Expert, Personalized Breast Cancer Care, Delivered with Compassion

By Jennifer Webster
Thursday, October 26, 2017

WellSpan Health specialists and other clinical staff provide advanced breast cancer treatments that help each patient achieve their goals, while fostering peace of mind.

Mammographer Korrie Wolf helps a patient prepare for her screening mammogram using the new 3-D technology available at WellSpan.

Offering a unique level of care in South Central Pennsylvania, WellSpan Health treats patients with breast cancer at its cancer centers in Adams, Lancaster, Lebanon and York counties. The programs in Adams and Lancaster counties are accredited by the National Accreditation Program for Breast Centers (NAPBC) — two among fewer than 30 in Pennsylvania so recognized — and other WellSpan cancer centers, such as the one in York County, are pursuing accreditation. Confirmed every three years, NAPBC accreditation establishes rigorous standards that practices must meet, including best clinical practices, community education, continuing medical education, leadership, research and the adoption of quality improvement metrics.

“The NAPBC accreditation tells patients and referring providers we practice state-of-the-art breast care,” explains Bill Piepgrass, MD, a WellSpan surgeon who specializes in breast procedures. “The vast majority of cases of breast cancer can be treated close to home, and having multiple centers nearby with NAPBC accreditation gives patients confidence we are using current practices and therapies in a quality manner.”

Advanced Treatment Options

Patients who turn to WellSpan Health for breast cancer care will find screenings, diagnostic techniques, treatments and follow-up care in accordance with the most recent national standards.

“For excisional biopsies and lumpectomies, we use standard needle localization techniques, and in York we can use a newer technology, the SAVI SCOUT device, which is a specialized radar clip that can be used to localize the targeted area for excision,” says Jillian Smith, MD, MPH, surgical oncologist with WellSpan. “This minimally invasive technique enables certain patients to avoid needle localization.”

In a recently added approach that is also welcome to patients, Dr. Piepgrass says, pathology results can be available the same day via a frozen section biopsy.

“When a woman comes to the imaging center with a suspicious lump in her breast, we can perform a needle biopsy and send the tissue to the pathologist that very day,” he says. “In 15 to 20 minutes, we can let the patient know whether she has cancer. We can then start a conversation about treatment immediately, rather than waiting a few days or scheduling another consultation.”

In terms of treatment, tissue-sparing partial breast radiation, as opposed to whole breast radiation, is available to patients. Additionally, many patients have the option to choose between mastectomy and breast-sparing lumpectomy. Chemotherapy is also customized to each patient’s situation.

“Depending on the tumor characteristics, we deploy oncotyping, genetic testing on the tumor itself, in cases in which that information may affect the patient’s chemotherapy treatment,” Dr. Smith says. “As for cosmetic procedures, we use oncoplastic reconstruction of lumpectomy cavities to minimize deformity in the breast. We have surgical techniques to reduce scarring and spare the nipple whenever possible.”

Broad Experience and Expertise

At WellSpan, providers from physicians to nurses to social workers bring high levels of training and clinical experience to the care of breast cancer patients.

“Our approach to biopsy has changed dramatically,” Dr. Piepgrass states. “What once was a surgical procedure is now a needle-guided outpatient technique, allowing us to essentially eliminate one surgery from the process.”

Another procedural advancement was minimizing lymph node sampling in the process now known as sentinel biopsy, in which only a small “sentinel” sampling of lymph nodes is taken. This reduces the danger of chronic lymphedema, he notes.

Dr. Smith brings a high level of expertise, as well. She is fellowship-trained in surgical oncology, board-certified in general surgery and complex general surgical oncology, and has specialized training in breast cancer surgery. And, she notes, each discipline, such as radiology or nursing, has its own accreditations, to which WellSpan’s clinicians adhere.

“One WellSpan Imaging location each in Gettysburg, York and Ephrata is a Breast Imaging Center of Excellence-certified facility,” she says. “That requires that all our radiologists, mammographers and technologists be specially trained and certified. Likewise, our pathologists adhere to specialized cancer protocols and have specific training. Our nursing staff meet the NAPBC requirement of having continuing medical education dedicated to breast care.”

“We have the resources to treat the patient as a whole, focusing both on the cancer and on optimizing quality of life.”
— Jillian Smith, MD, MPH, surgical oncologist with WellSpan

These providers work together across disciplines to provide a cohesive, streamlined experience for patients. For instance, a tumor conference gives providers from all disciplines — including imaging, medical oncology, radiation oncology, surgical oncology and pathology — the opportunity to interact and formulate a coordinated treatment recommendation for each patient.

“We function as a team of physicians and caregivers, guiding patients through the process,” Dr. Piepgrass says. “That journey may stretch over months or years, so we prioritize coordinating with patients and making it as smooth an experience as possible for them to get the most effective treatments in a timely and caring way.”

Patient-centered Medicine

Individualized care can mean many things: multiple treatment options, risk-reduction advice, or help with maintaining quality of life during and after treatment, for example. For most WellSpan patients, the point of connection between the many facets of breast cancer care is the nurse navigator.

“She can meet with or have contact with a new breast cancer patient at the time of diagnosis and helps them through all stages of treatment,” Dr. Smith says. “She can even go to appointments with them to be a support person and help them take notes and ask questions. She can coordinate resources such as dietary and nutritional services, financial counseling, support groups, and social work.”

After treatment, patients may enroll in survivorship programs that follow them into recovery. These programs help patients keep up with screenings and manage health risks.

“Breast cancer is one of the most common cancers confronting women,” Dr. Piepgrass notes. “Referring physicians should know that women who come to WellSpan will receive excellent quality of care in a coordinated and personal fashion close to home, according to the standards recognized by our NAPBC accreditation.”

To refer a patient for breast cancer care in Adams and York counties, call Dr. Smith at 717-812-7676. In Lancaster and Lebanon counties, call Dr. Piepgrass at 717-733-2055.