“You have breast cancer.”
These are four words that no woman wants to hear. Dread, anger, confusion – a kaleidoscope of emotions swirls after diagnosis and before another feeling inevitably flickers to life: determination. The Cancer Center of Doylestown Hospital offers information, direction, the latest treatment choices, and the hope to match that determination. Advanced diagnostic technologies like breast MRI and digital mammography, along with the brand new Cancer Risk Evaluation Program (CREP) are part of the most comprehensive breast cancer treatment program available to women in our community.

CREP Launches in October
Through its affiliation with the University of Pennsylvania Cancer Network, Doylestown Hospital will launch the innovative CREP program at the Health and Wellness Center in Warrington at the beginning of October. Guided by physicians and nurses specially skilled in the diagnosis and treatment of breast cancer, CREP is a screening tool that helps to identify women with defects in the BRCA1 and BRCA2 genes that scientists linked to breast and ovarian cancer more than 10 years ago.

The thorough, personalized program assesses the risk of developing breast cancer in women with family histories of breast cancer, those under 50 years old who are diagnosed with the disease, and the worried well, too. “Through testing and counseling, many women who worry about breast cancer may find that our data shows their risk isn’t greater than average. Others will learn that they are indeed at higher risk and should be extra vigilant with screening and self-exams or other interventional options. All women will receive the very latest information, including what factors they can control to further reduce their risk,” says Eileen Engle, MD, the program’s medical director.

Searching Your Family Legacy
CREP participants buckle down to important homework before their first CREP appointment with Kathy Nellett, Breast Care coordinator and CREP nurse. Kathy sends along assignments in a thick packet. “We ask for family history of any type of cancer for both men and women on both sides of the family – and any history of male breast cancer, which is a red flag for risk,” she explains, adding that she requests a personal health history as well. Building a ‘pedigree,’ as the program calls it, helps round out a comprehensive picture of actual breast cancer risk.

After an initial visit to review the completed packet, Nellett and her colleagues assess whether further testing makes sense based on the patient’s history. If so, at a second visit Nellett draws several vials of blood for genetic analysis. Women who had blood drawn return for a third visit about six weeks later, bringing family members along to a physician-patient meeting.

If genetic defects have been identified, Dr. Engle addresses what it means for the patient as well as implications for family members such as sisters, brothers, daughters, and sons. She presents a wealth of breast cancer information and education, then discusses more intensive screening or prophylactic measures such as tamoxifen, a medication that may help prevent breast cancer development. Patients guide both discussion and plans for action, with some at-risk women opting for watchful waiting and others considering stronger measures like prophylactic mastectomies and oophorectomies (ovary removal).

One of the CREP program’s greatest contributions, however, may be its team approach. Learning you are at high risk for breast or ovarian cancer isn’t as frightening and lonely with a united front of skilled fighters arrayed on your side.

MRI and Mammography: Detection Partners
Early diagnosis of breast cancer leads to more effective treatments. The Cancer Center of Doylestown Hospital pairs CREP with the latest technology to expose this stealthy disease. Digital mammography has been available since 2001. This improvement over traditional mammography produces clearer images that can be manipulated and magnified for closer examination. Digital files also make it easier for physicians to share, store, and compare images from a patient’s previous mammograms.

For women already battling breast cancer, breast MRI – a complementary technology to mammography – can help physicians further customize treatment. “MRI offers a threedimensional view of the breast as well as information about blood flow to tumors or other abnormalities,” remarks Doylestown Hospital radiologist Richard Patt, MD, who emphasizes that no single imaging process shows everything in every patient, so breast MRIs can’t replace mammography or vice versa.

Overlying tissues don’t complicate MRI images, as they can with mammography, and image quality improves for those with breast implants or dense breast tissue. MRI flags some smaller lesions that could be missed by mammography. It also appears to help women recently diagnosed with cancer in one breast: in partnership with mammography, MRI often uncovers disease hiding in the opposite breast. The technology excels at revealing more aggressive cancers such as invasive ductal carcinomas, exposing these tumors with more than 95 percent accuracy.

“Like every imaging technique, MRI can produce false negatives and false positives that will need further investigation,” Dr. Patt points out. “It also can fall short in picking up slower growing cancers and ductal carcinoma in situ, a precancerous condition, which is why we recommend a combination of diagnostic technologies.” Dr. Patt was one of the early advocates of breast MRI and has shared his knowledge by authoring numerous journal articles and book chapters as well as lecturing and teaching internationally on the subject. A radiologist’s experience in reading MRI images is absolutely critical to getting good, reliable data from the scans, Dr. Patt advises, and patients shouldn’t be afraid to ask about the radiologist’s qualifications.

Hope Grows Through This One-of-its-Kind Program
At the Cancer Center of Doylestown Hospital, hope takes shape through caring specialists, committed patient advocates, and advanced programs and technology. “If the CREP program proves as successful as we believe it will be, it’s certainly possible that we’ll expand it to test for familial colon cancer genes,” Dr. Engle concludes. “There’s no other program like it in the area, and there’s room for growth.”

Gynecologist Eileen Engle, MD, is medical director of women’s services at Doylestown Hospital and newly appointed director of the CREP program. She is in practice at the Women’s Midlife Health Center in Warrington. Richard Patt, MD, is a radiologist and MRI specialist with Parlee and Tatum Radiology Associates. Kathy Nellett, Breast Care coordinator and CREP nurse, can be reached at 215-345-4871.