For One Woman, When it Comes to Mammograms, There is No ...

NWomen
E s s E n t i a l H E a l t H i n f o r m a t i o n f o r t o d a y ’ s W o m a n
W A S H I N G T O N
H O S P I TA L
C E N T E R C E N T E R E D O
INSIDE
BATTLING
BREAST CANCER: A
TEAM APPROACH
SUN PROTECTION
4-1-1
DR. ABBIE FIELDS:
MERGING SCIENCE
WITH WARMTH
Patrice Wimbush
For One Woman, When it Comes to
Mammograms, There is No Controversy
Last November, the United
States Preventative Services
Task Force recommended that
women without risk factors
for breast cancer should delay getting
mammograms until age 50 instead of
the current age of 40. They also
recommended that women younger
than 75 have the test every other year
instead of annually, and that physicians
stop teaching breast self-examination.
The recommendations went against
those of key organizations involved in
the diagnosis and treatment of breast
cancer, including the American Cancer
Society, the National Cancer Institute,
the American Medical Association and
the American College of Radiology,
and the experts at the Center for Breast
Health, Washington Cancer Institute at
Washington Hospital Center.
The recommendations set off a
firestorm of controversy, but
to Patrice Wimbush, a
Prince Georges County
mother who was
diagnosed with stage 1
breast cancer last
November, there is no
controversy at all: her annual
mammograms saved her life.
“I knew the
importance of
mammograms,
and had gone
faithfully every
year since I
was 40,”
says Patrice.
Luckily, the
45-year-old
medical
assistant also knew that the radiologist
reading the test should have the images
from previous mammograms. Since
she was visiting a new mammography
center, Patrice took her films with her.
This is important, because according
to breast imaging specialist Brooke
Wolvin, MD, Director of Breast MRI
at Washington Hospital Center,
comparison is a critical component of
mammography. “When we compare
mammograms from year-to-year, we
can pick up on subtle changes. These
changes tell us when we need to take a
closer look, possibly get additional
images, an ultrasound or an MRI,”
she says. “Technology allows us to
discover breast cancer before it is
symptomatic—long before a tumor
can be felt.”
Patrice’s journey with breast cancer
began when she received a “callback”
letter following her mammogram.
Callbacks occur in about ten percent
of mammograms in the United States,
according to the American Cancer
Society, and rarely result in a cancer
diagnosis. Patrice knew that, and
wasn’t terribly alarmed. “I have dense
breasts, as does my family, so I just
expected the second studies to rule
out cancer.”
After Patrice’s follow-up mammogram,
the wait in the office that day took a bit
too long, and soon she found herself
sitting in the radiologist’s office
looking at her five annual mammograms
side-by-side. The changes were
subtle, but her radiologist’s gut told
her there might be something there.
Her gut was right. Patrice had cancer
in her right breast.
Since Patrice’s cancer was caught so
early, her prognosis was—and
remains—excellent. In fact, her tumor
was so small that during the biopsy, a
tiny metal pin had to be inserted near
the tumor so the surgeon could find it
using radiologic guidance in the
operating room. The size and stage of
the tumor also allowed Patrice to have
a lumpectomy followed by radiation
instead of a mastectomy because it had
not spread. “We see it over and over
again—early detection through
mammograms saves lives,” says her
oncologist, Nitin Verma, MD.
Today, Patrice still has both of her
breasts, minus a tumor, and will start
radiation treatments soon. Her
outlook on life has never been better.
From the beginning, the experts at
the Hospital Center’s breast cancer
program encouraged her, stepped her
through the process, and were in sync
with each other throughout her
treatment. This is an advantage of an
accredited breast center, with every
specialty in the diagnosis and treatment
of breast cancer, under one roof.
