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The Yale-New Haven Breast Center took a giant step forward in December 2009 when it moved into a beautiful new location on the first floor of Smilow Cancer Hospital. With a spacious waiting area and beautiful artwork, the suite has a warm, caring feeling that can make a difference for a patient nervously anticipating an appointment.

“It has been a wonderful change,” said Lyndsay Harris, MD, chief of breast medical oncology. “It’s a gorgeous facility with bright open spaces. This kind of environment lifts up the spirit, especially for patients going through a hard time already.”

Another change is that the four disciplines—breast imaging, oncology, surgery and therapeutic radiology—are all practicing in the same space. Other specialties related to the management of breast cancer are nearby, including pathology, plastic and reconstructive surgery, psycho-oncology and social work, complementary medicine, physical medicine and rehabilitation, palliative care and genetics.

The Yale-New Haven Breast Center continues to grow and anticipates a 25-percent increase in patient volume this year, according to Director Anees Chagpar, MD. The program always has had a strong team of surgeons who perform breast surgery exclusively, as well as highly respected oncologists, diagnostic radiologists and therapeutic radiologists. Its pathology team is led by Fattaneh Tavassoli MD, a world-recognized expert and authority who consults nationally and internationally on challenging breast lesions.

Last year, the center expanded its staff by more than 20. Dr. Chagpar, a practicing breast surgeon, arrived in New Haven last September from the University of Louisville in Kentucky, where she served as director of the Multidisciplinary Breast Program at James Graham Brown Cancer Center. Other new members include experienced surgeon Nina Horowitz, MD; medical oncologists Erin Wysong Hofstatter, MD, Tara Sanft, MD, and Arthur Levy, MD; and reconstructive surgeon Stephanie Kwei, MD. In addition, there are new nurses, nurse coordinators, imaging specialists, mammographers, support staff and a new social worker.

Dr. Horowitz, who has the distinction of being the first woman surgeon in private practice in New Haven in 1984, became a full-time faculty member partly for the opportunity to work more closely with other breast experts on a daily basis. “You can’t take lightly the prospect of spending the day talking about patient care with people who think the way you do about it. You can discuss different approaches, and it’s easier to get to all of the conferences and participate in them. It’s better for my patients, and it’s impacting the way I approach patient care,” she said.

Breast centers are an anchor at most cancer centers, according to Dr. Chagpar. “Breast cancer is complicated and requires a multidisciplinary approach. As we build one of the nation’s finest breast centers, we want to be out in front, setting the bar.” She finds Yale’s Breast Center particularly exciting because it is part of Smilow Cancer Hospital’s new vision, with multidisciplinary approaches, patient- and family-centered care and personalized medicine.

Smaller changes are making a difference as well. The center is realigning its teams to create a better synergy, revamping its patient education materials to focus them more on patients and family, and improving one-on-one care so that patients can always ask for the same person when they call with questions.

Service is continually improving in diagnostic radiology, which in the last two years increased its faculty from four to seven. Liane Philpotts, MD, chief of diagnostic radiology for the center, used to have to go from the Yale Physician’s Building to Fitkin to perform MRI-guided biopsies, clustering appointments one or two mornings a week. “Now everything is in one place and we do MRI-guided biopsies every single morning. Our biopsy volume has gone way up,” she said.

The new suite now has a dedicated breast MRI with a high-strength 3-tesla (T) magnet—the only MRI of its kind in Connecticut dedicated to breast imaging. Dr. Philpotts said, “It provides exquisite images of the breast. The better the images, the more likely you are to pick up small things and not miss anything.” Diagnostic radiologist Reni Butler, MD, is comparing data from the 3T images with 1.5T images taken previously.

In February, the FDA approved breast tomosynthesis, which uses X-rays to create a 3D picture of the breast. Philpotts and her staff were part of the data trial for the equipment and plan to install their first unit in the next few months. Tomosynthesis shows “a whole series of slices of the breast,” instead of overlapping tissues, said Dr. Philpotts. “It’s like the pages of the book. It’s like looking at one page at a time instead of the whole thing at once.” She hopes tomosynthesis will reduce 30 to 80 percent of callbacks due to suspicious mammograms, and find cancers that might otherwise be missed particularly in dense tissue.

When patients are diagnosed, they are given cutting-edge treatment options. Plastic surgeons are experienced in complex surgeries for eligible patients including latissimus flaps and DIEP flaps — microsurgeries to recreate breasts using tissue from other areas of the body. The center is currently recruiting additional nationally renowned reconstructive surgeons with microvascular expertise to augment the reconstructive team.

Dr. Harris is proud of the medical oncologists, whose ranks have grown to seven since she started, with subspecialists in such areas as genetics, survivorship and novel therapies. Treatment strategies such as using adjuvant therapies to shrink tumors before surgery are standard practice for eligible patients.

