Breastlink is a network of comprehensive breast centers that specifically focuses on providing treatment and care to women with breast cancer. The Breastlink Medical Group was founded in 1995 by John Link, MD, and now operates 5 breast cancer centers in California (4 in Southern California). Today, Breastlink offers a team-based, patient-centered approach to care, as well as a focus on research into the causes of and the cure for breast cancer. Lori Kells-Rezabek, NP, PhD, of the Manhattan Beach, California, center tells us how Breastlink’s multidisciplinary team works and what is happening in the areas of breast cancer prevention, care, and research.
Breastlink has a philosophy of providing “Optimal Care” to women. Can you describe this philosophy and how it impacts your ability to provide personalized care to your patients?
Lori Kells-Rezabek (LKR): In addition to providers specializing in breast cancer who are at the top of their field, we have a whole array of services to ensure that we are providing optimal care.
We have a weekly Radpath conference in which the radiologists, surgeons, and medical oncologists participate. Cases of all new patients diagnosed with breast cancer are presented, treatment options discussed, and recommendations made for optimal treatment, including surgery, neoadjuvant versus adjuvant chemotherapy, and plastic surgery options.
We have a monthly Metastatic Tumor Board that meets and discusses complicated cases of metastatic breast cancer that includes a review of the history, radiology studies, and molecular profile. We then make further recommendations for treatment.
We have a monthly Metastatic Breast Cancer Support Group that meets with both the patients and their husbands to provide psychotherapeutic support. We have a Young Women’s Support Group for women with children that meets monthly.
We send 2 patients to the San Antonio Breast Cancer Symposium every year and then offer our findings and their impressions of the conference in an educational presentation every January.
But most importantly, we have a great team of professionals, including a breast medical oncologist, a breast oncology nurse practitioner, an oncology nurse, and an on-site oncology therapist, who evaluate and treat patients on a daily basis.
What are you excited about right now in the breast cancer field?
LKR: The breast cancer vaccine. We have a collaborative relationship with the University of Washington, which has developed a vaccine for women with HER2/neu–positive breast cancer. We have treated 20 patients to date with the vaccine, with overwhelmingly favorable results. A new clinical trial is planned that we will be participating in for women at high risk for relapse.
Caris molecular profiling. We have been working with a company called Caris that provides us with molecular profiles of our patients with breast cancer. These profiles provide us with potential targets of therapy that are based on the individual patient’s tumor and tell us what the best options of treatment are. Because breast cancer tends to change over time, we routinely repeat biopsies to monitor potential changes in estrogen and progesterone receptors, as well as in HER2/neu status, and obtain updated molecular profiling if necessary.
Research. We have clinical trials, and we select out trials looking for the newest drugs, diagnostic tools, and molecular tests available for women with breast cancer. We also provide research in the areas of quality of life and survivorship.
What are the most important lifestyle changes women can make for breast cancer prevention?
LKR: Maintaining a BMI (body mass index) under 25. It is important to maintain an ideal body weight, as obesity is the biggest risk factor for the development of breast cancer.
Exercise. Brisk walking for 30 minutes a day has been shown to decrease the risk of breast cancer by 15%. Four hours of strenuous exercise a week has been shown to decrease the risk of breast cancer by 25%.
Optimizing vitamin D. We check vitamin D levels every 6 months and recommend a vitamin D level of 50 or greater. We recommend supplemental vitamin D of approximately 4000 IU daily to keep levels where they need to be to help decrease risk of breast cancer.
Limiting alcohol intake. We recommend limiting wine or beer intake to less than 3 ounces a day, or an average of 21 ounces a week, as this has been shown to decrease risk of breast cancer.
Daily low-dose aspirin. We recommend taking 81 mg aspirin daily to decrease not only the risk of breast cancer, but also colon cancer, lung cancer, and esophageal cancer.
Any advice for nurses just entering the oncology field?
LKR: Working with women who have breast cancer is extremely rewarding. To be able to help and witness these wonderful women fight their courageous battle with this disease is an honor, and the most rewarding job one can imagine! From their diagnosis, to their staging studies and treatment recommendations, often including chemotherapy, I am there with them every step of the way, encouraging them, supporting them with education and experience, and helping them survive breast cancer.
We have a significant number of women who have been dealing with metastatic disease for 5, 10, and even 20 years, and done so with such courage and grace. I am privileged to be included on their journey. That is the best part of my job, to be able to witness how women deal with their diagnosis and their treatment every day, all the while juggling their work, their relationships, and their families. It is the most rewarding job you can have, to make a difference in someone’s life, and ease their struggles with this disease.
What is a Survivorship Program?
LKR: We have developed a Survivor - ship Program here at Breastlink that starts the minute the patient calls for an initial consultation. From our expert breast cancer intake advisor (a breast cancer survivor herself), who collects all the necessary information to provide optimal care, to the breast cancer team, we are considering survivorship issues. From deciding the best referral, whether it be to the surgeon or the medical oncologist first, we are paving the way for the breast cancer patient to be a survivor in the best possible way.
We consider all issues, and take into account the age of the woman, and recommend treatment based not on age but on quality-of-life issues. We also take into account fertility issues in women of childbearing age.
Once women have completed their treatment, they return to their lives with the tools they need to survive breast cancer.
What does it mean to be a community- based medical group conducting research?
LKR: We are the first nonhospital and nonacademic medical group conducting breast cancer research. We are also helping to develop the tools and treatment options for targeted breast cancer therapy while looking at the molecular composition of tumors and their biomarker expression patterns.