The Gazette is partnering with title sponsor Penrose-St. Francis Breast Care Center and ribbon sponsor Peak Vista Community Health Centers to bring you inspiring stories of local breast cancer survivors and a behind-the-scenes look at the care process from physicians, surgeons, nurses and volunteers throughout October.
There are as many surgical and treatment plans as there are patients diagnosed with breast cancer.
“We ask people to make pretty big decisions after receiving a breast cancer diagnosis, but we’re all about individualized care,” said Nicole Choy, MD, breast surgeon with the Southern Colorado Breast Care Specialists in the Penrose Cancer Center, part of the Centura Health Cancer Network, delivering advanced, integrated cancer care across Colorado and western Kansas.
“Everyone comes in to this with their own questions and preconceived notions from their experiences with a mother, an aunt, a neighbor,” Choy said. “I see a variety of responses in the decision-making process – some of it is valid, some of it comes from fear. That’s why it’s so important I spend time listening to my patients and understanding their voices and what they are basing their decisions on.”
Choy takes a multi-disciplinary approach to helping her patients make surgical decisions, working with oncologists to explain and recommend treatment options. “We build plans on a case-by-case basis; there’s not one plan that’s right for everyone.”
Many of Choy’s patients ask for her recommendation after understanding all the options. “I have to be balanced,” she said. For some with smaller tumors, Choy might recommend a lumpectomy, removal of the tumor and surrounding tissue. For those with more advanced, aggressive cancer, she might recommend a mastectomy, or removal of all the breast tissue. “It all depends on what the patient’s goal is.”
As new research on breast cancer surgery emerges, surgeons like Choy are able to develop more effective plans for patients. “We’ve seen a lot of changes in the treatment paradigm, including movement away from axillary dissection for node-positive disease,” she said. Traditionally, anyone with a sentinel lymph node that tested positive for cancer would opt to have a majority of the lymph nodes under the arms removed. “There have been some studies released that show this doesn’t necessarily lead to higher numbers of survival, so this allows us to pursue additional treatment options like radiation, endocrine therapy and chemotherapy.”
Biology is also playing a larger role in surgical and treatment options as cancer care and research develops. “We are paying more attention to genetics, keeping in mind a patient’s family history and genetic testing results when tailoring treatment,” Choy said. “Ultimately, we always tell they patients it’s up to them, they are in control of the process.”