ST. CLAIR HOSPITAL OPENS NEW BREAST CARE CENTER VOLUME IV ISSUE 4
HouseCall
Family Affair
Sisters Take On Breast Cancer
inside
Raye J. Budway, M.D. Helps Family Successfully Fight Breast Cancer I Ask The Doctor Features Of The New Breast Care Center I The Benefits Of Mammography I Genetic Link Breast Reconstruction Surgery I The Newly Expanded UPMC/St. Clair Hospital Cancer Center
PatIENt ProfIlE
Sisters, from left, Lori Hawthorne, Cindy Bartram and Linda Russell enjoy an after-work dinner at Papa J’s Ristorante on E. Main St. in Carnegie.
2 I HouseCall I Volume IV Issue 4
ASisters’ Story Siblings face battle against breast cancer together These women share Their experiences in hopes They may serve as a source of supporT To oThers whose lives have been affecTed by breasT cancer and as a reminder of The imporTance of mammography screening. Their sTories, like Those of Thousands of oTher breasT cancer survivors, are why sT. clair hospiTal’s new breasT care cenTer is helping raise awareness in The baTTle againsT breasT cancer.
E
legance. It’s a word that suggests sophisticated style and
publicly sharing their very private experiences, they can educate others.
refinement. It’s often used to describe icons like Grace
Their goal, say the sisters, is that women will read about them and will
Kelly or Audrey Hepburn. It’s not a word that is typically
not be afraid to be tested and treated for breast cancer.
associated with breast cancer. But to breast surgeon Raye J. Budway, M.D., director of the St. Clair Hospital
Breast Care Center, elegance is exactly the right word to describe her
In their response to their extraordinary circumstances, the Resnik sisters are indeed the epitome of elegance: graceful, dignified and classy. Lori Resnik Hawthorne, Cindy Resnik Bartram and Linda Resnik
patients, the Resnik sisters. The Resnik women— Lori, Cindy and
Russell all work in the greater Pittsburgh area and reside with their
Linda, and their late sister Dianna — are siblings in a family that has
respective families in nearby Weirton, W.Va. They are a trio who would
been impacted by breast cancer in a rare and almost unbelievable way.
command attention in any setting. Each sister is beautiful, vivacious
Lori, the oldest, recently had breast cancer surgery and is receiving
and engaging. They laugh and chat easily, glowing with a vitality that is
ongoing treatment; Cindy is a breast cancer survivor; Dianna died of
contagious. Their medical history is unique and fascinating, and their
breast cancer in 2001; and Linda is cancer-free but high-risk, and, in
personal stories are compelling and moving. With courage, candor and
September, had prophylactic bilateral mastectomy to prevent breast cancer.
great generosity, the sisters, along with Dr. Budway, have chosen to tell
Each of the sisters has had to confront breast cancer in a different
their story to honor National Breast Cancer Awareness Month, to pay
way and each one, individually, is an inspiration. Together, they are a
tribute to their sister Dianna, and to enlighten others about the critical
powerhouse: a formidable and unstoppable force, eloquent and honest,
importance of breast cancer screening and early detection, the keys to
deeply wounded but heart-strong. They are gentle warriors, fighting for
higher survival rates. Here are their stories.
each other, for their children and for all women, with the hope that, by Continued on page 4
Volume IV Issue 4 I HouseCall I 3
PatIENt ProfIlE Continued from page 3
“
I thought I was safe. I’ve always been In perfect health. I belIeved that I was the lucky one, that It had bypassed me …
”
BREAST CANCER PATIENT LORI HAWTHORNE
lorI —thE lEaDEr Lori Hawthorne, 49, is the oldest of the four sisters, who were born over a span of just seven years. Married to Blake, with one daughter, 17-year-old Erin, Lori has a busy and satisfying life. She works as a Legal Assistant for the Mt. Lebanon law firm of Riley, Hewitt, Witte and Romano. Like a typical oldest sibling, Lori is the spokesperson and organizer in the family. Lori is also the sister who has breast cancer right now. Her cancer was found by mammography in March of this year and, despite having two sisters with breast cancer, she was shocked by her diagnosis. That’s because Lori had been tested for the BRCA2 (breast cancer gene) mutation, the one that caused her sister Cindy’s cancer, and had tested negative. “I thought I was safe,” she explains. “I’ve always been in perfect health. I believed that I was the lucky one, that it had bypassed me, because I didn’t have the gene mutation that Cindy had. But I was tested for the other gene mutations and it turned out that I had a BRCA1 mutation.” According to Dr. Budway, this is almost unheard of. “Lori’s gene mutation may actually be spontaneous rather than inherited. To find two different gene mutations in a single family — it just doesn’t happen.” BRCA1 and 2 refer to genes that a woman inherits from either parent. When these genes contain an abnormality, or a mutation, the woman is at much higher risk of developing breast and ovarian cancer. Most of the time, women who develop breast cancer have no family history of it. But when there is a history, it may be that the BRCA1 or BRCA2 mutation has been passed from generation to generation. (Please
risk factors 1 in 8 women will be diagnosed with breast cancer in their lifetime. Most significant risk factors are getting older and a family history of breast cancer.