“One thing we think is very important is integrating the newest information in genomics into the care,” Dr. Harris said. “We’re doing clinical trials to understand which patients benefit the most from a particular therapy, using genomic screens.” Yale pathologists including Dr. Tavassoli and David Rimm, MD, are specialists in testing tumor tissue to determine risk of recurrence and how the patient will respond to particular therapies.

Meanwhile, Joanne Weidhaas, MD, PhD, chief of the breast therapeutic radiation program, says her group has been actively partipicating in a national phase III trial of partial breast irradiation (PBI), as well as conducting a Phase II trial to test MammoSite breast brachytherapy, another form of PBI. The role of PBI is gaining momentum as an alternative to whole-breast radiation, and the Yale group is actively helping develop this new approach to patient care.

Dr. Sanft, the new medical director of the Adult Survivorship for the Connecticut Challenge Survivorship Clinic, is developing “survivorship care plans,” which are documents that detail the treatment a patient has received, along with potential side effects and recommendations for continued care. “I’m hoping to prove through research that survivorship care plans improve patients’ knowledge of the care they received, the potential side effects, and the recommendations for surveillance going forward,” said Dr. Sanft. The majority of the patients who visit the clinic are breast cancer survivors, and better follow-up may help catch any recurrences early, she said.

In addition, the Yale-New Haven Breast Center is taking a new look at its patients’ growing interest in complementary therapies, with a new patient support group and yoga classes. Dr. Chagpar is teaming up with Judson Brewer, MD, PhD, director of the Yale Therapeutic Neuroscience Clinic, to explore mindfulness training for breast cancer patients. In addition, physicians at the center are working with colleagues including Melinda Irwin, PhD, from the School of Public Health, to study the effect of exercise therapy in reducing cancer risk.

Meanwhile, since she arrived eight months ago, Dr. Chagpar, MD, has been working on building upon the Breast Center’s reputation. “Building a spectacular program is only half the battle,” Dr. Chagpar said. “That’s kind of like having a diamond and no one knowing about it. You need to polish it up and put it in a display case. We need to wave our flag and take our place on the national stage.” As part of this commitment, she has been working with the rest of the team at the Breast Center to move systematically towards national accreditation, which she emphasizes would “highlight our commitment to the highest quality of clinical care for our patients.”

She has connected with Susan G. Komen for the Cure, the Breast Cancer Alliance, other breast centers, businesses and interested organizations throughout the state and nationally to establish collaborations and make sure people know what the Yale-New Haven Breast Center has to offer. She’s getting the word out through both local and national media as well.

As the center moves forward, plans are in motion for more research, more physicians publishing in journals, and more collaboration with physicians and researchers not only within the clinical practice, but with Yale schools of nursing and public health. Dr. Chagpar also plans to refine the breast surgical oncology fellowship program, in an effort to move toward Society of Surgical Oncology accreditation. The plan is to make the Breast Center a destination that patients choose first because they know it’s the best, she said. “We are moving toward a unified and comprehensive care model where patients go home at the end of the day and say, ‘I may have cancer, but I’m in a really good place, and I’m going to be OK.’ ”

Surgery:

• Anees Chagpar, MD, Director, Yale-New Haven Breast Center at Smilow Cancer Hospital
• Baiba Grube, MD
• Nina Horowitz, MD
• Brigid Killelea, MD
• Stephanie Kwei, MD (reconstructive breast surgery)
• Donald Lannin, MD
• Michael Matthew, MD (reconstructive breast surgery)

Medical Oncology:

• Maysa Abu-Khalaf, MD
• Gina Chung, MD
• Michael DiGiovanna, MD, PhD
• Leonard Farber, MD
• Lyndsay Harris, MD, chief
• Erin Hofstatter, MD
• Arthur Levy
• Tara Sanft

Therapeutic Radiology:

• Susan Higgins, MD
• Joanne Weidhaas, MD, PhD, chief
• Lynn Wilson, MD

Diagnostic Radiology:

• Liva Andrejeva, MD
• Reni Butler, MD
• Jaime Geisel, MD
• Regina J. Hooley, MD
• Laura J. Horvath, MD
• Liane Philpotts, MD, chief
• Madhavi Raghu, MD

Pathology:

• Veerle Bossuyt, MD
• Natalia Buza, MD
• G. Kenneth Haines, III, MD
• Malini Harigopal, MD
• Sihem Khelifa, MD
• Ozlen Saglam, MD
• Fattaneh Tavassoli, MD, chief

Front page photo: Medical oncologists Michael P. DiGiovanna, MD, and Lyndsay Harris, MD, discuss a case during a weekly team meeting.