When I founded The Desert Breast Institute back in 1988, it was the first comprehensive breast center in the Coachella Valley and one of the first in the country. Almost universally there were no “comprehensive teams” active in research, no pre-treatment planning sessions and no multi-talented personnel dedicated to preserving mind, body and spirit. Unfortunately even today we do not have a national system that is comprehensive and networked all working together to be the best we can be. Now there is a “comprehensive breast center” it seems on every corner all trying to out do each other. We’re the best, no we’re the best, etc, etc. Who do you believe, where do you go to entrust your life to someone? It reminds me of the situation back in the 1980s when cardiac surgeons from around the country were asked by the patient what the odds of dying from the open heart operation were? For the most part the answer to that question was about 2-3%. As it turned out, a reporter from Night-Ridder Newspapers under the FOIA (Freedom of Information Act) found out that, unknown to anyone, Medicare was keeping track of mortality rates on heart programs doing more than 100 open hearts per year. As it turned out, the open heart team (of which I was an associate surgeon then) at Eisenhower Memorial Hospital in Rancho Mirage, California had the lowest mortality rate in the country at 0.6% for two years running, taking on all comers. There were well known hospitals with high mortality rates as high as 26%. Then under pressure from the surgeons and their societies, Medicare stopped keeping track.
The breast situation is a little like that only I don’t think Medicare is keeping track of individual surgeons’ mortality rates concerning breast cancer. So the only way for people to know how a breast center is doing is to ask for their mortality rates or mastectomy rates. This is something I know is almost never done but should be. Our efforts should be transparent and the only way to do it is to get your data published in a peer reviewed journal of some repute. I have included in the next pages our data on mastectomy rates and mortality rates for our most aggressive breast cancer patients. While it is about time to re-do the figures by adding more patients we have seen and cared for, the patients listed have been followed for many years now. Included in this mix are patients with invasive breast cancer who never had an operation, a knife never touched them. Eighteen years later they are all still alive. That is, we were able to treat very aggressive forms of invasive breast cancer without surgery 7% of the time. In fact, I have included the page from the Program/Proceedings of the American Society of Clinical Oncology, Thirty-Third Annual Meeting May 17-20, 1997. The American Society of Clinical Oncology (ASCO) is the largest oncology research group in the country. They actually had to make a new heading for our abstract, “Non-surgical treatment selection.”
It reminds me can you guess how many cardiac surgeons from around the country called us to ask what we were doing different or could they come out and watch us? If you guessed 0, you’re right. That’s the same number of breast surgeons that called me to inquire just how we were able to treat aggressive invasive breast cancers without surgery. Also included in the data is our overall survival rate which is 92% and 96% had lumpectomies. This was back some years ago now. I really can’t remember the last mastectomy I did. Now with The Lavender Procedure it’s all changed. I have included all the journals where this data is published followed by the abstract they published after peer review. Soon I will author a paper on the first 1000 infrared patients as well as the initial Lavender Procedure patients.
I have also included a surgical procedure I came up with to augment partial breast irradiation and it is called The Bretz-Stevenson Patch. We presented this in Las Vegas, April 27-29 2006 at the 30th Anniversary Symposium American Society of Breast Disease. We will now start to publish more data including using MammoSite partial breast irradiation to treat locally recurrent breast cancer (that comes back in the breast) after lumpectomy and external beam radiation. We have performed six such surgeries and follow the patients for over six years now with two re-recurrences. One patient elected to have yet another lumpectomy as opposed to mastectomy and she is OK. The other patient chose The Lavender Procedure. Until we pioneered this, the only option was mastectomy as you can’t do external beam radiation again.
I think the key to all this is taking personal responsibility for each patient. It’s on your shoulders so to speak. Equally important is working with the same team year after year on thousands of patients and being involved in research. I’m probable could be labeled a hybrid surgeon/researcher. I’m not just a test tube researcher who never sees a patient or loses track of the reason they are doing the research in the first place and goes home at night oblivious to the horrendous situation women have been in for decades. I’m there every day making tomorrow happen for my patients, summing up all my experience to provide optimal care. The team I work with has a combined 120 years of experience and it takes a long time to know what they know.
Enjoy the abstracts.