Lori Resnik Hawthorne
4 I HouseCall I Volume IV Issue 4
St. Clair Hospital Breast
see ‘It’s All In The Genes’, page 12.) In the Resnik family, breast
with whatever challenges life presents. That intrepid spirit has served
cancer has been present for at least three generations; a paternal
her well as she has coped with breast cancer for the past two years.
aunt and even their grandfather had breast cancer. “When Dianna was
Cindy was diagnosed shortly before Christmas 2010.
diagnosed, we thought it was an isolated case,” says Lori. “We didn’t
She was already in the care of Dr. Budway,
know our family history. Our story shows how important it is to talk to
having been referred to her by her
your older relatives and find out. My aunt made a ‘cancer tree’ from
gynecologist. “My OB/GYN felt that
our family tree and we were shocked to see how much cancer
I needed to be followed by a
there was.”
breast specialist, because my
Lori had bilateral mastectomy and breast reconstruction surgery
breast density and my
in April. Her cancer is the HER-2 positive type, which is a protein that
history — especially having
identifies the cancer susceptible to a targeted chemotherapy. She is
a sister who died of
receiving chemotherapy and the drug Herceptin. Despite this, she is
breast cancer — made
continuing to work full time. “The treatment is the harder part,” she
me high-risk. So I
says. “The surgery was not that bad. You don’t need to be afraid to
had been seeing
have a mastectomy. You can get a reconstruction, get the breast size
Dr. Budway for
you want, get your nipples reconstructed and even get areolas tattooed
several years,
on. The skin and muscles are stretched in a gradual process in which
and she was
saline is injected into the implants.”
sending me
Lori’s husband Blake has been her rock, supporting her through her surgery, recovery and continuing treatments, and attending every appointment with her.
every six months for Continued on page 7
CINDY—thE BEaCoN May 2012 was a busy month for 47-year-old Cindy Resnik Bartram, the second oldest sister. She is a mother of two — Justin, 20, and Kristen, 17 — with a demanding job as Office Supervisor for the regional headquarters of McDonald’s Corporation in Robinson Township. Early in that month, she was a beautiful and beaming bride, walking down the aisle with her groom, Gary. One week later, with her extended family, she participated in the Susan G. Komen Race for the Cure, a family tradition since Dianna’s diagnosis in 1999. For Cindy, all this activity is standard — she is a dynamo who simply forges ahead
“
we’re not anxIous people In my famIly and that comes from our parents. to us, strength means beIng realIstIc, practIcal and posItIve. Just deal wIth It — whatever It Is. we belIeve In makIng the best of It.
”
BREAST CANCER PATIENT CINDY RESNIK BARTRAM
Cindy Resnik Bartram
C a r e C e n t e r,
412 .942 .3177
Volume IV Issue 4 I HouseCall I 5
World-Class Cancer Care Close To Home
Capabilities Include: Intensity-Modulated Radiation Therapy (IMRT)
IMRT gives radiation oncologists the ability to more precisely “custom sculpt” the shape of a tumor, delivering the right amount of radiation with more accuracy and helping to preserve healthy tissue around the tumor. Image-Guided Radiation Therapy (IGRT)
B
reast cancer treatment, as well as other cancer care, has been enhanced at St. Clair Hospital with the recent addition of a state-of-the-art linear accelerator to the Hospital’s growing arsenal of advanced cancer-fighting weapons. The new accelerator is the second at the UPMC/ St. Clair Hospital Cancer Center and expands St. Clair’s capabilities and elevates the patient experience. An accelerator delivers high-energy X-rays to patients’ tumors with precision. The new accelerator was first used to treat cancer patients at the center in August. The center, located on St. Clair Hospital’s main campus in Mt. Lebanon, is a joint venture between St. Clair and UPMC CancerCenter, a partner with University of Pittsburgh Cancer Institute. The joint venture constructed a 1,885-square-foot addition to the existing 8,000-square-foot center to house the new multi-million dollar accelerator. Radiation oncologists at the center work with referring physicians and other cancer care specialists to deliver the latest therapy, close to home. The high-tech radiation delivery systems and imaging technologies available at the center are designed to help treat cancerous tumors while preserving healthy surrounding tissue.
St. Clair’s state-of-the-art linear accelerator.