And even with the new recommendations
to delay mammograms, which
are attributed to the stress of callbacks
and the expense of the tests against
the low rate of breast cancer in
women younger than 50, nothing has
changed in the medical community:
government and private insurance
companies still pay for the tests in
women older than forty and in
younger women when indicated—
and doctors still request them—
something the experts at the Hospital
Center say will save lives. ❋
For a free breast health kit or an
appointment for a mammogram,
call 202-877-DOCS.
www.whcenter.org

A N E W V I E W O N
Breast Cancer
Recent progress in the treatment of
breast cancer offers new hope to the
nearly 200 thousand women
diagnosed each year. Scientists know
more about the makeup of tumors
than ever before, allowing them to
develop medicines that target specific
types of tumors. Perhaps the most
significant advance was the advent of
such a treatment—Herceptin. ®
According to Sandra Swain, MD,
medical director of Washington Cancer
Institute, Washington Hospital Center,
“Herceptin is the biggest advance in
the systemic treatment of HER2
positive breast cancer we have had.”
Since the Food and Drug Administration
approved Herceptin in 1998, the
drug has markedly impacted the
survival and recurrence rates associated
with HER2 positive breast cancer.
HER2 positive breast tumors have
too much of a protein found in the
body that causes cells to grow and
divide. HER2 positive breast cancer is
known to spread rapidly and come
back more frequently than its HER2
negative form. About twenty percent
of breast tumors are HER2 positive.
Herceptin is not chemotherapy;
rather, it is an antibody that attacks
the HER2 protein. When given in
combination with chemotherapy, it
reduces the recurrence of these
tumors by 50 percent.
“Before, patients with HER2 positive
breast cancer did very poorly,” adds
Dr. Swain. “Herceptin has saved a lot
of lives, and has essentially changed
the way medical professionals view
HER2 positive breast cancer.”
“Herceptin has saved
a lot of lives…”
— S A N D R A S WA I N , M D
Battling Breast Cancer
Takes a Team of Warriors
Hospital Center Offers the Full Range of Services Under One Roof
a
ccording to the National
Cancer Institute, one in
nine women under the age
of 85 will develop breast cancer
during her lifetime.
But there is good news, according to
Sandra Swain, MD, medical director
of Washington Cancer Institute at
Washington Hospital Center.
“Advances in treatment have
improved survival of all types of
breast cancer during the last several
years. And, many of these therapies
allow women to maintain a better
quality of life during their treatment.
That can include continuing to work
and care for their families,” she says.
“Chemotherapy treatments are much
better tolerated than in the past. I have
patients receiving chemotherapy,
and you wouldn’t know.”
She adds that “with the advent of the
Oncotype DX® test, we can determine
the genetic makeup of a tumor,
whether it will respond to chemotherapy,
and how likely the cancer is
to come back. This allows many
women to avoid
the rigors of
chemotherapy
altogether without
risking longterm
survival.”
And, the Hospital
Center offers
access to a wide array of proven
clinical trials, including one that can
shorten a woman’s course of radiation
therapy from six weeks to five
days. So where should a woman with
breast cancer turn? Most are referred
to a breast surgeon, who removes
the tumor and connects her to other
professionals for adjuvant—or
follow-up—treatment, such as
radiation, chemotherapy, hormone
or biologic therapies. However, while
the surgeon is the first provider in
the continuum of breast cancer care,
breast surgeon Marc Boisvert, MD,
medical director of the hospital’s
Center for Breast Health, recommends
seeking out an accredited
breast center as a first step.
“The treatment of breast cancer is
interdisciplinary, and should be that
way from the start,” he says. The
Hospital Center’s breast cancer
program is accredited by the
National Accreditation Program for
Breast Centers (NAPBC), which
requires programs to demonstrate
outstanding quality and encompass
the full range of diagnostic and
treatment options. Accredited
programs also participate in clinical
trials and offer extensive psycho-
The ability to understand the whole picture is a
big advantage of seeking care from a comprehensive
breast cancer program.
social, spiritual, family and qualityof-life
services, as well as cancer
genetics services. And at the Hospital
Center, all of this is available on the
Cancer Institute’s campus.
