Cancer Awareness

Advances in Breast Cancer Care

by Leslie Cardé

WHEN ANGELINA JOLIE CHOSE to have a prophylactic double mastectomy in 2013, despite not being diagnosed with breast cancer, it left many wondering why. Jolie had learned she had a genetic mutation called BRCA, which put her at a heightened risk for breast cancer. Many more women since that time have opted to have the same procedure in order to ensure that breast cancer would not be a part of their future, and have chosen to have all breast tissue removed.

For patient Sarah Olivier, it would be a different genetic syndrome which put her at risk for a variety of cancers, including breast cancer. Because her aunt had breast cancer at the age of 43, Sarah began getting mammograms at the age of 35. With dense breast tissue, there were always questions as to whether the mammogram could be a definitive diagnosis, so radiologists would recommend an ultrasound and often an MRI, as well. Suspicious lesions would often involve biopsies in which small pieces of tissue were removed for analysis. Over the next 12 years, Olivier would have five biopsies because of suspicious radiology. Every time she waited for the results, it was agonizing.

“At that point, I decided to have genetic testing, which was done in December 2019,” remembers Olivier. “The genetic testing came back positive for Lynch syndrome, a rare condition that put me at a much greater risk for many cancers, including breast. I went to see my ob/gyn doctor, who referred me to breast surgeon Dr. John Colfry, who told me he had rarely seen a patient who had already had five biopsies, and that I was quite literally a walking time bomb.”

In this particular patient’s case, not only was there the genetic component, but her family history created an exponential problem. Not only was her aunt an issue, but Olivier’s own mother had been diagnosed years earlier with colon cancer---another Lynch syndrome cancer.

“Genetic testing has become much more sophisticated of late,” says Colfry. “Twenty years ago we tested for the BRCA 1 and 2 genes. These days there are nearly 40 gene mutations that we can find... among them Lynch syndrome. It’s not one of the common ones, and breast cancer is certainly on the spectrum, but not as strong as colon cancer. However, her strong family history along with that gene mutation caught my attention.”

Mastectomies, once upon a time, were disfiguring.

MILESTONE PHOTOGRAPHY MELANIE LANGTEAU photo:

Reconstructive techniques were not as sophisticated, and the old radical mastectomies included removal of underarm lymph nodes and chest muscles. Nowadays, only the tissue from the breast itself is taken, and the nipple and surrounding areola are spared whenever possible. The empty cavity is then filled with either tissue from the patient’s abdomen, or additionally from an inner thigh, depending upon how much tissue is needed and how much the patient has to spare. And, an implant is often tucked away in the fat layers, making it a hybrid or composite procedure. The scars are all hidden underneath the new breast.

“Trends have changed considerably to a much more natural type of reconstruction,” says Dr. Ravi Tandon, a fellowship trained microsurgical breast reconstruction specialist or artist. “Breast replacement surgery avoids the necessity of radiation, which is required with a lumpectomy which only removes the cancerous tissue. But, with this particular kind of reconstruction, to give the patient the most natural look, we must decide if indeed the patient has enough surplus abdominal tissue and much like in a cosmetic tummy tuck, we take the excess skin, and use it to fill the new breast. Breast cancer will not return to nonbreast tissue obtained from the abdomen, thigh, or lower back.”

Advances in implants have made them safer, which is of primary importance. For decades, breast enhancement, a cosmetic procedure, has used both saline and silicone implants. There were pros and cons to each. Silicone always looked more natural, but a rupture could spread silicone throughout the bloodstream. Saline was safer, but didn’t have the preferred cosmetic result. Newer implants have the best of both worlds.

“They are made of a highly cohesive silicone gel, as opposed to a liquid,” says Dr. Tandon. “The material stays together like a gummy bear, so if there is some sort of trauma to the breast, the material won’t travel anywhere. But, when considering whether to use an implant, the age of the patient should be considered. The life of an implant, statistically, is around 20 years, at which time it would need to be replaced, so it’s not always practical in very young patients, and should be discussed with each individual.”

Sadly, women are contracting breast cancer at increasingly younger ages. In general, it’s become more prevalent over the decades, but to see very young patients is startling, even for the medical breast experts.

