Tom Fallon, now 69, felt a lump in his left breast while taking a shower about a year ago. The Florida retiree didn't think much of it at all -- at first.
Within a few months, the lump grew sore and larger, so he went to see his internist. He quickly learned he had breast cancer and was scheduled for a mastectomy almost immediately. But his family urged him to seek a second opinion.
"I didn't even know men could get breast cancer. I work out, I eat healthily. This was a shock," Fallon said.
Then he met Dr. Katherina Zabicki Calvillo, a breast surgeon and founder of New England Breast and Wellness in Wellesley, Mass. She spent 16 years as a breast surgeon at Boston's Dana Farber Cancer Institute before opening her practice earlier this year.
Calvillo's clinic is one of a handful of breast health centers popping up across the country. Her practice focuses on breast health, from estimating cancer risk across a lifetime to managing screening and treatment for people with breast cancer and people concerned about their risk for developing breast cancer. She performs exams, genetic testing, breast surgery and biopsies, all of which are typically covered by insurance.
She recommended that Fallon try hormone-blocking therapies to shrink the mass so the lump could be removed, but the breast could be spared. His doctors were open to the suggestion, and he is now cancer-free and did not lose his left breast.
Fallon also underwent genetic screening, which could have been potentially lifesaving for his brother, sisters, sons and grandsons if he had tested positive for any cancer genes. Fortunately for all involved, he did not.
One-stop breast cancer care
When people come to see Calvillo, she performs a formal breast cancer risk analysis to see if genetic testing is needed. If it is, she offers testing for a full panel for 77 cancer-causing genes. These genes may increase the risk for a host of other cancers, including colon, breast, ovarian, pancreatic, brain and prostate.
"It's no longer just the two breast cancer genes that we look for," she noted. "I also calculate every woman's lifetime breast cancer risk, to tell us if we need to add additional breast cancer screening and preventative medicine."
Some patients at high risk will need additional imaging. Some people come in for a second opinions, while others see her more regularly for treatment and close surveillance.
"At 50 years of age and seen at an academic primary practice, I never had a formal cancer risk assessment nor a lifetime breast assessment done on myself," Calvillo said. "We need to be proactive, not reactive."
When Kathy M., 54, a self-employed retailer who lives outside of Boston was diagnosed with aggressive triple-negative breast cancer in January, she saw several surgeons before meeting Calvillo. Kathy underwent chemotherapy to kill errant cancer cells before having a mastectomy. She eventually chose Calvillo to do a nipple-sparing mastectomy with hidden scars. She is now using tissue expanders to make room for breast implants. Calvillo helped her understand the pros and cons of each procedure.
Kathy's initial doctors wanted to see her yearly for a follow-up, but she feels more comfortable seeing someone more frequently to make sure the cancer is still at bay, which is why she sees Calvillo several times a year.
There's not a one-size-fits-all solution for breast cancer surveillance, Calvillo said.
The most important thing is that people with or at risk of breast cancer get the best possible care, say breast cancer experts.
"As breast cancer care becomes more and more specialized, and as more patients take a proactive role in their care, specialized care is a definite trend," said Dr. Marisa Weiss. She is the chief medical officer and founder of Breastcancer.org in Ardmore, Pa.
"We believe each person challenged by breast cancer deserves the best care possible -- which means the best in each specialty: radiology, surgery, pathology, radiation oncology, medical oncology, tumor genomic and inherited genetic testing, etc.," Weiss said. “This may be available in a specialty clinic or in a hospital -- depending on where you live, what your medical insurance coverage will allow, what is culturally comfortable, and where you feel listened to, understood, respected and cared for."
Cancer centers are the best place to be treated for cancer, said Dr. Sarah Cate, director of the Breast Surgery Quality Program and the Special Surveillance and Breast Program at Mount Sinai Health System in New York City. "We are able to do same-day imaging, offer genetic counseling and testing, and have more resources than a private practice."
That said, there is a role for these niche breast health practices.
"There is a patient population who needs need a bit more time to understand their screening options or the next steps after an abnormal mammogram," Cate said. "Many primary care physicians or obstetricians-gynecologists don't have the time to go over all of these concerns with their patients."
Breastcancer.org offers more on gene testing for breast cancer risk.
SOURCES: Tom Fallon, breast cancer patient, Bradenton, Fla.; Katherina Zabicki Calvillo, MD, founder, New England Breast and Wellness, Wellington, Mass.; Kathy M., breast cancer patient, Boston; Marisa Weiss, MD, chief medical officer, founder, Breastcancer.org, Ardmore, Pa.; Sarah Cate, MD, director, Breast Surgery Quality Program, Special Surveillance and Breast Program, Mount Sinai Health System, New York City