IGRT uses two- and three-dimensional imaging during the course of radiation treatment to direct radiation therapy to the coordinates of the radiation treatment plan. Like IMRT, IGRT is designed to deliver radiation with precision and protect healthy surrounding tissue. On-Board Imager® (OBI)
This is an imaging technology used in conjunction with radiation delivery systems prior to treatment to ensure that a patient and the tumor are in the same place as originally planned. Respiratory Gating
During a radiation treatment, a patient’s tumor may change position due to the patient’s breathing cycle or other involuntary movements. In a respiratory gating treatment, a tracking device “watches” the tumor’s position and briefly shuts off the radiation treatment device when the tumor moves beyond a certain point. Rapid Arc®
This advanced equipment rotates 360 degrees around a patient’s body, providing radiation precisely sculpted to the tumor. RapidArc delivers treatment in two to three minutes, compared to other conventional treatments, which may take up to 30 minutes. Brachytherapy
Brachytherapy is the general name for a type of radiation treatment in which radioactive seeds, smaller than a grain of rice, are implanted inside or near the area requiring treatment. Radiation oncologists at the center use prostate seed implants — a low-dose rate brachytherapy — to shrink a tumor. Diagnostic Services
The center also offers the latest diagnostic services to improve tumor detection and localization, patient management, therapy planning and assessment of response to therapy. Services include onsite PET/CT (positron emission tomography/computed tomography) imaging services to assist radiologists in determining any abnormal cell activity and in pinpointing the location of cancerous tissue so a biopsy can be performed. To contact the UPMC/St. Clair Hospital Cancer Center regarding radiation treatment services, please call 412.502.3920 between 8 a.m. and 4:30 p.m. Monday through Friday. n ROBERT WERNER, M.D. Medical Director, UPMC/St. Clair Hospital Cancer Center; Radiation Oncologist Dr. Werner earned his medical degree at the University of Pennsylvania School of Medicine, Philadelphia, and an undergraduate degree at Cornell University, Ithaca, N.Y. He completed his residency at Memorial Sloan-Kettering Cancer Center, New York City. Dr. Werner is board-certified in radiation oncology. To contact Dr. Werner, please call 412.502.3920.
6 I HouseCall I Volume IV Issue 4
PatIENt ProfIlE Continued from page 5
alternating breast MRIs and mammograms. I didn’t let myself get worked up about it; it became a habit. And it paid off: thanks to Dr. Budway’s vigilance, we caught my breast cancer early.” Patients are often eager to get treatment initiated once they are diagnosed, says Dr. Budway. “We treat this like an emergency, getting them in for the initial consult right away. It’s essential to convey a sense of empathy at the first visit and to begin educating them immediately about how breast cancer happens and what the treatment options are. I also ‘open the door’ regarding chemotherapy and radiation, with basic information. I believe that education helps women make better choices, and they do have choices. Treatment can be individualized.” In January 2011, Cindy had bilateral mastectomy, performed by
“
both surgeons prepared me very well. dr. budway wrote out, by hand, fIve pages of explanatIons and drawIngs. she educated me In a personal way; she dIdn’t hand me a pre-wrItten brochure. she made sure I understood everythIng that was goIng to happen.
”
BREAST CANCER PATIENT CINDY RESNIK BARTRAM
Cindy has also undergone removal of her ovaries and is now in her
Dr. Budway, followed by immediate breast reconstruction, performed
second year of Tamoxifen treatment. She has experienced no side effects
by St. Clair Hospital plastic surgeon Robert W. Bragdon, M.D. Cindy
like hair loss or mood swings. “Cindy has estrogen-receptor positive
says she felt confident. “Both surgeons prepared me very well.
breast cancer, which means that her cancer is accelerated by the
Dr. Budway wrote out, by hand, five pages of explanations and drawings.
presence of estrogen,” Dr. Budway says. “She is being treated with
She educated me in a personal way; she didn’t hand me a
Tamoxifen for five years. She is doing great.
pre-written brochure. She made sure I understood everything that was going to happen. She gave me lots of time and made me feel like I was her only patient.” Cindy says that her husband Gary was beside her every step
“Among the sisters, Cindy is the beacon. After she was diagnosed, the others ‘fell into line.’ Her attitude has been incredible. She knew how high-risk she was and once she was diagnosed, she handled her situation with such grace. She has met every hurdle with strength and dignity.
of the way and has played a key role in her recovery.
Continued on page 9
tamoxifen Tamoxifen, an “anti-estrogen,” is the most commonly used hormone therapy for the treatment of breast cancer. Tamoxifen slows or stops the growth of cancer cells.
Lori and Cindy lean on each other for strength and support.
St. Clair Hospital Breast Care Center, 412 .942 .3177
Volume IV Issue 4 I HouseCall I 7
Early Detection
The Benefits of Mammography s
t. Clair Hospital’s new Breast Care Center provides a convenient location for women to receive comprehensive breast care services, including the most advanced diagnostic imaging technologies. “Our goal in opening this center is to bring the best technologies to St. Clair Hospital in order to offer women the highest quality breast care services,” says Sherri H. Chafin, M.D., a St. Clair diagnostic radiologist who specializes in breast imaging. “We have the most advanced imaging equipment, including digital 3D breast tomosynthesis, which is similar to a CT scan. Rather than taking a single picture, it captures several images in ‘slices’ of breast tissue. It helps eliminate callbacks for repeat studies due to shadows. We also offer breast MRI and ultrasound at the center.” The all-digital center enables women to have their mammograms completed in 30 minutes. Dr. Chafin hopes that such efficiency will make it easier for busy women to make time for this essential annual screening. “We understand that women want to get in and out, as quickly as possible. We’re trying to make it easier for them to take good care of themselves. We are able to give same-day results and if a more extensive work-up is necessary, we’re able to offer that right away.” Dr. Chafin emphasizes that women should continue to
Mammography will detect about 80 percent to 90 percent of breast cancers in women without symptoms in the U.S.
