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Diane Radford, MD
dianeradfordmd (Physician - Surgery - Breast (Verified) )| Communities: Breast Cancer | Answers: 61 |
| Member Since: Aug. 2011 |
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Professional Statement
I was called to a career in surgery early on, in my teens. My focus in breast surgery began during my residency in Scotland in the early 1980s, training with Professor Sir Patrick Forrest. My philosophy is patient-centered care with a team approach.
Professional Info
Credential: MD
Primary specialty: Surgery - Breast
Secondary specialty: Surgery - Surgical Oncology
State Licenses: MO
Languages: English, French
Medical school: Glasgow University Medical School, Scotland
Residency: St. Louis University, Royal Infirmary Edinburgh, Western Infirmary Glasgow, Crosshouse Hospital Kilmarnock
Internship: St. Louis University, Gartnavel Hospital Glasgow, Monklands Hospital Airdrie
Board certifications: Surgery
Professional memberships: American Society of Breast Surgeons, American Society of Breast Disease, AMA, American College of Surgeons, Royal College of Surgeons of Edinburgh, Society of Sugical Oncology, Roswell Park Surgical Society
Areas of expertise: Breast cancer, benign breast disease, genetics of breast cancer
Research interests: Tumor suppressor genes in breast cancer, transition from DCIS to invasion
Awards and publications:
Best Doctors 1996-2012,Who's Who in America, Who's Who in Medicine and Health Care,Woman of Distinction in the Sciences, 2010, Girl Scouts of Eastern MO,Fran Lefrak-Brown Illuminator Award, AMC Breast Cancer Research Center 2006 (jointly with fellow partners of the St. Louis Cancer & Breast Institute),Best Science Research Report: Roswell Park Cancer Institute, Buffalo, NY 1987,First Prize, Resident’s Competition, Missouri Chapter, American College of Surgeons, 1989,2. Lorimer Bursary and John Hunter Medal,Physiology, Lorimer Bursary, Biophysics, Distinction, Medical Chemistry.
Publications in British Journal of Surgery,Cancer Research,Am J Surgery, Cancer,Annals of surgery
Hospital affiliation: St. John's Mercy Medical Center
Practice name: Mercy Clinic St. Louis Cancer & Breast Institute
Practice address:
15945 Clayton Rd Suite 120
St. Louis, MO
63011
Practice phone number: 636-256-5000
Webpage:
http://www.stlcancer.com
Personal Bio (My story)
I came to the US in 1985 for my fellowship in surgical oncology and decided to stay. I arrived with my suitcases and, of course, my golf clubs. My interests include writing, cycling, and spending time with my family and our pets.
dianeradfordmd Activities
There has been debate about the association between hypothyroidism and breast cancer for over fifty years. A recent meta-analysis from Sydney concluded "there was significant evidence of an increased risk of BC in patients with autoimmune thyroiditis" and "the results supported an increased risk associated with the presence of anti-thyroid antibodies ...and goitre." However there was insufficient data to support causality.
New answer by dianeradfordmd (Physician - Surgery - Breast (Verified))
1
Answer |
1 month ago
Usually mastectomy with or without an expander reconstruction involves an overnight stay. By the next morning, most patients will be up walking around, they will be able to eat breakfast without nausea, and their IV will have been removed. If a patient has other illnesses such as heart or lung disease, or is elderly or infirm, a longer stay will be required.
New answer by dianeradfordmd (Physician - Surgery - Breast (Verified))
1
Answer |
1 month ago
The second surgery is likely to obtain a better margin of normal tissue around the cancer. Although best attempts are made to obtain a good margin at surgery (by bracketing with wires for example), the final pathology can show a close or involved margin. In situ cancer is often invisible to the naked eye, so the margin status may not be determined till the pathology report returns.
New answer by dianeradfordmd (Physician - Surgery - Breast (Verified))
1
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1 month ago
It would be meaningful to test you first. Only if you test positive would it be of value to test your sisters (and they could have single site analysis rather than complete sequencing). Generally, the most information is yielded when the person tested has had either breast or ovarian cancer (or pancreatic cancer). The NCCN issues guidelines for BRCA testing which are updated regularly. Most insurance companies follow NCCN guidelines.
New answer by dianeradfordmd (Physician - Surgery - Breast (Verified))
1
Answer |
1 month ago
It certainly makes sense to see a genetic counselor and consider testing. The counselor will require a detailed family history including information from both the maternal and paternal side. Data should cover the age of diagnosis (if known), and type of cancer. It is recommended that someone in the family who has had cancer be tested first. If no-one is still living who had cancer, then the family member whose result will be most informative should be tested.