“We see a massive younger population of late,” says Dr. Colfry. “It’s rampant, actually. It’s not unexpected to see women with cancer in their 50’s, 60’s or 70’s. But, we are now seeing lots of women in their 30’s, and we currently have a patient who is 21 years old, and just had a double mastectomy, because her chances of getting another cancer

Drs. John Colfry and Ravi Tandon.

were high.”

Statistics show that the percentage of breast cancers are indeed rising, although no one is sure exactly why. Speculation points to the environment, diet, and obesity, but nothing is certain. What is certain is that the risk of breast cancer used to be one out of 10 women. The current percentage rate is 12.3%, nearly one out of every eight women.

What Drs. Tandon and Colfry both know is that although the numbers may be going in the wrong direction, new technology has afforded both patients diagnosed with cancer and those who choose mastectomies as a preventive method, results that had never been possible just a short time ago. Many patients feel they look just as they did before their surgeries, or even better, considering that the by-product of the mastectomy is often a tummy tuck and a

Drs. John Colfry and Ravi Tandon with patient Sarah Olivier.

MILESTONE PHOTOGRAPHY MELANIE LANGTEAU photo:

breast lift.

“I had all the concerns you would expect when debating about prophylactically having my breasts removed,” remembers Olivier. “Since I hadn’t actually been diagnosed with cancer, I had lots of time to research the latest techniques and the best surgeons. I knew I wanted to look like I did before the surgery. I am 49 years old, and still wanted to wear the clothing I had been accustomed to without looking disfigured. And, I didn’t want the numbness that has long been associated with this surgery, so I looked for a reconstructive surgeon who would address all of my issues.”

“During a mastectomy, everything is removed, including nerves,” recounts Dr. Tandon. “Microsurgical techniques have improved markedly over the years. Six months ago, I wasn’t reconnecting nerves, but now I am. I connect from the nipple stump where there had previously been a nerve, find sensory nerves in the abdominal tissue and connect them together. Regeneration takes time. Nerves grow at a rate of about a millimeter a day. So, a breast takes about 18 months to get sensation back. The data coming out of Memorial Sloan-Kettering has shown encouraging results on this next frontier. We as reconstructive surgeons have primarily been concerned about what the new breasts will look like, and now it’s about what they feel like, as well.”

For Sarah Olivier, whose surgery included nerve grafts, it’s a wait and see game. But, so far, her surgery which took place seven months ago, looks promising.

“I was evaluated with the representative from Resensation, (a company that develops techniques for nerve regeneration),” explains Olivier. “I was put through a battery of tests to figure out where I had sensation and just how much. Since I was only a matter of months, postop, I was told I had a lot of sensation. I think people need to understand that this isn’t just about erotic sensation. Without feeling in your breasts, you can burn yourself and not know it because the area is numb. You can come out of your bathing suit, and not be aware of it. I considered this to be a very necessary and worthwhile procedure, and it only added about 30 minutes of operating room time to my surgery.”

For the team of Colfry and Tandon, who have worked together as a team for about six years now, their training is stellar by any measure. Dr. John Colfry is among a few elite breast surgical oncologists in our entire region. Following medical school at LSU in Shreveport, he completed general surgery training at Atlanta Medical Center, then specialized in surgical breast oncology at MD Anderson Cancer Center in Houston.

Dr. Ravi Tandon is one of a very few microsurgical fellowship-trained plastic and reconstructive surgeons in New Orleans. After medical school at Vanderbilt University and general surgery training at Tulane University, he specialized in plastic surgery at Albert Einstein College in New York City. He then completed a microsurgery fellowship at NYU, focusing on advanced microsurgical breast reconstruction techniques.

A breast cancer diagnosis can be frightening. Finding out you have a heightened susceptibility for breast cancer due to a genetic mutation can be equally so. However, the road can be much less bumpy in the hands of skilled, compassionate professionals.

“I am 100% relieved that I made the decision to have a preventive double mastectomy,” points out Olivier. “And, I couldn’t have asked for a better team, including all of the nurses involved. I got a notification recently, as I do every six months, that it was time to schedule another imaging of my breasts. I called them back and told them to take me off of their list.... permanently! Living without that looming anxiety any longer means absolutely everything.”

