Today's approaches to breast surgery are less invasive than in the past, returning women to the comfort of their homes and their daily life routines more quickly than ever before. "This is because we are increasingly seeing cancers diagnosed at earlier and earlier stages," explains Freya Schnabel, MD, Professor of Surgery and Director of Breast Surgery.
At the NYUCI, some 85 percent of breast cancer surgeries are performed on an outpatient basis - even mastectomies. A woman may be admitted as an inpatient if she has reconstruction at the time of mastectomy or other complications that prevent her from returning home the same day. But most often, the patient has her procedure and is back in her own bed by nightfall.
Breast surgeons are also incorporating "oncoplastic" techniques into their repertoire to enhance the appearance of the breast area after surgery. "As breast surgeons, we are becoming more sensitive to how we can do the best job we can of removing cancerous tissue while enhancing the likelihood of a good cosmetic outcome," says Dr. Schnabel. "This approach lends another dimension to our surgery."
Dr. Schnabel is also working with geneticists and other clinicians at NYU to design a study aimed at identifying a new set of genes associated with an increased risk of breast cancer. The researchers - including David Fishman, MD, Professor of Obstetrics and Gynecology; Feighanne Hathaway, MS, Genetic Counselor; Ruth Oratz, MD, Clinical Associate Professor of Medicine (Oncology); Harry Ostrer, MD, Professor of Pediatrics (Genetics), Pathology and Medicine (Genetics) and principal investigator of the study; Elsa Reich, MS, Genetic Counselor and Clinical Professor of Pediatrics (Genetics); Daniel Roses, MD, Leonard Whitehall Professor of Surgery; Julia Smith, MD, PhD, Clinical Assistant Professor of Medicine (Oncology); Deborah Axelrod, MD, Director of Clinical Breast Surgery in the Department of Surgery and Director of Breast Services in the Clinical Cancer Center; and James Speyer, MD, Professor of Medicine (Oncology) - will explore breast cancer genetics in women with a strong family history of breast cancer but no mutations in the BRCA genes, as well as women with BRCA mutations who do not develop breast cancer. "This effort is part of a national movement to expand our knowledge of the genetic factors contributing to breast cancer," says Dr. Schnabel. This study is supported by gifts from the Meyers-Schiffrin Breast Cancer Research Fund and from the Ginsberg-Kanengiser family.
The NYU Cancer Institute also aims to create a registry of women at high risk for breast cancer, and to develop collaborations with other institutions to create a multicenter high-risk program to monitor risk and ensure access to early detection and prevention efforts. The NYU Cancer Institute already has experience in this area through its Clinical Genetics Service and the Lynne Cohen High Risk Women's Clinic, which provide services for women with a high risk of breast and ovarian cancer. The Clinical Genetics Service provides genetic risk assessment, including genetic testing and counseling for more than 500 women per year.
David Kleinberg, MD, Professor of Medicine (Endocrinology), as principal investigator, with Dr. Axelrod, Baljit Singh, MD, Chief of Breast Pathology, and Dr. Smith, recently received a grant from the US Department of Defense to look at risk modification in women diagnosed with breast atypia (abnormal breast cells) and lobular carcinoma in situ. "We are looking for innovative ways to reduce breast cancer risk in a safer and more effective manner than what is now available, which is the drug tamoxifen," explains Dr. Axelrod. "The changes we are looking for occur on a molecular level in breast tissue."
These efforts build on NYU's commitment to a comprehensive program for women with breast cancer. "This is an institution whose reputation for clinical excellence is very well deserved," says Dr. Schnabel, who came to the NYUCI from Columbia University Medical Center earlier this year. "The people here who are interested in advancing breast cancer care are remarkable."
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