perform monthly self breast exams, in addition to getting mammograms. “I encourage this,” she says. “Women know their own bodies best and many women find their own breast cancer. But it doesn’t eliminate the need for mammograms; you need to use every tool.” Not all tumors can be palpated (felt) by a patient or physician, so the screening mammogram remains the most important tool for early detection. Dr. Chafin notes that some women might be confused by the U.S. Preventive Services Task Force recommendation that routine screening mammography for breast cancer was unnecessary for women under 50. According to Dr. Chafin, the data used in making that recommendation was flawed; both the American Cancer Society and the American College of Radiologists still recommend that the age to begin annual screening mammograms is 40. If there is a family history of breast cancer, then screening should begin 10 years before the age of diagnosis in the family member, but not before age 25. For patients who are reluctant to have mammograms due to fear of pain or radiation exposure, Dr. Chafin offers some advice: “Some women have more sensitive breasts. Compression of the breast is essential, though, to see the breast tissue. But patients can reduce discomfort by taking Advil, cutting back on caffeine, and scheduling mammograms post monthly periods. As for radiation, we must always weigh the risk versus the benefit. Most radiation doses that we receive are from natural sources referred to as background radiation. A mammogram is equal to two months of background radiation. Ultrasound and breast MRI do not use ionizing radiation and are especially useful tools in patients with dense breast tissue.” Financial assistance for screening mammograms is available from The Susan G. Komen Foundation’s Mammogram Voucher Program. If interested, please call 888.687.0505. ■
SHERRI H. CHAFIN, M.D. Dr. Chafin specializes in diagnostic radiology at St. Clair Hospital, where she is Vice Chair of Medical Imaging. She earned her medical degree at the Penn State Hershey Medical Center and completed her residency at Allegheny General Hospital, Pittsburgh. Dr. Chafin is board-certified by the American Board of Radiology. She practices with South Hills Radiology Associates.
8 I HouseCall I Volume IV Issue 4
PatIENt ProfIlE Continued from page 7
She’s one of the strongest women I’ve ever had the pleasure of treating.” Adds her sister Lori, “Cindy is tough and capable; she can do anything. She thinks nothing of public speaking before hundreds of people.” To Cindy, that strength comes naturally. “We’re not anxious people in my family and that comes from our parents. To us, strength means being realistic, practical and positive. Just deal with it — whatever it is. We believe in making the best of it.” Now, as Cindy watches Lori go through a breast cancer experience so like her own, she returns Lori’s
“
my breasts are not my IdentIty, but gIvIng them up Is stIll stressful. at my last mammogram and ultrasound … I crIed through the whole ordeal. It’s an emotIonal experIence for me.
”
BREAST CANCER PATIENT LINDA RESNIK RUSSELL
praise, citing her resilience. “Lori is one of the strongest people I know. She rolls with the punches and is bubbly and upbeat, no matter what.”
lINDa—thE gIvEr Linda Resnik Russell is “the lucky sister” — her BRCA testing revealed that she has none of the breast cancer gene mutations. “After Cindy was diagnosed,” Linda says, “I referred myself to Dr. Budway. We discussed my risk factors and were surprised when I scored higher than expected on the Breast Cancer Risk Assessment (Gail Model). Dr. Budway presented me with options. One was to go on Tamoxifen for five years. Another was to consider a surgical option — prophylactic (preventive) bilateral mastectomy, to prevent breast cancer, followed by breast reconstruction.” According to Dr. Budway, “Linda has breast changes that can eventually lead to breast cancer. In any other family, she would be offered Tamoxifen for risk reduction. But with this history, with three older sisters with breast cancer, prophylactic mastectomy was an important option.” Prophylactic surgery is a risk-reducing option in which almost all the breast tissue is removed. It can reduce risk by 90 percent to 97 percent and the younger a woman is at the time of the surgery, the greater the benefit. Still, it is not a simple decision for a young, healthy woman. “My breasts are not my identity,” Linda says, “but giving them up was still stressful. At my last mammogram and ultrasound, which took place two weeks after Lori was diagnosed, I cried through the whole ordeal. It’s an emotional experience for me.” Linda spoke to her mother, Sylvia Resnik, and Mrs. Resnik told her that this was a no-brainer. “Mom was right,” Linda says. “There was no better choice and my family agreed.” With two sisters who have had the same surgery, Linda had experts close at hand to guide her through it. Like Cindy and Lori, she had her surgery done by Drs. Budway and Bragdon at St. Clair. “I know how good their work is,” she said before the surgery. “I’ve seen my sister’s reconstructed breasts and they’re amazing.” Continued on page 10
Linda Resnik Russell
St. Clair Hospital Breast Care Center, 412 .942 .3177
Volume IV Issue 4 I HouseCall I 9
PatIENt ProfIlE Continued from page 9
Linda lives with her 18-year-old son, Jacob. She works as a Human Resources Specialist for ANH Refractories Company in
DIaNNa—thE INsPIratIoN In 1999, Dianna Resnik Orsini was a happy 33-year-old wife
Moon Township. At age 44, she is the baby of the family, but is as
and mother with a toddler named Sean and a new baby on the way.
