difficult. Clinical judgement and surgeon experience are very important factors in successfully evaluating surgical margins.
The key to answering this question is to understand that how the breast cancer is best seen radiologically is critically important. If a mammogram well characterizes the cancer, no additional imaging is necessary. This is generally true for woman who have fatty replaced breasts. For woman with dense breast tissue, mammograpghy does not perform as well. In that setting ultrasound and MRI can be helpful preoperatively to help define the extent of breast tissue that should be resected. Unfortunately MRI is not perfect and can over estimate the amount of tissue that should be removed especially if it is performed after a needle biopsy.
This has been a controversial area within the breast surgical community. The largest studies from the NSABP which validate lumpectomy as a safe approach used the criteria of “no ink on tumor”. This means that there is some discernible distance from the cancer to the surface of the lumpectomy specimen. Most surgeons will accept a 1mm margin. Important to note that this does not include the anterior (skin) or posterior margins where skin and muscle fascia after often removed as part of the lumpectomy specimen.
Unfortunately thermograms are not a replacement for mammograms. The idea of a non radiation based breast screening method is very appealing. There is no evidence to suggest that mammograms cause cancer. Unfortunately I have seen many patients with breast cancer who have normal thermograms
The nipple can be saved unless there is cancer involving the nipple. However for patients with large ptotic(droopy)breasts, saving the nipple may not be good from a cosmetic point of view since the nipple position will be very low on the reconstructed breast and will not have a good appearance.
This technique requires a highly trained breast cancer surgeon. It involves making small cosmetically placed incisions through which all of the breast tissue is removed. It is important that the entire core of breast tissue going into the nipple is removed and checked to be certain that it does not contain cancerous breast tissue. This must be done in a very delicate way to be certain that the blood supply to the nipple is preserved so that the nipple stays alive.
Oncoplastic surgery combines the principles of breast cancer surgery with complete removal of the disease with plastic reconstructive methods to maintain a normal breast appearance. The advantages are preserving normal body image. The potential disadvantage is that the surgery can take longer to perform. It can be used both for mastectomy and breast conservation surgery.
Risk stratification based upon family history and established risk factors is essential. There are models such as the GAIL model which can calculate risk based upon age, age of menarche, age first live birth, # first degree relatives with breast cancer, hx breast biopsies and finding of atypia. For patients determined to be at high risk, genetic counseling to discuss possible benefit of BRCA testing is important. Surveillance may include self, exam, clinical breast exam, mammography, ultrasound and MRI depending on the level of risk.
Yes, there are CDs with guided meditations that are extremely helpful. Comprehensive pain management approaches including pre-emptive analgesia with nerve blocks and the use of pain pumps is also very beneficial.
It is important that patients receive educational materials specific to their problem so that they can fully understand their disease and treatment options. Patient can record the conversation during their visit so that they can listen again to the discussion. Providing the opportunity for patients to speak with “experienced” patients is extremely helpful to be certain that all questions are answered. Open access via email so that additional questions can be answered is also valuable.
Yes, I believe that surgeons at many centers have growing awareness and interest in CAM(complementary alternative medicine). Helping patients prepare for surgery using mind-body techniques such as meditation and audio relaxation tapes is become fairly routine. Additionally patients are becoming more proactive in assuming responsibility for their care incorporating other modalities to ensure rapid healing.
I am doing mammaprint on all patients with tumor 1cm or greater.
Mammaprint is a 70 gene assay that can be used determine if a breast cancer is high risk or low risk for recurrence. Additionally it allows for tumor subtyping so that we can know if the tumor is luminal, basal or her2neu over-expressing. This can be very helpful for helping patients make decisions about the potential benefit of chemotherapy as well as helping to decide which medications are most effective. This assay can only be done on fresh tumor tissue either obtained at the time of core biopsy or during surgery.
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