For more information, visit ravitandonmd.com or call Dr. Tandon’s office at 504-455-1000. Call Dr. Colfry’s office at (504) 325-2900, or visit his website at lcmchealth.org/ physician-directory/alfred-colfry-iii-md/.

Contact reporter Leslie Cardé at leslieinolamag@gmail.com.

Wherever your body produces melanin, you can have a freckle or a mole. Your eye is no exception! When a mole or freckle appears on your eye, the spot is called a nevus. Just like any dermatological concern, once you detect a nevus, you need to monitor the spot annually to make sure it does not develop into a type of cancer called ocular melanoma.

Dr. Lauren Agnew, OD, owner of Eye Wares, says a comprehensive eye exam creates a baseline to monitor possible signs of eye cancer. “If you have a nevus, don’t panic,” she says. “Think of your eye exam as something similar to a dermatological examination of a specific nevus. Only an eye doctor can discover a nevus in the back of your eye. Through a dilated exam or Optos photography we can compare each year’s photos that are automatically saved to your chart. It’s important to have baselines when we monitor potential signs of ocular melanoma.”

How to Spot Ocular Melanoma

According to the Kellogg Eye Center, 5-10% of the population have at least one nevus, a non-harmful mole located on the eye. Most nevi are not dangerous, but a small percentage can develop into ocular melanoma. This risk increases along with the size and location of the nevus. A nevus is not always visible unless you have a dilated exam

or Optos photography, which is why regular eye exams are so important, especially if you have a family history of skin cancer.

Your optometrist will either dilate or perform fundus photography (serial photographs taken of the interior of your eye) to detect and evaluate developing nevi. This is why, even if you have perfect vision, it is so important to schedule regular eye exams to monitor your vision as well as your eye health. And if the nevus is changing, it may be cancerous.

Treatment for Ocular Melanoma

Ocular melanoma is the most common variety of cancer in the adult eye. It can lead to dangerous and even fatal complications if not identified and treated immediately. Specifically, ocular melanomas metastasize very quickly to the liver but can spread to any organ in the body. One of the questions Dr. Agnew hears most often is, “Why can’t you just surgically remove a nevus?”

“You don’t surgically remove a nevus unless it becomes an ocular melanoma. You can surgically remove eye melanomas, but our goal is to identify the ocular melanoma immediately, so the patient still has the chance to treat the cancer with radiation or laser therapy,” she says. “Cutting out an eye melanoma can result in a black spot in your vision and is considered a last resort.”

The following are the most common treatments for ocular melanoma: • Radiation Therapy. A common treatment for eye melanoma, radiation therapy uses high-energy x-ray treatment to eliminate cancer cells. • Laser Therapy. Transpupillary thermotherapy is primarily used to treat very small melanomas. The treatment heats and kills the tumor directly using infrared light. • Surgery. Surgical removal of eye melanoma is typically considered necessary only when the eye has already been severely damaged by the tumor.

About Dr. Lauren Agnew

Dr. Agnew owns Eye Wares in Mandeville, Old Metairie, and Uptown, New Orleans (opening Fall 2021). She is a Louisiana native and a graduate of Tulane University. She completed her Doctor of Optometry degree at Southern College of Optometry and has been serving the Greater New Orleans community ever since.

Ocular Melanoma A Healthy Nevus

Eye Wares has over 20 years of experience providing the Greater New Orleans area with friendly, advanced eye care services and fashionable independent and designer frames. You can schedule your eye exam online at EyeWaresNola.com. Most major insurance accepted. To book your appointment with Eye Wares scan QR code below.

6001 Magazine Street, New Orleans • 504-571-5623 800 Metairie Road, Suite Q, Metairie • (504) 301-1726 3601 U.S. Hwy 190, Mandeville • (985) 624-3314

Thibodaux Regional Health System’s State-of-the-Art Cancer Institute

New Center to Provide Latest Innovations in Care and Clinical Services

MORE THAN 25 YEARS AGO Thibodaux Regional Health System made a strong commitment to provide the best cancer care possible to the people of the Bayou Region. That commitment continued when Thibodaux Regional broke ground on a new four story, 80,000-square-foot cancer care facility in 2019.

