Winning Against Breast Cancer

For more than a decade, Hoag Cancer Center has maintained the highest volume breast cancer program in Orange County. With a multidisciplinary approach that includes prevention, early detection, the use of promising new therapies, participation in laboratory and clinical research, and extensive complementary care, the team at Hoag Cancer Center provides breast cancer patients with every diagnostic and therapeutic advantage.

Hoag’s comprehensive site-specific breast cancer program provides:

Higher than national figure survival rates
Highly skilled and specialized physicians
Medical Director of Hoag Breast Care Center and Director of Breast Imaging
Treatment and Technology
- Minimally invasive surgery
- High-tech radiation therapy capabilities
- The latest in systemic therapy
- Treatment of metastatic disease
Weekly breast cancer case conferences
Hereditary Cancer Program
Breast Cancer Support Group

Survival Rates

The superior care provided to Hoag breast cancer patients is evidenced by the cancer center's exceptional survival rates, which have steadily increased as shown in the graph below.

The above graph shows overall survival rates for Hoag breast cancer patients diagnosed in each era from 1983-2003. It’s important to note that “overall” survival figures are not breast cancer specific. In other words, overall survival rates include death from any cause, not just breast cancer.

The table above and the graph below show that Hoag patients have continued to achieve better survival outcomes than nationally for every stage of breast cancer. It’s important to note that “relative” survival rates are adjusted to exclude other causes of death not specific to breast cancer. Therefore, the relative survival rate for Hoag breast cancer patients (adjusted to not include causes of death outside of breast cancer) is 99 percent. What this figure represents, when compared with the overall survival rate of 86 percent (shown in graph one), is that during the five years after diagnosis, only one percent of Hoag patients died of breast cancer, while 13 percent were predicted to have died from other causes.

Hoag's higher relative survival rate is one reason why patients diagnosed at Hoag remain at Hoag for treatment, and why many patients come to Hoag shortly after their initial diagnosis to receive treatment. As shown above, the five-year relative survival rate for Hoag breast cancer patients is a full 10 percentage points higher than national figures (99% vs 89%). It’s important to note, “relative survival” figures are adjusted to exclude causes of death outside of breast cancer.

Medical Staff Expertise

Hoag’s expert medical team is just one of the many reasons why patients diagnosed at Hoag remain at Hoag for treatment. Our multidisciplinary team of board certified diagnostic radiologists, pathologists, breast cancer surgeons, radiation oncologists and medical oncologists provides the latest in state-of-the-art diagnostic and treatment options for patients with breast cancer.

As part of Hoag’s multidisciplinary approach, the breast cancer team conducts weekly cancer case conferences where experts from all disciplines gather together to review cases from every angle to ensure the latest knowledge in cancer treatment is applied.

Additionally, Hoag’s expert medical staff is complemented by its highly trained team of oncology nurses. Dedicated to delivering patient-centered care, Hoag’s nursing staff ranks among the nation’s top nurses, as validated by Hoag’s designation as a Magnet™ hospital by the American Nurses Credentialing Center.

Hoag-Affiliated Breast Cancer Experts

Director of Breast Imaging Gary Levine, M.D. (left) and Medical Director of Hoag Breast Care Center Melvin Silverstein, M.D. (right).

Medical Director of Hoag Breast Care Center and Director of Breast Imaging

Medical Director of Hoag Breast Care Center
Melvin Silverstein, M.D., is the medical director of Hoag Breast Care Center. For more information, please select from any of the following: Dr. Silverstein’s bio, contact information, or news release about his appointment as medical director.

Director of Breast Imaging at Hoag Breast Care Center
Gary Levine, M.D., is the director of breast imaging at Hoag Breast Care Center. For more information, please select from any of the following: Dr. Levine’s bio, or contact information.

Physician Expertise

Obtaining your cancer care from a medical team that treats a high volume of patients with your specific cancer type has its advantages – namely, successful patient outcomes.