At the Hospital Center, new breast
cancer patients are connected to the
multidisciplinary team from the
start, where they meet individually
with each discipline to learn about
the process and discuss treatment
options. Then, the team gathers to
discuss the case, recommending
an individualized treatment plan.
This is called an interdisciplinary
approach, and ensures that every
decision made incorporates the
full range of services of the cancer
program, all revolving around the
patient’s needs.
Marc Boisvert, MD and a breast
cancer patient
Generally, the first priority in breast
cancer care is the removal of the
tumor. For early stage tumors, the
Center for Breast Health suggests
lumpectomy with radiation to most
patients. According to plastic surgeon
Rafael Convit, MD, “for early stage
tumors, there is no difference in 15
year survival with this approach.”
He works with the breast surgeon
from the beginning, planning the
incision to allow for the best cosmetic
result. Once the tumor and surrounding
tissue
are removed,
Dr. Convit
follows, using
the remaining
tissue to reshape
the breast.
Following
radiation, which can create slight
deformities in the tissue, fat from
other areas of the body can be
injected to make final adjustments.
“With lumpectomy, a woman can
keep her own breast, with its natural
feel and sensation—it’s better that
way,” he says. Mastectomy may be
necessary in certain cases. If so, stateof-the-art
reconstruction services
are available.
The ability to understand the whole
picture is a big advantage of seeking
care from a comprehensive breast
cancer program. “When patients
come in with a new diagnosis, they
are caught up in the moment of
‘I’m dying of breast cancer,’ and
immediately want their breasts
removed. Once they meet with the
C O N T I N U E D O N PA G E 4

Sun Protection 4-1-1
Controlling Sun Exposure Critical, Regardless of Skin Color
a
h, spring has sprung! And
with warm weather upon
us, now is a good time to
remember that sun protection is
essential, regardless of skin color or
type. The incidence of melanoma—
the most serious form of skin
cancer—has increased markedly
across the population over the last
two decades, and experts attribute
the increase to damage from ultraviolet
(UV) rays. Whether people
are intentionally seeking a tan or
they are merely getting incidental
UV exposure from outdoor jobs or
activities, sun protection is essential.
According to skin cancer expert
Suraj Venna, MD, “there is no such
thing as a safe tan, as any amount of
ultraviolet is damaging. And,
although the risk of melanoma is
lower for people of color, they still
need to avoid sun damage.”
Given the abundance of sun-care
products on the market today, it
should be fairly easy for someone to
find a product that gives them
adequate sun protection and fits
their lifestyle. But sometimes, having
too many choices can be mindboggling.
Dr. Venna, director of
the Melanoma Center, Washington
Cancer Institute at Washington
Hospital Center, helps unravel the
mysteries of sun protection with
useful information and a few tips:
There are two types of sunscreen:
physical and chemical.
Physical sunscreens contain
either the ingredients zinc or
titanium. They essentially
provide an “opaque
umbrella” over the DNA
of the skin’s cells, which,
when damaged, is where
skin cancer begins. Physical
sunscreens reflect and
scatter harmful ultraviolet
(UV) rays away from the
skin, effectively blocking
the sun. Physical sunscreens
have several benefits: they
are less likely to irritate the skin,
tend to be more waterproof,
are effective immediately upon
application and are easier to
ensure complete coverage when
applied because they are neither
clear nor absorbed. UV rated
protective clothing also provides
an effective physical barrier
from the sun.
Chemical sunscreens create a
chemical reaction that allows
the skin to absorb UV rays,
preventing them from entering
the cell’s DNA. Although
many people prefer chemical
sunscreens because they are not
visible on the skin, they must be
applied about a half-hour before
the skin can be exposed to the
sun, so this protective chemical
reaction can take place.
Spray-on sunscreens, wildly
popular, convenient and easier to
apply, can be more difficult to
ensure adequate coverage, and tend
to have a higher concentration of
water, causing them to lose their
effectiveness more quickly.
