Recently Dr. Evans took part in course work at the School of Oncoplastic Surgery in Frisco, Texas. The goal of oncoplastic surgery is to remove the cancer from the breast and then to reshape the remaining breast tissue so that the breast will appear normal. The School of Oncoplastic Surgery (SOS) provides an opportunity for surgeons to immerse themselves in knowledge alongside world-renowned pioneers in oncoplastic surgery. The SOS provides ample time for attendees to get hands-on teaching and experience with many different oncoplastic techniques.
More of my patients are becoming more aware of alternative imaging, a.k.a. “thermography” for breast cancer screening. As a physician who has dedicated her career to helping women (and men) fight and win the battle of breast cancer, I would like to remind you that mammography, a low-dose X-ray image of the breast, is still the most effective breast cancer screening tool, second to the human hand, with breast self-exam (BSE) being equally important. Unfortunately, 9 out of 10 women in my clinic when asked, report they DO NOT do self-exams for one reason or another.
I had the honor and privilege of going to Florence this past July to support the Dragon Boat Race put on by the International Breast Cancer Paddlers’ Commission. It was an amazing event and truly moving to see over 2,500 women (and a few men) from all over the world affected by breast cancer compete with each other on the Arno river. These participants had stronger bonds and strength of character like so many of the amazing women (and men) I have had in my office. We need to develop a team of paddlers here in the Tri Cities!
Get more information in the IBCPC Newsletter!
I went to Viet Nam in Dec 2016 unaware this was the monsoon season. Torrential rainfall and lack of communication and no roadmap made for an interesting and challenging trip, to say the least. I went in hopes of providing some new ideas and techniques in the surgical treatment of breast cancer.
It was a unique experience doing this with an organization I have never traveled with before. Teaching and adjusting in a foreign country requires pre-planning and patience and I was fortunate to have a bright young eager surgeon and veteran companions to help make it all possible.
The conditions we worked in were very eye opening and I am not sure who learned more. Adaptability and creativity goes a long way when supplies and proper tools are lacking. I was trying to emphasize margin assessment for breast tumors and some new techniques for conservative management of the breast cancer patient. I don’t know if I had much of an effect on the surgeons as a whole but I do know there is at least one young doctor who is “seeing the light ” that maybe things can be done differently. I hope to bring him here to the states so he can further his studies.
If anyone wants to further this mission, feel free to contact me.
Recently, a number of my patients have commented that they feel as if they are being “fed into a machine” as they move through the process of breast cancer screening. Between the time that an abnormality is seen on a screening mammogram and the time that definitive treatment begins, an increasing number of patients feel that they are being moved along an assembly line of repeat mammograms, ultrasounds, MRI’s and biopsies in a lock-step process which leaves them little opportunity for thought, reflection and consultation with their own physician. In this day of increased automation, corporate pressure and medical technology, it is not surprising that patients feel depersonalized by a system which seems increasingly devoid of compassionate counsel.
Patients are not the only ones who feel disempowered by the changes in medical care. Physicians, who are being strongly influenced to manage their patients in this new environment, are left frustrated as well; frustrated for their patients and by the level of patient care they are able to provide in an increasingly “managed care” landscape.
Our Breast Cancer Center of Excellence, which is composed of providers and support staff from each of the three health care systems in our community, is trying to oppose that trend. All of us are committed to giving patients in the Tri-Cities the best possible care in a setting of compassion, patient education, community support and access to the best and most hopeful clinical trials in the field. We strive to provide our clients with as much choice and understanding of their treatment plans as possible so that patients and providers feel connected and active in the decision making process.
Being diagnosed with cancer forces people to confront their mortality and question the ability of friends and family to understand what they are going through. More frighteningly, it makes each individual cross the bridge from the world in which they were a “person” to a strange and unpredictable world in which they are a “patient”. Helping these frightened and disoriented new residents become survivors in their new world takes time, understanding and communication. It is an aspect of the practice of medicine that makes sense to all involved whether or not it fits within the confines of the current managed care directives.
It takes courage to provide compassionate care and as providers, we have to stand up for what is right for our patients and for our colleagues. Historically, the concept of “Patient Advocate” has been a part of a physician’s job description since the time of Hippocrates. If a patient is confused or concerned about her breast cancer and frightened by the choices she must make as she struggles to survive, it is her physician who must comfort, educate and advise her. It takes courage to admit that sometimes there are no best answers, and even more courage to encourage a patient to seek an outside opinion. Patients today are increasingly aware that there may be other options and other providers who can help answer their questions.
