LEADING ONCOLOGY SURGEON TALKS TO US ABOUT BREAST CANCER
By Nancy Esteves
Dr. Robert B. Donoway, MD, FACS is a leader in the field of cancer, and was the first surgical oncologist in Florida to perform cryoablation and radiofrequency ablation, and he continues to lead the way as the first surgeon in Florida to perform pancreatic and liver treatments such as irreversible electroporation (IRE) NanoKnife® ablation therapy.
In his practice, Atlas Oncology in Hollywood, Florida, Dr. Donoway offers the most advanced cancer treatments. He received the South Florida Health Award for the use of microendoscopy for early-stage breast cancer detection. Dr. Donoway is an active member of the Society of Surgical Oncology and the American Society of Breast Surgeons and has served on numerous renowned medical boards.
Dr. Donoway, are more incidents of cancer cases being seen today?
Dr. D: Although it is increasing, earlier detection through screening has resulted in better survival due to earlier diagnosis than was possible two or three decades ago. Using computer-assisted programming, images can be evaluated using an Artificial Intelligence-type platform that allows more sensitive and specific targeting of mammographic abnormalities, resulting in fewer false-positive results than we saw years ago.
What is your recommendation on early detection?
Dr. D: Today we try to better stratify patients according to their risk. Clearly, women with several family members with breast cancer should be more proactive and start screening earlier, occasionally in their 20s. All women should be familiar with their “normal” baseline exam. This can only be established through a monthly “breast self-exam” routine. Unfortunately, in women who only do that and not a mammogram, ultrasound or breast MRI, breast cancers are usually at a more advanced stage and often require additional therapy. For patients in the highest-risk category, those carrying the BRCA 1 and 2 mutations, annual screening is often stepped up to every 6 months, which brings MRI into play – it can be very sensitive but not as specific, meaning more biopsies than cancers can be expected.
Tell us about your most advanced procedures:
Dr. D: One procedure I still use on occasion is breast microendoscopy. Endoscopic procedures allow direct visualization of a tumor and are useful for evaluating suspicious nipple discharge in high-risk individuals. Based on the average size of the lesion detected (that is, cancer or precancer), it can identify disease up to five years before a standard mammogram. The goal of all breast cancer specialties – surgery, radiation and medical oncology – has been to match the specific individual’s disease to the exact treatment they need. No more, no less. In surgery we usually remove only 1, 2 or 3 lymph nodes and therefore rarely see lymphedema. We also place small absorbable orientation implants (BioZorb) that often allow radiation to be limited to that area, reducing treatment time from 7 to 1 or 2 weeks.
Testing: Our medical colleagues have benefited from genomic testing of the actual tumor. This has allowed us to determine which patients require chemotherapy (only about 10% of the total) and who can avoid it. The test I prefer is MammaPrint because it stratifies patients into a yes-or-no answer.
Cryotherapy: Recently, interest in tumor ablation with cryotherapy has been renewed. Studies have shown it to be effective with excellent aesthetics. Because the tumor is left in the breast, closer surveillance is often performed to ensure the tumor has not reappeared.
IRE (irreversible electroporation): One area in which I have begun to pioneer for the breast is the use of high-voltage electrical current (3,000 volts) that can pass through and around the tumor. I have been using it in pancreatic cancer for almost 10 years, and we have diversified to treat other cancers beyond the pancreas, the liver and soft-tissue tumors.
What lifestyle changes do you suggest to your patients?
Dr. D: Maintaining your ideal body weight through a combination of a balanced diet and regular “low-impact” exercise will reduce your risk by up to 20%. Avoid alcohol as much as possible. Even small amounts have a negative effect. It is likely not that simple, and genetics possibly plays a role in its metabolism.
What is your best advice for our readers?
Dr. D: The most important thing is to start breast self-exams at an early age and continue doing them monthly throughout your life. Annual imaging, whether digital mammograms and annual ultrasounds and/or risk-based MRIs, should always continue.
For a consultation, please call the office: 954-986-6366
For more information, visit: www.atlasoncology.com
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