“The construction of the new Cancer Institute marks another milestone in the history of Thibodaux Regional and our cancer program,” says Greg Stock, Thibodaux Regional Health System CEO. “We are excited to open a premier facility that will continue to provide patients with high quality cancer care close to home.”

The new state-of-the-art Cancer Institute will accommodate the growth that Thibodaux Regional is experiencing as well as position the health system for the future of cancer care. Designed with the patient in mind, the Institute will feature an open design with lots of natural light and soothing decor that creates a warm and caring healing environment. The innovative and technologically advanced facility will include radiation therapy and chemotherapy infusion, medical and radiation oncology clinics, clinic space for visiting oncology specialists, an education center, an activity center, a library, a diagnostics center, a laboratory, an onsite pharmacy, a conference center and a chapel.

The Cancer Institute will also further integrate wellness services with the latest treatments, and is an important element in achieving Thibodaux Regional’s ongoing vision to improve the health and wellness of the region. Statistics show Louisiana as having one of the highest incidences and mortality rates in the country for breast, colorectal, prostate and lung cancers, which are the most prevalent in the bayou region.

“When a patient is diagnosed with cancer, we have a multidisciplinary team who works together to ensure every patient receives the best treatment possible,” continues Stock. “The new Cancer Institute will help foster greater collaboration and communication among physicians and care providers to enhance and save lives.”

Construction of the new Cancer Institute is currently on schedule and should be completed by early November. While the new facility is being built, patients continue to receive outstanding care in an adjacent building that was renovated to accommodate clinic and treatment areas.

Cancer AwarenessResources

Cancer is often a topic no one wants to discuss. Yet, it’s important to know who to call for prevention and treament. The below is a list of resources available to Greater New Orleans.

American Cancer Society

cancer.org One in three people will be diagnosed with cancer in their lifetime. If you’ve been recently diagnosed, or know someone who has, the American Cancer Society has answers, guidance, and support.

Aesthetic Surgical Associates

Stephen Eric Metzinger, M.D., M.S.P.H., F.A.C.S. 3717 Houma Blvd., Metairie 504-226-8200 Stephen Eric Metzinger, M.D., M.S.P.H., F.A.C.S. can use his experience and expertise to enhance your appearance with cosmetic plastic surgery, while our warm office atmosphere can make you feel at home.

Audubon Facial Plastic Surgery

Dr. Claire Melancon 6001 Magazine Street, Ste D 504-565-2779 audubonfacialplastics.com Facial plastic surgeon Dr. Claire Melancon offers a concierge, boutique New Orleans experience through holistic, patient-centered treatment plans that revitalize the face, body, and mind.

Eye Wares

Dr. Lauren Agnew, OD Mandeville, Metairie and (coming soon) Uptown 504-301-1726 eyewaresnola.com Dr. Lauren Agnew, OD, owner of Eye Wares, says a comprehensive eye exam creates a baseline to monitor possible signs of eye cancer. Call Eye Wares to schedule your exam today.

Family Dermatology Specialists, LLC

3421 N Causeway Blvd., Ste. 202, Metairie 504-832-6612 Family Dermatology is now offering the new SRT-100 Vision™, a high-frequency ultra-sound guidance system to non-invasively treat non melanoma skin cancers. Benefits include a 99% cure rate and no cutting, bleeding or scarring.

New Orleans Aesthetics

Dr. Zeena Al-Dujaili 3434 Prytania Street, Suite 420, New Orleans 504-475-1000 neworleansaesthetics.com New Orleans Aesthetics treats a variety of conditions from minor skin irritations to complex skin cancer surgery for patients of all ages.

The Skin Surgery Centre

Keith LeBlanc, Jr., M.D. Elizabeth Bucher, M.D. R. Corey Rougelot, M.D. 1615 Metairie Rd. #101, Metairie 504-644-4226 theskinsurgerycentre.com The Skin Surgery Centre specialize in providing toplevel surgical and cosmetic treatments for skin cancers and other skin issues that maximize the health and appearance of your skin.

Thibodaux Regional Medical Center

602 N. Acadia Rd., Thibodaux 985-447-5500 thibodaux.com At Thibodaux Regional, you are not a number – you are someone who will be treated with respect, cared for with compassion, and treated kindly.