Medical professionals have become used to acting as if they always know what’s “best,” or what the “standard of care” is for specific situations. But what is “best” is very individual. No two people are exactly alike and everyone has different histories and coping methods. If a patient doesn’t question the approach recommended by her physician, it may just be because she is not aware that alternatives exist, or simply because she is too afraid to ask. After all, isn’t the doctor supposed to know what’s ” best”?
The basis for our health care system lies in the belief that people (patients) are the ultimate decision-makers when it comes to taking (or not taking) medications, and having (or not having) procedures performed on their bodies. We, as physicians, try to do what we think is “best” according to our knowledge and experience. We must never forget, however, that the final decision is with the patient, and it is our responsibility to ensure that she has access to all the support and resources she needs in order to make a decision she is comfortable with, and can (perhaps!) live with. The day we stop providing that level of communication and comfort to our patients is the day we have forgotten why we’re here.
L Evans MD, PC, FACS
By: Cindy Miller, RN, CN-BN, Breast Program Coordinator, Tri-Cities Cancer Center
This is an exciting time to be talking about breast health in our community. A little over two years ago, the Tri-Cities Cancer Center partnered with Lourdes Health Network to pilot a Breast Oncology Program with the intent of achieving accreditation by the National Accreditation Program for Breast Centers (NAPBC) as a Breast Center of Excellence.
Our program is no longer in pilot and includes over twenty area physicians from the Tri-Cities Cancer Center, Kadlec Regional Medical Center, Lourdes Health Network, and Trios Health (including ancillary staff from all organizations), each specializing in breast cancer. Appropriate patients enrolled in this program will have their case reviewed in a group setting by these board-certified providers. This group setting is referred to as a multidisciplinary conference, which includes: Breast Surgeons, Radiologists, Pathologists, Radiation Oncologists, Medical Oncologists, a Plastic Reconstructive Surgeon, Nurse Navigators, a Genetic Counselor, Clinical Research Coordinators & Psychosocial Support Professionals.
The goals of the program are to shorten time to treatment and improve outcomes for patients. This is achieved as the different specialists previously mentioned give their professional opinion regarding the best course of treatment for the patient being presented. The value to patients is that physician specialists from four different organizations are providing input for their treatment and care. It is the equivalent of getting multiple second opinions without having to leave the community. To achieve national accreditation as a Breast Center of Excellence, our program must operate at the 75th percentile (top 25%) of participating cancer treatment facilities in the country and provide the following:
- A multidisciplinary, team approach to coordinate the best care and treatment options available
- Access to breast cancer-related information, education, and support
- Breast cancer data collection on quality indicators for all subspecialties involved in breast cancer diagnosis and treatment
- Ongoing monitoring and improvement of care
- Information about clinical trials and new treatment options
According to NAPBC, “Accreditation by the NAPBC is granted only to those centers that are voluntarily committed to providing the best possible care to patients with diseases of the breast. Each breast center must undergo a rigorous evaluation and review of its performance and compliance with NAPBC standards. To maintain accreditation, centers must monitor compliance with NAPBC standards to ensure quality care, and undergo an on-site review every three years.”
Full accreditation takes a minimum of three years to complete. It is an arduous process that is well worth the effort. To date, through the hard work of our participating physicians and ancillary staff, we have reduced the time from screening to treatment by 30%. This is exciting news, but there is more work to be done as we continually endeavor to improve care coordination between physician specialists for the benefit of our patients. We have a great team of physician leaders providing exceptional care for breast patients entered into our Breast Oncology Program. Our pursuit of accreditation as a Breast Center of Excellence is providing the tools to create a truly integrated system of care.
– MD, PC, FACS & Breast Surgeon –
Greetings, it’s the time of year again when we all make new resolutions and promises to ourselves and to others to do all sorts of things! The beginning of the year is always a great time to start new ventures and renew past resolutions. I can’t think of a better time than now to share a story with a new character in the Tri-Cities and introduce a new team. I have been in solo practice in the Tri-Cities for over 20 years! Yikes, where has the time gone? I was asked the other day if I had a “story” to tell. We all have stories to tell and could all probably write a book if given the opportunity and talent. Suffice it to say, there are many stories, as we all have different paths that have led us to where we are now. I have seen alliances form and then dissolve. People come and people go. This particular story is about passion and resolve to do the best we can under the circumstances and provide the most comprehensive and compassionate care possible in our community.