strong as her sisters and is described by them as a woman with a
She and husband Tony were building their family and looking
heart that doesn’t stop giving. “We tease her about being spoiled,
forward to life together. But early in her pregnancy, she was diag-
but Linda was so helpful to me after my surgery,” Cindy says.
nosed with breast cancer — a shock for her entire family. She had
“I couldn’t lift my arms post-op and she helped me with everything,
a lumpectomy, followed by chemotherapy during the pregnancy
doing things I never even asked of her. Now, she’s doing the same
and, later, radiation. Despite significant risks, Dianna and Tony
for Lori.”
continued the pregnancy, relying on their solid faith that the baby
The role of caregiver is a familiar one for Linda, whose husband had a brain tumor, a glioblastoma, in 2008. When Dianna was
would be okay. She was: Dianna gave birth to a full-term, healthy girl and they named her Faith.
diagnosed, Linda lived next door, so she was available to help in
But Dianna was not okay. The hormones of pregnancy had
any way she could. She was especially close to Dianna; they grew
accelerated the growth of the cancer and it spread throughout her
up sharing a room and had many of the same friends. “I know that
body. When she became very ill, her mother asked Tony to move
the role of caregiver is tough, so I wanted to help my mother and
with Dianna and the children into her home, so she could care for
brother-in-law when Dianna was sick. I was around for a lot of it,
her daughter. “It was a homecoming for Dianna,” recalls Lori.
and sometimes I felt so helpless. A loss like this wakes you up;
“We all helped, taking care of her and her babies.” But in June 2001,
you understand that life is short and fragile.”
The Resnik women in 2000 during the Race for the Cure. From left, Lori, Dianna, Sylvia, Cindy and Linda.
10 I HouseCall I Volume IV Issue 4
St. Clair Hospital Breast
Dianna lost her battle. Linda says that her death made the sisters even closer. “We talk almost every day, about everything, and get together often. My sisters are my favorite people.” Every Mother’s Day, the family gathers for the Race for the Cure in
“
It’s a sImple message: you have to get mammograms. no excuses. there are ways to get free mammograms If necessary. early detectIon can save lIves.
”
Pittsburgh, followed by lunch at the Green Tree Olive Garden. On their t-shirts, they wear signs that say, “In Memory of Dianna Orsini.” More
SYLVIA RESNIK, MOTHER OF BREAST CANCER PATIENTS
recently, they added “In Honor of Lori and Cindy” to those signs. Lori, Cindy and Linda speak of their sister often; to them, Dianna remains a constant presence and they have remained close to Tony and the
“My girls give me and my late husband, Larry, credit for their
children. “Dianna means so much to us. She never complained, never
strength but it’s not me, it’s them. They have such a positive attitude.
asked, ‘Why me?’ Not even once,” says Cindy. “She was young, she
They never ask, ‘Why me?’ but I do. Why them? Why three of my
had a toddler, she was pregnant — but there was no self pity. She
daughters? I’m 71, why can’t it be me? And Linda, having the courage
gave us a great example. Dianna is our inspiration.”
to have her breasts removed. It’s the right choice, but it’s still hard. Dianna was so young; she had two little children. It’s horrible to watch
sYlvIa—thE MatrIarCh The sisters grew up in the rural hills surrounding Weirton, next to the farm that has been in their mother’s family since the 1870s. It was an idyllic childhood in a beautiful setting, in a family with a strong work ethic. The girls were expected to help out, baling hay, planting gardens and mowing the grass. The isolation of farm life was not a problem; the sisters
your child go through that. I wanted to take care of her, and Tony worried that it would be too hard on me. But it was my honor. Dianna was wonderful, wonderful, just like her sisters.” Mrs. Resnik supports her daughters’ decision to share their story. “It’s a simple message: you have to get mammograms. No excuses. There are ways to get free mammograms if necessary. Early detection can save lives.”
had each other as playmates. Church was an essential aspect of their lives, and they still attend the Pleasant Valley United Methodist Church, a country church
Dr. raYE BuDWaY— “thE fIfth sIstEr” “This family is unusual,” says Dr. Budway. “They are unique as a medical case and exceptional in their attitude. Cindy, once she was diagnosed, was amazing in how she came through all her hurdles.
with a small congregation.
She and her sisters have a graceful presence that they bring to dealing
That church remains a
with this disease. They make smart decisions, not emotional decisions.
source of support for Sylvia
They’re generous in their desire to educate others. They’re full of life,
Resnik, matriarch of the Resnik clan. Healthy and active at 71, she has watched her children endure daunting trials with
a testament to how successful breast cancer treatment can be. No matter how bad you think it might be, breast cancer is both treatable and survivable. Who better than these three women
breast cancer. She could not be more
to carry that message to the
proud of them.
women of this region?” Continued on page 12
Prevention Can breast cancer be prevented? There is no definitive way to prevent breast cancer. Eating a healthful diet and being physically active might help reduce the risk.
