2005 Best Breast Cancer Hospital
Hour Detroit Magazine
The Institute’s Breast Cancer Program is based on a flexible multidisciplinary team approach to accommodate patients from initial risk assessments through diagnostic evaluation, treatment and follow-up. Patient, irrespective of diagnosis and status, can benefit from this team evaluation.
The team convenes each weekday. Real-time breast imaging and diagnostic studies as well as consultation on outside films and pathology slides are available onsite.
Patients are scheduled with appropriate team members for primary evaluation depending on their presenting situations -- ranging from full time nurse practitioners evaluating screening failures through surgeons, medical oncologists, radiation oncologists, and genetic councilors.
Combined appointments are possible when appropriate and real-time cross referral is possible (as for unforeseen neoadjuvant therapy evaluation or the need for surgical consultation).
The entire team, including ancillary personnel, meets on Monday mornings for clinical discussions on new patients or decisions regarding current patients. Because of the large volume of patients, precedence is given to real-time management issues and to rare or instructive cases. Access to this tumor board is open to all breast practitioners at the Detroit Medical Center.
Qualifications of Members
Members of the Institute’s Multidisciplinary Breast Cancer Team devote all or most of their clinical time to the care of breast patients and hold appropriate certification in their disciplines. They are clinically adept participants in a breast care community that cumulatively represents scores of years of experience with thousands of breast patients at all stages of malignant and benign conditions. They participate in local and national treatment protocols offering standard of care from prediagnosis to late stage breast cancer.
Team Members
Zeina Nahleh, M.D., (Team Co-Leader), Hematology Oncology
David H. Gorski, M.D., PhD, FACS, (Team Co-Leader), Surgery
Nelia Afonso, M.D., Internal Medicine
Zaid Al-Wahab, M.D., Benign Gynecology
Keiva Bland, M.D., Surgical Oncology
Robert Boorstein, D.O., Surgery
Robert Burack, M.D., Internal Medicine
Lawrence E. Flaherty, M.D., Medical Oncology
Elaina Gartner, M.D., Medical Oncology
Sharon Helmer, M.D., Radiology
Jennifer Holt, M.D., Radiation Oncology
Pamela Johnson, M.D., Surgical Oncology
William Kestenberg, M.D., Surgical Oncology
Mary Ann Kosir, M.D., Surgery
Peter Littrup, M.D., Radiology
Patricia LoRusso, D.O., Medical Oncology
Michael Meininger, M.D., Plastic & Reconstructive Surgery
Guillermina Nava, M.D., Plastic & Reconstructive Surgery
Linda Rissman, D.O., Radiation Oncology
Wael Sakr, M.D., Pathology
Julie Shultz, M.D., Radiology
Michael S. Simon, M.D., Medical Oncology
John Stucka, Jr., D.O., Radiology
Paul Tranchida, M.D., Pathology
Gwendolyn Wright, R.N., MDT Coordinator
Lisa Astalos-Chism, Nurse Practitioner
Jennifer Barrick, MS, Genetic Counseling
Brenda Boyd, R.N., Staff Nurse
Maria Gird, R.N., Staff Nurse
Debrorah Karwan, Nurse Practitioner
Cynthia Marsack, Nurse Practitioner
MaryAnn Milczuk, Nurse Practitioner
Catherine Nichols, Nurse Practitioner
Nancie Petrucelli, M.S., Genetic Counseling
Lynn Rossier, R.N., Staff Nurse
Christine Rymal, Nurse Practitioner
Susan Siepierski, Surgical Physician Assistant
Lee Sippel, R.N., Staff Nurse
The team also includes representatives from the Institute's Clinical Trials Office and the Cancer Genetic Counseling Service.
Clinical Trials
Patients are informed of clinical trials appropriate for their clinical situations. Studies at the Institute include cryotherapy for benign lesions, dietary supplement interventions, prevention interventions, chemotherapy protocols for all stages of disease, neoadjuvant studies, radiotherapy studies including partial breast irradiation, tumor genetic profiling, support and information access interventions, and additional studies.
The Institute’s Breast Cancer Program began as the basic breast cancer research program of the Michigan Cancer Foundation in 1943 that led to the discovery of major malignant and benign breast cell lines that are now international standards of breast cancer research.
Cancer Genetics
Although a specific cause of breast cancer is not identifiable in many women, numerous risk factors have been identified. With the majority of breast cancer cases occurring in women over the age of 50, aging is considered the single most important risk factor. A family history of breast cancer is also a key risk factor. When appropriate, patients may be referred to the Cancer Genetic Counseling Service for breast cancer risk assessment. It is estimated that between 5 and 10 percent of breast cancer cases are hereditary, meaning the risk to develop the disease is being passed on in the family through their genes. Patients who have hereditary breast cancer may also be at an increased risk for other types of cancers. Furthermore, their relatives may be at an increased risk to develop these cancers as well. Through careful examination of one’s family history, our cancer genetics specialists can determine the likelihood that the cancers in the family are hereditary, can advise patients about the appropriateness of cancer genetic testing and can give them information about their personal and family cancer risks, including their options for prevention, early detection, and treatment
Patient Participation
Patients who benefit the most from a consultation with the Institute’s Multidisciplinary Breast Cancer Team include those with:
- Diagnosed but untreated breast malignancies as referrals or second opinions;
- Diagnosed breast malignancies in the midst of treatment as referrals or second opinions;
- Asymptomatic screening failures;
- Asymptomatic perceived high risk patients; and
- Symptomatic patients with breast findings or complaints.
- A personal and/or family history suggestive of hereditary breast cancer, which includes any of the following:
- Breast cancer before age 50.
- Ovarian cancer at any age.
- Breast cancer in a male relative.
- The presence of related cancers (e.g., breast cancer and any of the following: ovarian cancer, thyroid cancer, endometrial (uterine) cancer, or early onset primary bone cancer).
On Appointment Day
Patients and their guests receive personal attention from the moment they arrive until they leave the Institute. Cinic nursing staff conduct preinterviews and review pathology slides and films. Patients are evaluated by a team member who obtains and reviews the patient’s history, conducts a physical examination, and secures any additional pertinent information, including documents, test results and studies.
This physician consults with breast imaging staff, pathologists, and any additional team members as necessary. If necessary, patients might be required to undergo additional breast imaging or other diagnostic procedures or schedule a subsequent visit pending results or greater multidisciplinary team member involvement. Additional support or nursing education is scheduled as needed. The physician may suggest presenting the case at the tumor board for appropriate interventions.
Appointments
Referring physicians or patients may call (800) KARMANOS (1-800-527-6266). Patients are asked to bring the following to their appointments:
- Mammogram films and reports (from three most recent years);
- Ultrasounds films and reports (from three most recent years), if applicable;
- Pathology reports and breast surgery(ies) slides – including biopsies;
- Cat scans/reports;
- Bone scans/reports;
- Current lab results;
- Chest X-ray films/reports;
- Any X-rays pertaining to recent diagnosis;
- MRI films/reports;
- Estrogen/progesterone/Her2-neu reports;
- Radiation/chemotherapy records; and
- Medication summary including over-the-counter medication, vitamins/herbs, and or alternative therapy(ies).
The Multidisciplinary Breast Cancer Program is located at the Barbara Ann Karmanos Cancer Institute’s Walt Center. Valet parking and ample security are provided.