Sunscreens can be labeled as
water-resistant or waterproof. Go
for waterproof, especially if you
plan on sweating or swimming.
And be sure to use a “broadspectrum”
sunscreen.
ONWomen CENTERED |
Although there are sunscreens
with SPF as high as 100, SPF 50 is
adequate, as it blocks more than
98 percent of the sun’s harmful
rays. “We believe that higher SPF
sunscreens create a false sense of
security, and people don’t reapply
often enough,” says Dr. Venna.
The key to the effective use of sunscreen
is to apply it abundantly
and frequently. “Sunscreen,
regardless of the SPF value, must
be reapplied every two to three
hours—more frequently when
swimming. And use a lot,” says
Dr. Venna. Ample, complete
coverage is the best way to ensure
adequate protection.
Don’t forget your eyes. “In the
back of the eye, the retina has
pigment producing cells that
can develop moles and ocular
melanoma. Think of your eyes in
the same way as your skin, and use
sunglasses that block all UV rays.”
For children, Dr. Venna recommends
physical sunscreens,
WASHINGTON HOSPITAL CENTER | WWW.WHCENTER.ORG
and favors a combination
of rated Ultraviolet Protection
Factor (UPF) clothing, hats,
sunscreen and sunglasses. “A
child should never get sunburn,”
he emphasizes.❋
For more information or an
appointment with our experts,
call 202-877-DOCS, or visit our
website at WHCenter.org.
Hospital Center First in
the Area to Acquire Large MRI
Women who need breast magnetic resonance imaging (MRI) can count on a more comfortable,
less stressful experience at Washington Hospital Center, thanks to its new Toshiba Titan MRI
and its accompanying Sentinelle breast coil. The machine offers extraordinary image quality,
and the widest and shortest opening available, making it more spacious than any other unit in
the area. The large size of the opening, combined with the unit’s weight capacity of 550 pounds,
make it much easier for overweight or claustrophobic patients to have the test instead of having
to use an open MRI, which doesn’t provide the same image quality.
A coil is a component of the imaging process specific to the area of the body being studied.
For breast MRI, the Titan’s Sentinelle coil has 12 Tempur-Pedic® pads that can be adjusted
for the optimal comfort of every patient, and holds more breast tissue than any other on the
market. Since women are laying face-down during a breast MRI, comfort is very important.
“Breast MRI is a terrific use of technology, but it never replaces traditional mammography,”
says Brooke Wolvin, MD, Director of Breast MRI at Washington Hospital Center.
“Complementary to mammography, it is most often used for the screening of
women at high risk for breast cancer, for some women who have been
diagnosed with breast cancer prior to surgery, or to determine whether a
tumor is responding to treatment. Breast MRI can also be used to check
certain types of breast implants for leakage.”
Washington Hospital Center is the only facility in the area with this type of
equipment. For more information call 202-877-6133.

110 Irving Street, NW
Washington, DC 20010
nformation And Advice For The Maturing Woman
Women CENTERED ON
Centered on Women is produced by the
Public Affairs Department of Washington
Hospital Center, 110 Irving Street, NW,
Washington, DC 20010-2975.
www.WHCenter.org
Officers
Harrison J. Rider III, President,
Washington Hospital Center
Marc N. Duber, Chairman of the Board,
Washington Hospital Center
Kenneth A. Samet, President and CEO,
MedStar Health
Janis M. Orlowski, MD, MACP, Senior
Vice President and Chief Medical Officer,
Washington Hospital Center
Carolyn Hammond, Interim Vice President,
Public Affairs and Marketing,
Washington Hospital Center
Julie Stanish, Director,
Marketing Communications,
Washington Hospital Center
Washington Hospital Center is a not-forprofit,
926-bed acute care teaching and
research hospital based in Northwest
Washington, D.C. It is the largest private
medical center in the nation’s capital,
among the 25 largest hospitals in the mid-
Atlantic and the referral center for the
region’s most complex medical cases. The
Hospital Center consistently ranks among
the nation’s top hospitals in the research
and treatment of cardiovascular and kidney
disease, cancer, stroke, endocrine
disorders, neurological injury and illness,
as well as geriatric and respiratory care.