The matriarch, Sylvia Resnik
C a r e C e n t e r,
412 .942 .3177
Volume IV Issue 4 I HouseCall I 11
PatIENt ProfIlE Continued from page 11
Lori, Cindy and Linda like to refer to Dr. Budway as “the fifth sister” and are grateful to her for her skillful care and compassion. “Dr. Budway is like family to us,” says Lori. “We love her. She’s honest, positive and open; you can talk to her. Even her staff treats us like family.” Dr. Budway is a Pittsburgh native and a medical school graduate of Hahnemann University in Philadelphia. As a breast care specialist, she directs St. Clair’s Breast Care Center, which offers women a range of advanced diagnostic, treatment and support services. Dr. Budway says that the incidence of breast cancer has
“
no matter how bad you thInk It mIght be, breast cancer Is both treatable and survIvable. who better than these three women to carry that message to thIs regIon?
”
DR. RAYE J. BUDWAY, DIRECTOR, ST. CLAIR HOSPITAL’S BREAST CARE CENTER
stabilized: “Breast cancer peaked in the early 2000s with 225,000 cases per year nationwide, but now it’s down to 200,000. This is due to our understanding of the impact of estrogen replacement therapy on breast health. At St. Clair, we get excellent outcomes. We believe that survivorship has multiple dimensions and we
Beating the odds
offer women many resources.” Dr. Budway is an emphatic advocate of education. “The more you know, the better off you are. Women need to educate themselves about screening, including breast self exam and mammogram. Early detection and diagnosis makes an impact, increasing the odds of survival.”
There are 2.9 million breast cancer survivors in the U.S. today — the largest group of all cancer survivors.
Like the Resnik family and thousands of others, Dr. Budway participates in the Komen Race for the Cure every year. For her, it’s a day of intense and conflicting emotions. “The worst feeling for me is to see the name of one of my patients on the back of a t-shirt, below the words “In Memory Of” — I can’t even explain how that feels,” she says. “But the best feeling, 100 times better, is to see a patient who is alive, thriving and healthy. That is the absolute best feeling in the world.” ■
RAYE J. BUDWAY, M.D. Dr. Budway earned her medical degree at Hahnemann University in Philadelphia. She completed her residency training in general surgery at The Western Pennsylvania Hospital and a fellowship in surgical critical care at The University of Pittsburgh Medical Center. She served as the Site Surgical Clerkship Program Director for Temple University School of Medicine, Site Program Director for the Allegheny General Hospital General Surgery Residency Program, and Director of the Surgical Breast Disease Program and Surgical Intensive Care at West Penn Hospital. She is board-certified in surgical critical care and general surgery. She is a Fellow of the American College of Surgeons and serves on the Fellowship’s Commission on Cancer. To contact Dr. Budway, please call 412.942.5600.
12 I HouseCall I Volume IV Issue 4
It’s all In
tHE GEnEs D
NA in the human genome is arranged into 24 distinct entities called chromosomes, which are large molecules
that physically resemble convoluted spiral staircases.
Each chromosome contains many genes, which are the basic physical and functional units of heredity. “Base pairs” of molecules constitute each step of the spiral staircase. Genes are
specific sequences of base pairs that encode instructions to make proteins; the proteins in the cells perform most life functions and even make up the bulk of cellular structures. Proteins are large, complex molecules composed of amino acids; chemical properties that distinguish the 20 different amino acids cause the protein chains to form structures that define their particular functions in the cell. Cancer develops when abnormalities called mutations occur
The BRCA1 and BRCA2 genes have been associated with hereditary forms of breast and ovarian cancer.
in specific genes, resulting in uncontrolled cell growth that eventually forms a tumor. These mutations can be acquired over
prostate cancer in the younger population. BRCA2 mutation
one’s lifetime, or they can be inherited. The BRCA1 and BRCA2
carriers have a higher risk of melanoma.”