Studies show that physicians who treat large numbers of patients with a specific disease achieve better patient outcomes. During 2005-2006, three Hoag-affiliated surgeons (Drs. Police, Snyder and Coleman) accounted for more than 80 percent of breast cancer surgeries performed at Hoag, and each performed more than 125 breast cancer surgeries. Additionally, during that same time period, five Hoag-affiliated medical oncologists in good standing with Hoag Cancer Center managed the majority of breast cancer patients treated at Hoag (Drs. Vandermolen, Barth, Mahdavi, Nanci, Carroll and Semeniuk).

Hoag’s expert medical team and higher than national figure survival rates are just two reasons why the majority of patients diagnosed at Hoag remain at Hoag for treatment. Hoag also has several plastic surgeons on staff who are experts in breast reconstruction for patients who undergo mastectomy.

Diagnostics

Breast Imaging
The key to surviving breast cancer is early diagnosis. Hoag Breast Care Center is committed to utilizing the latest advances in the early detection and treatment of breast disease, including emerging technologies that may not be available elsewhere. Our highly specialized breast radiologists employ these technologies to diagnose breast cancer at its earliest stage, when it is easily treatable, often allowing breast preservation.

Screening Mammography
Screening mammography remains the most effective tool in the early diagnosis of breast cancer. Clinical trials have demonstrated up to a 46 percent long term reduction in mortality from breast cancer in women who undergo routine screening mammography.

At Hoag, we utilize the most advanced mammographic technology available, “digital mammography,” which has been shown to be superior to traditional film mammography, especially in young women and in women of any age who have dense breasts. In 2007, nearly 40,000 women obtained a screening mammogram at a Hoag facility.

Diagnostic mammography
When a patient presents with clinical signs or symptoms of breast disease, or when a previous screening mammogram is interpreted as abnormal, a diagnostic work-up is indicated. Usually the diagnostic work-up begins with a diagnostic mammogram, which includes magnification and special views, and may also include breast ultrasound, breast MRI and a clinical breast exam. Image guided minimally invasive needle biopsy may be done to obtain tissue when a breast lesion is considered suspicious.

Hoag Breast Care Center provides the latest in state-of-the-art breast care services including:

Direct-to-Digital Mammography
Dedicated Breast Magnetic Resonance Imaging (MRI)
Dedicated Breast Ultrasound
Ultrasound Guided Cryoablation
Digital Tomography – one of only 11 sites in the U.S. (presently used only in clinical trials)
Minimally Invasive Image Guided Breast Biopsy

For more information about Hoag Breast Care Center, Orange County’s leading provider of breast care services, please click here.

Comprehensive Diagnostics

If diagnosed with breast cancer, Hoag’s state-of-the-art diagnostic services give patients convenient access to a full spectrum of technologies that enable our breast care physicians to pinpoint the exact nature and extent of the disease – and the best treatment plan for each individual patient.

Hoag’s sophisticated imaging technologies and expert radiologists provide an essential component of service. Anatomic and physiologic imaging are utilized to define the extent of disease and assist in developing the most effective treatment plan.

Advanced imaging techniques available at Hoag include:

Hereditary Cancer Assessment

It is estimated that up to 10 percent of all breast cancer occurs due to inheritance. Hoag’s Hereditary Cancer Program offers genetic counseling and genetic testing for BRCA1 and BRCA2, as well as other hereditary causes of breast cancer.

Treatment/Technology

Hoag Cancer Center’s expert medical team works together to determine the best course of treatment for each individual patient. From minimally invasive surgical options, to the latest in radiation therapy and systemic therapy, Hoag’s comprehensive approach to breast cancer has resulted in outstanding survival rates – significantly outpacing national figures by 10 full percentage points.

Surgery

Upon diagnosis, definitive surgery to remove cancer from the breast is usually the first step for treatment. Hoag breast cancer surgeons are experts in performing the latest surgical options, including lumpectomies, skin sparing mastectomies and the sentinel lymph node procedure.