Washington Hospital Center is also home
to MedSTAR Trauma and Transport and is
the region’s adult Burn Center.
Gynecologic Oncologist Abbie Fields:
Forming Special Bonds with Patients
a
bbie Fields, MD, renowned
Gynecologic Oncologist
and Medical Director of
Gynecologic Oncology for
Washington Cancer Institute at
Washington Hospital Center, loves
her job. Some may find it unusual to
find pleasure in treating women with
cancer, but to Dr. Fields, a pleasure it is.
Abbie Fields, MD
One aspect of the field that Dr.
Fields embraces is the discipline’s
scientific challenge. “I really enjoy
the complexity of the process,” she
says. Dr. Fields has training in all
battling breast cancer F R O M PA G E 2
multidisciplinary team, they learn that
there are other options, there is life
after cancer treatment, and they’re in a
much better place,” says Dr. Boisvert.
The Cancer Institute’s educational
and supportive programs also
distinguish it, offering invaluable
services and reliable information to
help patients and their families
during and after treatment. “Our
programs can help patients access a
wide range of resources, including
counseling, finding someone to
areas associated with the treatment
of cancers of the female reproductive
system, including radical pelvic
surgery, chemotherapy and radiation.
Her specialty was designed to allow
the Gyn/Oncologist to remain
intimately involved in all aspects of a
patients’ treatment. Her areas of
interest also include the genetic link
to cancers, and the design and
participation in clinical trials.
“When a woman has cancer, she has
three choices: the standard treatment,
a clinical trial, or no treatment. It’s
her choice. My job is to give her as
much information and guidance as
possible and honor her wishes,” she
says. “We know so much more about
the treatment of cancer than ever
before, and survival is at an all-time
high. Clinical trials are not to be
feared—remember, yesterday’s
clinical trials are today’s standard
treatments.”
But, for as much as she is stimulated
scientifically by her work, as one of
the area’s only female gynecologic
oncologists, Dr. Fields’ favorite part
of her job is the special relationships
deliver groceries, or helping with
insurance copayments and deductibles
if eligible,” says Heather Kapp,
director of patient and community
services. “This is important, because
patients’ outcomes do improve with
access to psychosocial education
and support.”
Regardless of the severity of the
cancer and the type of treatment
needed, the Center for Breast Health,
Washington Cancer Institute at
Washington Hospital Center is the
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she forms with her patients—no
surprise given her warm and
comforting demeanor. “Through my
years of clinical experience, to have
had the opportunity to take a woman
through the experience of cancer
and watch her come out on the other
end of the tunnel to have a ‘rest of
her life’ is a totally enriching
experience. Patients learn what and
who are really important; I love to
watch them evolve into totally
different women,” she says.
Dr. Fields received her training in
Gyn/Oncology at Johns Hopkins,
and served as clinical faculty in New
York and Richmond. She came to
Washington, D.C. because she was
impressed by the physicians and
leadership at the Hospital Center. She
believes that the quality of care that is
practiced there is unsurpassed.
Dr. Fields and Washington Hospital
Center’s gynecologic oncology team
is the area’s most experienced in the
treatment of reproductive cancers.
Dr. Fields has offices in Rockville, on
K Street and on the Hospital Center
campus. ❋
For an appointment, call
202-877-DOCS, or visit our
Website at www.WHCenter.org.
best option for women facing this
illness. “A diagnosis of breast cancer
is a complicated story that is hard to
hear, let alone comprehend,” says Dr.
Boisvert. “Breast centers are set-up
to handle that, and I think we have
the most comprehensive, patientcentered
program around.”❋
For more information or an
appointment with the experts at
the Center for Breast Health, call
202-877-DOCS, or visit our
Website at www.WHCenter.org.