are two genes that have been associated with hereditary forms of
Genetic testing, on a blood sample, is available to check for the
breast and ovarian cancer. Everyone has these genes. BRCA1 and
presence of BRCA1 and BRCA2 mutations. Dr. Budway recommends
BRCA2 are believed to be tumor suppressor genes, meaning that
genetic counseling to explain the results and their implications for
when they are functioning normally, they code for proteins that
breast cancer screening and preventive treatment options. In families
suppress the growth of cancerous cells. Women who have certain mutations along these genes, however, have an elevated lifetime risk of developing breast and ovarian cancer because their ability to suppress cancerous growth has been reduced. A woman with a BRCA mutation faces a 36 percent to 85 percent chance of contracting breast cancer and a 16 percent to 60 percent chance of ovarian cancer. BRCA mutations are also linked to breast and prostate cancer in men. “Abnormalities in each gene lead to differing clinical manifestations,” explains Raye J. Budway, M.D., director of St. Clair Hospital’s Breast Care Center. “For example, families with BRCA1 mutations have not only the increased risk of breast and ovarian cancer, but also a risk of pancreatic cancer that is more than twice the normal risk in both men and women. Women with BRCA1 have a slightly higher risk of other cancers in the abdominal cavity such as colon, stomach and fallopian tube cancer. Men have an increased risk of
with a history of breast or ovarian cancer, it is helpful to first test a member who has either of those cancers; if that person has BRCA1 or BRCA2 mutation, then other members should be tested to see if they, too, have the mutation. Women who have a relative with a BRCA1 or BRCA2 mutation and women who appear to be at increased risk of breast and/or ovarian cancer because of family history should consider genetic counseling to learn more about their potential risks and testing. A positive result means that the person has inherited a gene mutation and is therefore at increased risk of developing breast or ovarian cancer, but it does not predict that they will have cancer. Both men and women who inherit harmful BRCA1 or BRCA2 mutations, whether they develop cancer themselves or not, may pass the mutations on to their children. Genetic testing and counseling can remove uncertainty and enable people to make informed decisions about reducing their cancer risk. ■
Volume IV Issue 4 I HouseCall I 13
Breast Reconstruction Surgery u
st. ClaIr hosPItal’s Dr. roBErt BragDoN lEaDs thE fIElD
ntil recently, women who had mastectomies had no choice but to wear prosthetic breasts tucked into their bras to simulate natural breasts. They were often awkward and uncomfortable, and there was constant risk of them migrating or even falling out. Fortunately, that has changed, thanks to advancements in technology and plastic surgery, and women who have mastectomies now have many post-operative options, including several types of breast reconstruction, a plastic surgery procedure that rebuilds the breast mound to replace the one that has been removed. St. Clair Hospital’s Robert W. Bragdon, M.D., one of the Pittsburgh region’s leading breast reconstruction surgeons, believes that the procedure offers women both physical and psychological benefits. “Breast reconstruction is a wonderful thing,” he states. “It can reduce the trauma of the breast cancer experience by restoring wholeness and contour to a woman’s body. That’s important, emotionally and psychologically.” About half of women who have mastectomies will have some form of breast reconstruction. “We can do implants or autologous tissue reconstruction, using the patients’ own tissue,” Dr. Bragdon explains. “Often, this is a TRAM (transverse rectus abdominis muscle) flap, which uses tissue from the abdomen to create and shape a breast mound. Some women will opt for additional surgery later, to create nipples.” Abdominal tissue is preferred because it feels like breast tissue; patients also get the bonus of a “tummy tuck.” The newly constructed breast will look and feel natural, although it may lack sensation.
Post-surgery options About half of women who have mastectomies will have some form of breast reconstruction, often using the patients’ own tissue.
Breast implant surgery involves placing a device called a tissue expander under the chest muscle and injecting saline into it at intervals to gradually “inflate” the breast, until it has expanded to the desired size. Both implant surgery and the TRAM flap can be done immediately following mastectomy, or at a later date. Dr. Bragdon is a board-certified plastic surgeon and a pioneer in breast reconstruction surgery who performed the first TRAM flap procedure in Pittsburgh. He performs up to 150 breast reconstruction surgeries every year.
“
much of my motIvatIon stems from my experIence wIth my mother. the opportunIty to have breast reconstructIon dId not exIst when she was dIagnosed. I’m grateful that I’m able to gIve thIs opportunIty to women.
”
ROBERT W. BRAGDON, M.D.
He is committed to helping women with breast cancer, and that commitment has a deeply personal element. Dr. Bragdon witnessed his own mother’s ordeal with breast cancer, which took her life. “Much of my motivation stems from my experience with my mother,” he says. “The opportunity to have breast reconstruction did not exist when she was diagnosed. I’m grateful that I’m able to give this opportunity to women. They can return to a normal lifestyle, able to wear clothing without worrying about if it hangs right or if the prosthesis might dislodge. They can go swimming and play sports. They feel better about themselves. Breast reconstruction restores a woman’s image, giving her confidence in her fight against breast cancer.” ■
ROBERT W. BRAGDON, M.D. Dr. Bragdon specializes in plastic and reconstructive surgery at St. Clair Hospital, where he is Chief of Plastic Surgery. He earned his medical degree at the University of Pittsburgh School of Medicine and completed his surgical residency training at its affiliated hospitals. Dr. Bragdon completed his plastic surgical residency training at The Western Pennsylvania Hospital. He also completed a burn fellowship at West Penn Hospital and was the first fellow in plastic surgery at Dartmouth. He is board-certified by the American Board of Plastic Surgery. He practices with Plastic Surgical Associates of Pittsburgh. To contact Dr. Bragdon, please call 412.572.6164. 14 I HouseCall I Volume IV Issue 4
asK thE DoCtor
Ask the Doctor Q A
BruCE A. WrIGHT, M.D.
my wife has just been diagnosed with breast cancer. what can i do to help her get through this incredible challenge?
