By Andrea Bosco Stehle | Photographs by Michael Fornataro

Breast cancer detection and care have come a considerable way in the worlds of technology, research, and education. We’re fortunate enough to have the helm of some of the best medical practices in the country right here in our backyard. Given the positive advancements and paramount shift, the work and response for four UPMC doctors in particular has been notably rewarding. Also, “people are so much more proactive” than ever before, says UPMC CancerCenter radiation oncologist Colin Champ, MD, who is dually board-certified in radiation oncology and integrative medicine. “The accessibility of information to help patients live a healthier life has totally changed the field. Looking back five years, it’s night and day.”

The feelings are mutual for Margarita Zuley, MD, vice chair of Quality Assurance and Strategic Development in the Department of Radiology and chief of Breast Imaging at UPMC, who has noticed the introduction of innovative technologies and women’s keen observations going hand-in-hand. “In general, women are very well educated about their risk,” she says. “They want to understand all of their options. The majority of women lead busy lives — they want the most accurate and efficient imaging possible.”

Across America, doctors have seen an upswing in prophylactic, or preventative, mastectomies, the removal of one or both breasts, partially or completely to reduce the risk of developing cancer — a hot topic since it first engaged the masses in 2011 and 2013, respectively, when TV personality Giuliana Rancic and actress Angelina Jolie underwent double-mastectomy surgery. “Women want to live their lives and not have the disease hanging over their heads,” says Dr. Zuley.

For Barry Lembersky, MD, medical oncologist at UPMC CancerCenter, it’s been gratifying to conduct research and witness more accurate results among patients, as he and his team of colleagues helped to create an accomplished multidisciplinary management program at Magee-Womens Hospital of UPMC. “We have better early detection, better medicines, and a better attention to efficacy and side effects,” he says. “We are advising women to take the appropriate steps to be treated for their disease.”

Adds Gretchen Ahrendt, MD, associate professor of surgery at UPMC and the director of Surgical Breast Services at Magee-Womens Hospital of UPMC, “To be in this field and witness these changes is just incredible. I can’t even tell you how exciting it is to watch this transformation.”

“There is still work to be done to understand why some tumors  defy our best treatments,” continues Dr. Ahrendt. “But, the pace of progress has accelerated which will bring the promise of new therapies.”


Gretchen Ahrendt, MD | Director, Surgical Breast Services, Magee-Womens Hospital of UPMCBreast_1

The role of the surgeon in breast cancer treatment has changed dramatically in a number of ways, according to surgical oncologist Gretchen Ahrendt, MD, who does nearly 500 breast surgeries a year. One task is the management of affected lymph nodes. “Historically, we did a lymph node dissection, removing 15 to 20 nodes or so,” says Dr. Ahrendt. “However, patients were developing lymphedema or permanent numbness in the arm — a lifelong, chronic problem. We’ve learned how to pinpoint which nodes the cancer spread to first or if it spread at all.” This practice is known as a sentinel lymph node biopsy. Dr. Ahrendt participated in The American College of Surgeons Oncology Group (ACOSOG)’s landmark clinical trial, Z11, which determined that if the sentinel node was positive for cancer, it’s unnecessary to remove the remainder of the lymph nodes. “This changed our practice,” she says. “We’re trying to optimize the patient’s treatment, but minimize the footprint of surgery to avoid after effects, such as swelling in the arm, lack of range of motion in the shoulder, and numbness in the armpit.” Another advancement is the evolution of the mastectomy and an increase in preventative mastectomies. “Nipple-sparing mastectomies have been reintroduced,” says Dr. Ahrendt. “The nipple is really skin, not breast tissue, so it is feasible to do the procedure, remove the milk ducts, and still preserve the skin of the nipple and areola.” With that said, she has seen a dramatic increase in double mastectomies, even if the other breast is healthy. “Patients are risk-averse,” she says. “Women want to be empowered to do what they can to try and make that risk as low as possible.”