It started many years ago when I became interested in
diagnosing and treating women with breast cancer. The road
has taken many turns and there have been bumps along the way. Several years ago I attended a conference of plastic surgeons and was one of a few surgeons in the audience that was not a plastic surgeon. The conference was about the partnership between surgeons treating women with breast cancer and plastic surgeons helping women recover their body image after cancer surgery. This is a unique relationship and vital to the quality of cancer care and recovery. Surviving cancer is not easy. Being told you have cancer is not easy. Telling people they have cancer is not easy. But having a team of physicians that have a cohesive network and process in place with years of experience and the ability to work together towards the common goal of providing the best the field has to offer is reassuring. So, I stood up at this meeting and said “I need a plastic surgeon” in the Tri Cities and was approached after the meeting by one of the presenters, Dr. Karen Vaniver. This began a relationship that spanned several years during which we shared many patients and developed mutual respect. At last, I dogged her long and hard enough that she has finally moved here and started practice here in the Tri-Cities.
– MD,FACS, Lourdes Plastic & Reconstructive Surgery –
In 2006, as the result of a midlife crisis, I moved my life and my practice to Puget Sound. Prior to leaving the Midwest in November, 2005, I had a normal mammogram and a normal exam. In March, 2006, I was diagnosed with triple negative, BRCA-1 positive breast cancer. This disease had taken my grandmother, attacked my mother in both breasts, caused my sister to lose the ability to have or nurse her own children, and was now pulling me up out of my new life into an abyss of fear. After biopsies, port placement and removal for sepsis, chemotherapy, hand- foot syndrome, bilateral mastectomies, bilateral immediate reconstructive flaps, abdominal wall dehiscence, delayed flap hemorrhage, hysterectomy, and a revision surgery to my breasts and abdomen, I found myself bald, fat, unemployed, and alone. My best friend and my father both died that year. My beloved dog, Sam, was killed in front of me. Even writing this now, so many years later, I am shocked that one person could experience so much loss.
The ride from hell is a very slow elevator. After a year and a half off work, I slowly returned to work, doing part time cosmetic surgery and then segued into full time private practice at a major medical center in Seattle. For six years, I threw my heart and soul into work, learning more and more about evolving standards in breast reconstruction and cosmetic surgery. I did clinical research, presented at meetings, and received public recognition for my work. Midway through that period of time, I performed reconstruction on a redheaded 70 year old cheerleader from Hermiston, Oregon. Fortunately for me, she was very happy with her result, and reported back to her breast surgeon, Dr. Laurie Evans. Shortly thereafter, Dr. Evans and I connected at a meeting and began to collaborate on cases. The 7-8 hour round-trip commute was hard on patients, and so, the very persistent Dr. Evans reeled me in over the course of two years. I am embarrassed that it took so long, because what I really wanted was to work where I was wanted and needed, to know my patients as people, to work with collaborative individuals, to be involved in strategic planning and program development, and to have a healthy quality of life. It was all here waiting for me.
“I respect Laurie and she has become a cherished friend. Diamond earrings, friends, breasts, and the best surgeons come in pairs.”
You might wonder why it is so important that the breast surgeon and the plastic surgeon have to work closely together. We collaborate on the best treatment for your cancer and your body type. We decide whether you would best be served by unilateral or bilateral mastectomy. We determine if you are a better candidate for early or delayed reconstruction. We look at your possible need for radiation and evaluate what type of reconstruction is best for you. We plan the incisions together, taking into account the need to remove lymph nodes. We support each other, and you, during your post-operative care and recovery. Most importantly, we are active listeners, and we take your values into account. Since our offices are in the same clinic, it is very easy for us to see patients and collaborate together.We attend breast cancer conference together, in order to collaborate on the best possible treatment available for you.
I respect Laurie and she has become a cherished friend. Diamond earrings, friends, breasts, and the best surgeons come in pairs.
– MD, PC, FACS & Breast Surgeon –
This alliance has been a long time in coming and I am still in solo practice. I enjoy working with the many fine practitioners in this community and I am thrilled to have Dr. Vaniver as part of our team. We are developing a Breast Center of Excellence under the umbrella of the Tri-Cities Cancer Center and we are proud to be supported by all three hospitals in the area. There are many challenges ahead, but ask anyone and they will tell you I’m a bit headstrong and we will persevere until we become nationally recognized and accredited by the National Accreditation Program for Breast Centers.
Dr. Vaniver is a breast reconstruction specialist who can also see you for numerous aesthetic plastic and reconstructive surgical and non-surgical procedures.
she can see you for
- Botox – Cosmetic & Migrane Treatment
- Breast Augmentation
- Breast Lift
- Breast Reconstruction
- Breast Reduction
- Spider Vein Therapy
(509) 546-8405 or email us to schedule an appointment
7425 Wrigley Dr. Suite 204 in Pasco
Here’s some information from NAPBC, the National Accreditation Program for Breast Centers, the organization for which we are currently seeking accreditation. Learn more from their newsletter by following the link below.