New answer by dianeradfordmd (Physician - Surgery - Breast (Verified))
1
Answer |
1 month ago
Depending on the extent of disease and the desire of the patient to keep the breast, a reexcision can be done to achieve clear margins. If margins continue to be involved a mastectomy is usually recommended.
New answer by dianeradfordmd (Physician - Surgery - Breast (Verified))
1
Answer |
4 months ago
The report should include the type of cancer, grade , presence or absence of lymphovascular invasion, and size (though this may not represent total tumor size). The Nottingham score is used for grading, based on mitoses (cells actively dividing), nuclear pleomorphism, and tubule formation (how much like normal breast tissue the cells are). A copy of the report should be given to the patient if they ask for it.
New answer by dianeradfordmd (Physician - Surgery - Breast (Verified))
1
Answer |
4 months ago
Side effects from the surgery include risk of wound infection (about 1%), hemorrhage (also rare), scarring, and altered contour of the breast. Of course with current oncoplastic techniques cosmetic results are maximized. Side effects of the radiation associated with lumpectomy include: redness; discomfort; fibrosis and fatigue.
New answer by dianeradfordmd (Physician - Surgery - Breast (Verified))
1
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4 months ago
Adjuvant therapy means treatment after all obvious disease has been removed (i.e. after surgery). Examples of adjuvant therapy are: post operative radiation; endocrine therapy (such as tamoxifen or an aromatase inhibitor); or post operative chemotherapy. Neo-adjuvant therapy, on the other hand, means treatment given with the cancer still in place.
New answer by dianeradfordmd (Physician - Surgery - Breast (Verified))
1
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4 months ago
It means the cancer has spread from the primary site in the breast to the lymph nodes in the axilla. This will alter the stage of disease. Nodal metastases can be detected via sentinel node biopsy, or core biopsy (if nodal disease is suspected on imaging). If nodal involvement is suspected on examination, it should be confirmed by biopsy.
New answer by dianeradfordmd (Physician - Surgery - Breast (Verified))
1
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4 months ago
Make sure you understand why it's being done. If confused, ask for a fuller explanation.
Stop blood-thinners (after consulting with your doctor). Generally coumadin and plavix are held for 5 days before a biopsy. Ideally, aspirin and other non-steroidal anti-inflammatory drugs are held for 7 days.
If a surgical as opposed to a needle biopsy, then fast from midnight and make sure you have a driver to take you home.
Stop blood-thinners (after consulting with your doctor). Generally coumadin and plavix are held for 5 days before a biopsy. Ideally, aspirin and other non-steroidal anti-inflammatory drugs are held for 7 days.
If a surgical as opposed to a needle biopsy, then fast from midnight and make sure you have a driver to take you home.
New answer by dianeradfordmd (Physician - Surgery - Breast (Verified))
1
Answer |
8 months ago
A procedure where the nipple and areolar is left in place during mastectomy. The ducts behind the nipple are removed. Incisions for the procedure can vary, such as lateral, inframammary, lateral with a periareolar component, and vertical. An immediate breast reconstruction is done, either with an expander, or one-stage with an implant. The cosmesis of keeping the nipple is the main advantage. There is a 10% risk of nipple healing problems, 2% complete nipple necrosis and 8% partial loss of the nipple or areola.
New answer by dianeradfordmd (Physician - Surgery - Breast (Verified))
1
Answer |
8 months ago
Generally nipple sparing mastectomy would not be done if tumor is known to be within 2cm of the nipple. Better cosmetic results are obtained, with less chance of nipple necrosis (death due to poor blood supply), for women with smaller, less pendulous breasts. If the patient is a poor candidate for immediate breast reconstruction (smoker, multiple medical problems), nipple sparing mastectomy will not be considered. There is very careful patient selection involved when considering a nipple sparing procedure.
New answer by dianeradfordmd (Physician - Surgery - Breast (Verified))
1
Answer |
8 months ago
The surgeon will review with the patient the pathology report from the surgery. Then appropriate referrals to medical oncology (for adjuvant systemic treatment) and radiation oncology (if needed) are made.
Post-op visits usually occur for several weeks for wound checks and drain removal etc. If an expander is in place, the plastic surgeon will see the patient weekly for expansions.
Post-op visits usually occur for several weeks for wound checks and drain removal etc. If an expander is in place, the plastic surgeon will see the patient weekly for expansions.
New answer by dianeradfordmd (Physician - Surgery - Breast (Verified))
1
Answer |
8 months ago
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