Image courtesy of UC Irvine Health
Dr. Alice Police has been a surgeon for 30 years and is a pioneer in her field, having founded her own breast treatment center and currently holding the position of Regional Director of Breast Surgery for Northwell Health in Westchester County, NY. The surgeon provided us with a review of some of the most effective treatment technologies for breast cancer, and how the right combination of treatments can potentially have a dramatic reduction in the overall treatment burden placed on a patient.
“Early in my career, I discovered there was a huge need in the area of breast surgery for somebody who could really take charge of the entire patient process,” shared Dr. Police. “This can often be a very fragmented process and patients were very hungry for somebody to take the lead and get them through breast cancer treatment in a timely fashion.”
In that light, the surgeon started by sharing how she is utilizing intraoperative radiation therapy (IORT) in cases for which the data shows IORT is clearly the better technology compared to whole breast radiation. “Once patients know about IORT as something that does not have the toxicities involved with whole breast radiation, they start really demanding the technology,” the physician added.
Dr. Police also highlighted the benefits of radar-guided localization to direct her to a tumor, instead of the traditional wire localization method. She explained that the problem with wire localization, which has been used for 3 decades, is that besides it’s often inaccurate, it can also disrupt the entire surgical process. “Since wire localization must be done the morning of surgery, it causes havoc with the OR and imaging schedule,” she explained. “With radar-guided localization, you can uncouple the surgery from the radiology schedule. It used to be that I could never do a breast cancer case prior to 11 a.m., while now I can do a breast cancer surgery at 7:30 in the morning, and can do more cases in a day overall.”
MarginProbe delivers significant new impact in the OR
Dr. Police then pointed to the success she has had working with a technology she adopted very early in its lifecycle. “I was attending a breast cancer symposium and, over in the corner against the wall, I see a poster for this device called ‘MarginProbe.’ When I learned how it worked I realized that this was the most important development at the symposium. The more I learned about the technology, I knew I wanted to be part of the U.S. clinical trial.”
MarginProbe works by helping identify clear margins and reduce re-excision rates. “During the clinical trial, I ended up being the highest enrolling single surgeon in the entire U.S.,” said Dr. Police. “One of the reasons we were so successful is that MarginProbe is a real patient pleaser. Patients don’t like the idea that their doctor might not get clear margins. And as a physician, discussing the need for re-excision with a patient is one of the most painful conversations I can have. That’s why I was just thrilled to be part of the development of this technology and I continue to use it as my standard of care.”
“Like all tools, there is a bit of a learning curve with MarginProbe,” the surgeon continued. “You need to ink your own specimens, and you need to have a good relationship with your pathologist. But the impact on patients, especially when it is used in combination with other treatments, makes the effort so worthwhile.”
The surgeon went on to provide an example in real terms of the combined impact of MarginProbe when used with IORT. “In about 15% of cases, the final pathology would show that there is not a clear margin, and we would need to re-excise and do whole breast radiation,” Dr. Police explained. “Now, we have MarginProbe improving our visibility on the margins and IORT cutting down on the need to do something as drastic as whole breast radiation. With these synergistic technologies, we can make that 15% figure even smaller.”
Then Dr. Police made a very powerful statement, sharing that “With this approach, sometimes a patient can even go from diagnosis to cure in 7-10 days.”
Defining new technologies’ impact on patients’ lives
Dr. Police further explained how such a significant development is possible. “I had a recent patient; my first patient in California to have all three technologies. She was a young mother with three kids and didn’t have lots of time to take off work. We treated her with radar-guided localization, IORT and MarginProbe, and she had her breast cancer diagnosed and treated in about 10 days.”
“We had another lady who was in her 80s; sort of the opposite ends of the spectrum in terms of the demands on her life,” the surgeon continued. “She was diagnosed with cancer about two weeks prior to Thanksgiving and her whole focus was being able to spend the holidays with her grandchildren. We were able to treat her with the same three technologies. She had clear margins and had all of her necessary radiation in a 20-minute treatment during the surgery. The result was that she was able to see her grandchildren on time.”
While Dr. Police is using MarginProbe for every lumpectomy case and 75% of her breast cancer cases overall, she explained that this approach will not be for every patient. “But as more and more patients are diagnosed early with very small cancers, it increases our ability to take care of it quickly and easily for them,” she said. “That’s a very rewarding thing for me that I get to help these people through the disease and on with their lives without a long drawn out process.”
“While these technologies don’t always fit into the right niche in the economics of health care, that’s a situation which is starting to change,” the physician concluded. “As we move from a fee-for-service economy to an ACO model, where you have to prove that what you do is better, I think these technologies will become more and more popular. Our healthcare system is starting to recognize that getting people through the process quicker and easier is good for society, good for health care and good for everyone!”
Alice Police, M.D.
Board certifications:
- Surgery – American Board of Surgery
Medical school
- Loma Linda University School of Medicine
Residencies
- University of California – Irvine Medical Center
- LAC – USC Medical Center – GME
Internships
- LAC – USC Medical Center – GME
Affiliations:
- North Shore University Hospital
- Northern Westchester Hospital
- Northern Westchester Hospital
- Phelps Memorial Hospital Center
- Northwell Health Physician Partners
Disclaimer: The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of Dilon.