Colin Champ, MD | Radiation Oncologist, UPMC CancerCenterBreast_2

Radiation oncologist Colin Champ, MD, is also board-certified in integrative medicine. His role is centered on the research of lifestyle modification, and the synergy of preventative care and cancer treatment. Recently, Dr. Champ and his colleagues completed a study where breast cancer patients were provided with trackers that measured their activity levels before, during, and after radiation. “Our goal is to get women moving more,” he says. Whether it’s an increase in cardio or the addition of resistance training, his program incorporates diet changes to diminish addictive eating patterns. “I take into consideration where the patient struggles, where there are hurdles, and how to overcome them,” says Dr. Champ. Staying away from sugars and simple carbohydrates is the first step. “The foods we have our patients turn to are healthy meat and fish sources, along with the standard leafy green vegetables,” he says. “If you’re going to eat beef, go for grass-fed. If you’re going to eat eggs, eat those from chickens that roam freely. Eat healthy fats, like salmon and cod.” When it comes to dairy, he suggests consuming whole-fat dairy from grass-fed cows, which provides conjugated linoleic acid (CLA) that has been shown in preclinical studies to help fight breast cancer. Dr. Champ is proud to see a positive shift in Americans’ health habits. “Diet and nutrition in the medical field is no longer taboo,” says Dr. Champ. “Our patients are being so proactive to change their lifestyle habits. It’s very rewarding.” @ColinChampMD

Barry Lembersky, MD | Medical Oncologist, UPMC CancerCenterBreast_3

Board-certified in medical oncology, Barry Lembersky, MD, manages collaborative research in large, multi-center clinical trials, evaluating new treatments for breast cancer, from chemotherapy to endocrine therapy. One of the most rewarding parts of his career has been helping to develop and publish advantageous chemo programs that have prolonged patients’ lives. He’s had a hand in projects designed to evaluate long-term anti-estrogen therapy as potentially important for long-term control. Generally, since 1990, patients’ success rates of overcoming the disease have improved dramatically. “We’ve found that less surgery is equal to more. We’re doing less mastectomies, which significantly improves women’s body image and function.” Current research at Magee-Womens Hospital of UPMC on genetics and genomics is being conducted to understand breast cancer at the molecular level — both the primary and metastatic disease. “We aim to understand breast cancer at its fundamentals,” he says. “We use that information to develop new research, which is vital to improving breast cancer.” Taking care of patients and helping them to overcome their disease as well as helping families to cope with advancing disease, inabilities, and even death are all part of his job. “To feel the professional satisfaction of a long career of dedicated work of helping others has provided me with focus and contentment. To be learned and an expert in something, to make a contribution, and to be on the cutting-edge of breast cancer research and treatment has been a nice part of my career. In 25 years, I’ve witnessed the explosion of UPMC as a premier academic medical center, which is wonderful to be a part of.”

Margarita Zuley, MD | Vice Chair, Quality Assurance and Strategic Development, Department of Radiology, UPMC Chief, Breast Imaging, UPMCBreast_4

Dr. Margarita Zuley’s role is to use the right tools to screen for and identify invasive cancers, while reducing recalls and additional evaluation or biopsy of lesions that are not cancer. “We’re committed to just that, and always looking at new technology and research,” she says. A novel dimension in breast cancer detection is contrast-enhanced tomosynthesis, or 3D mammography, and Dr. Zuley and her colleagues at UPMC were the first in the country to offer it. “It’s very exciting,” says Dr. Zuley. “We’re finding cancers that we otherwise wouldn’t have found, and we’re limiting cost, stress, and unnecessary procedures.” With fast-growing cancers, like triple negative, 3D mammography can identify the disease hiding in layers of overlying tissue, which aren’t always seen in a traditional mammogram. At Magee, the average breast cancer screening recall rate is 10 percent — down since the introduction of 3D mammography. “Cancer detection rate is very high — five or six per thousand,” she adds. “We’re finding more invasive cancers and definitely heading in the right direction.” In addition, Dr. Zuley and her team are making an immense international impact as they helped to establish a UPMC breast cancer center in Kazakhstan, where doctors have detected an incredible number of cancers, Dr. Zuley says. “UPMC has a very strong international arm — a powerhouse. It’s really rewarding to provide patients great care in other parts of the world who aren’t lucky enough to receive the level of care that we have here in Pittsburgh.”

Information from UPMC CancerCenter and Magee-Womens Hospital of UPMC.

Information from UPMC CancerCenter and Magee-Womens Hospital of UPMC.

Previous post

Leading Ladies: Mother's Day Menus

Next post

WHIRL Women In Business: Class of 2016