Additionally, Hoag Breast Care Center Medical Director Melvin J. Silverstein, M.D., F.A.C.S. specializes in an innovative procedure called oncoplastic breast surgery. For details, click here.

A multidisciplinary approach to treatment planning is the standard at Hoag Cancer Center. That’s why Hoag breast cancer surgeons collaborate closely with medical oncologists to determine which patients would benefit from neoadjuvant chemotherapy (chemotherapy before surgery). And in the case of mastectomy, Hoag breast cancer surgeons work together with reconstructive surgeons to coordinate the reconstructive component of surgery.

Radiation Oncology

Hoag Cancer Center’s radiation oncology program is another example of the center’s commitment to excellence in breast cancer treatment. The entire first floor of the cancer center is dedicated to radiation oncology, where its highly specialized team of medical experts deliver the latest in state-of-the-art radiation therapy to patients.

The most progressive options available for breast cancer patients include:

MammoSite® brachytherapy
3-D Conformal Radiation Therapy
Gamma Knife for brain metastasis

Hoag’s radiation oncology program offers a full spectrum of leading-edge radiation treatment options. For a complete list of radiation oncology services, please click here.

Systemic Therapy

Systemic therapy is an important component of care for the vast majority of breast cancer patients. Hoag’s medical staff includes 30 board certified medical oncologists, each of whom is committed to providing the latest in systemic therapy options to patients.

Five Hoag-affiliated medical oncologists in good standing with Hoag Cancer Center managed the majority of breast cancer patients treated at Hoag during 2005-2006 (Drs. Vandermolen, Barth, Mahdavi, Nanci, Carroll and Semeniuk). Each of these physicians managed at least 30 patients with breast cancer during that year.

Treatment of Metastatic Disease

When breast cancer spreads, the most common sites are other organs. In women with hormone receptor positive tumors, the most common site of spread is bone, but breast cancer can also spread to the liver, lung and brain. Systemic hormonal therapy and/or chemotherapy are typically used in the treatment of such patients, but increasingly, local therapies are being used to eliminate certain locations of metastatic cancer.

For patients with small numbers of metastases to the liver, surgical resection, radiofrequency ablation, cryoablation and tomotherapy are all treatment options, in addition to systemic therapy or intrahepatic chemotherapy.

Isolated lung metastases may be treated by surgical resection, preferably video-assisted thoracic surgery, radiofrequency ablation, cryoablation or radiation therapy. Brain metastases can usually be effectively treated by Gamma Knife.

With the availability of all of these treatment options, patients with metastatic cancer often live for extended periods of time with good quality of life because cancer can now be treated as a chronic disease.

Multidisciplinary Breast Cancer Case Conferences

Hoag’s multidisciplinary Breast Cancer Case Conferences provide collaborative care planning for breast cancer patients.

Breast Cancer Case Conferences

Hoag breast cancer specialists meet weekly to discuss prospective treatment planning for patients. This multidisciplinary approach includes breast surgeons, medical oncologists, radiation oncologists, breast diagnostic and interventional radiologists, pathologists, nurses, a genetic counselor and support staff.

Clinical Trials

Currently, the following clinical trials are open through the Hoag Breast Care Center:

A Pilot Study of Ultrasound Guided Cryoablation of Small Unifocal Invasive Ductal Breast Cancer Using Contrast Enhanced Magnetic Resonance Imaging to Evaluate Tumor Viability and Immunologic Assays to Identify and Characterize a Cryoablation Induced Immune Response. For more information about this study, please call Cheryl Hanna, R.N., study coordinator, at 949/764-4537.

To learn more about Hoag Cancer Center’s Clinical Trials Department, please click here.

Breast Cancer Support

In addition to individual counseling and support, Hoag’s comprehensive breast cancer program offers a variety of support groups, which provide a place of support and understanding. In this reassuring setting, patients can gather information and the strength to overcome their fears.

To view our monthly events calendar, please click here.

Cancer Education

To learn more about breast cancer, please visit the National Cancer Institute Website.

Patient Stories

This area is currently under development.

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