A diagnosis of breast cancer is devastating to any woman — and also to those who love her, particularly her life partner. Men are often accustomed to taking an active and lead role in defending and protecting their wives, in alleviating fears, and in trying to make things right. Breast cancer, however, challenges everything, including interpersonal relationships. While a husband’s first reaction may be to try take control of his wife’s treatment and recovery, the best thing he can do for his wife is to first ask what she needs from him, allow her to consider this, and listen attentively to her replies. Not once, but often. Be observant also of nonverbal cues to her needs. Women fighting breast cancer experience strong, numerous, and varying emotions. Her husband’s mission is to support her, not to solve all problems. His tactic of being her champion in this life challenge is to be her strongest supporter in some gentler, but yet very powerful, ways. Most importantly, he must be an empathic listener. This is not the time to try to multitask, to text, write a report, or catch the latest sports scores while conversing with your wife. Empathic listening is being completely there for your wife, carving out time to give only to her. Meeting her needs in the present, whether that’s an ear to listen, a shoulder to cry on, a hand to hold, someone to accompany her to doctors’ appointments, or someone to help her take a break from thinking about cancer. While helping her to navigate unfamiliar, changing, and rough seas, he must remember that she is the
captain of this ship. She’s lost control in a profound, terrifying, and intimate way. Helping her to meet her challenges on her terms and to retain, and where possible regain, a sense of control will be one of the most loving things he can do for her. You can best care for her if you’re also meeting your own needs and keeping yourself strong and healthy. It’s important to be strong enough to ask for professional help if you need it for yourself, your wife, or the two of you together to chart your way and stay afloat. There are many resources available, including support groups sponsored by St. Clair Hospital. The Breast Cancer Support Group meets 7 to 9 p.m. on the third Tuesday of the month. A Cancer Support Group meets 7 to 9 p.m. the second and fourth Thursday of the month. And a program called “Look Good … Feel Better,” which is designed for women in cancer treatment who are dealing with side effects to their appearance, meets 10 a.m. to noon the first Monday of every other month. All of the support groups are conducted at the Hospital and are free. For more information, please visit www.stclair.org. ■
BRUCE A. WRIGHT, M.D. Dr. Wright is chair of the Department of Psychiatry at St. Clair Hospital. He earned his medical degree at the University of Pittsburgh School of Medicine and completed his internship and residency at the University of Pittsburgh Medical Center. Dr. Wright is board-certified by the American Board of Psychiatry & Neurology. He practices with Associates in Clinical Psychiatry, PC in the South Hills. To contact Dr. Wright, please call 412.347. 0170.
Volume IV Issue 4 I HouseCall I 15
St.Clair Hospital 1000 Bower Hill Road Pittsburgh, PA 15243 www.stclair.org
General & Patient Information 412.942.4000
HouseCall
Physician Referral Service 412.942.6560
Outpatient Center–Village Square 412.942.7100
is a publication of St. Clair Hospital. Articles are for informational purposes and are not intended to serve as medical advice. Please consult your personal physician.
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a space with a higher level of comfort and aesthetics than what is typically found in medical settings. To achieve that, Greene and her team utilized soft colors in light blue, green and silver, with a luminous touch, giving the center an elegant, feminine appeal. “There is a sparkle to the finishes in the waiting areas,” she explains. “The
NEW BrEast CarE CENtEr Is DEsIgNED for
lighting contains crystals and the wall
Comfort and Privacy
coverings have a shimmer to them. There also is a water feature, which provides a therapeutic effect.” The physicians and other caregivers
Patients will appreciate the presence of two
at the center describe it as a place where
in women’s health care with the recent
waiting rooms: a public reception area, and
women are treated with great care and
opening of its new, state-of-the-art Breast
a second private waiting room near the testing
compassion. “The goal in the design of the
Care Center in Bethel Park. Designed with
area. There are private dressing rooms,
new center was comfort and privacy,” says
a spa-like ambience, the center offers the most
including two that are attached directly to
Sherri H. Chafin, M.D., a St. Clair diagnostic
advanced diagnostic imaging technology
a mammography room. Even the acoustics
radiologist who specializes in breast imaging
in an environment of comfort, convenience
were addressed, with soundproofing on
and was instrumental in the center’s design.
and beauty.
doors to assure confidentiality of conversations
“In working with the architect, I believe
St. Clair Hospital launched a new era
with doctors or technicians. Architect Tami
we have created an environment which
St. Clair Hospital Outpatient Center–Village
Greene, AIA, of IKM, Inc. in Pittsburgh,
emulates the warmth and caring of our staff.”
Square, the center is a 6,000-square-foot
says that privacy was a major consideration
suite that is configured to maximize patient
in planning the space. “Women will be able
rooms; two ultrasound rooms; three
privacy and facilitate efficiency.
to circulate through the suite without ever
examination rooms; two mammography
entering a public area. This is important
reading rooms; three offices; and four
Located on the Third Floor of the
The center features three mammography
when you are wearing an examination gown
consulting rooms. (Please see ‘The Benefits
in a clinical setting.”
of Mammography’, page 8.) All mammography
That level of attention to the personal
rooms and restrooms are ADA compliant
experience of the patient is evident
and the doorways and halls are wide
throughout the center. Because having a
enough to accommodate wheelchairs.
mammogram is an emotional and often
There is free parking, plus free valet parking
stressful event for women, the center offers
for center clients. ■
St. Clair Hospital Outpatient Center–Village Square in Bethel Park, home to the Hospital’s new Breast Care Center.