The director of breast surgery at NYU Langone Health’s Perlmutter Cancer Center, Freya R. Schnabel, MD, focuses on breast cancer risk assessment, risk-reducing strategies, and the refinement of surgical techniques to treat the disease. Dr. Schnabel, a professor in the Department of Surgery, oversees vital breast cancer research and prospective databases that collect important clinical data and outcomes for people who have breast cancer. From 2016 through 2019, she has been named one of New York Magazine’s Best Doctors in New York.
Here, she discusses technology and her field’s rapid transformation, and why she’s happy to be on the team.
What’s it like to work in such a rapidly transforming area of breast cancer medicine?
Over the past 20 years, we’ve seen unbelievable progress in terms of early detection, better treatment, and much better outcomes in breast cancer treatment. That’s largely the product of intense investment in the United States. Don’t get me wrong: Forty-thousand women a year die of breast cancer. We haven’t cured the disease. But we’ve seen an incredible amount of science, and we’ve maximized patient outcomes while minimizing side effects and comorbidities.
What drew you to Perlmutter Cancer Center?
There’s such tremendous energy at NYU Langone. We have a clearly articulated vision for a way forward. Since I’ve been here, we’ve been designated a comprehensive cancer center by the National Cancer Institute. That’s huge.
What are some of the innovative devices you’re using in breast surgery today?
Perlmutter Cancer Center recently participated in a pivotal trial for FDA approval of the MarginProbe®, which is a device that supports breast-conserving surgery in the operating room by using electromagnetic waves to identify possibly cancerous tissue. So after you perform a lumpectomy, it signals in real-time if you need to take a little bit more tissue. Before this device was used, about 20 percent of patients who had lumpectomies would need second operations to remove additional tissue. But now, with this device, we have significantly lowered the re-excision rate, meaning people who have breast cancer are less likely to need additional surgery to remove cancerous tissue.
Another recent technical innovation is a wireless device called Scout that uses radar technology to locate nonpalpable breast abnormalities during surgery. Previously, a radiologist had to localize those abnormalities for surgery by inserting a long wire into the breast on the same day as surgery. But with this new method, we can insert the smaller chip on a different day than surgery. We’ve been using it for almost two years, since participating in the initial trials, and it’s much more patient-friendly.
What’s new in your research efforts?
One of the fabulous things about being at NYU Langone is having access to people from a variety of disciplines so we can really collaborate as a team. For example, I’ve been fortunate to work with Matija Snuderl, MD, who’s the director of molecular pathology, on a deep-dive look at triple-negative breast cancer. We’re hoping to get the funding soon for a whole genome sequencing and whole exome sequencing, looking specifically at the triple negatives as a population, and then couple some of that information with our cancer databases. There’s a lot to think about in terms of how to use advanced molecular techniques to better understand the nature of breast cancer and the nature of the patient.
Would you share a bit more about your databases?
When I joined NYU Langone from Columbia Presbyterian, we started a longitudinal database for patients with breast cancers who were newly diagnosed and treated here. We also established a parallel database for patients who were at high risk, whether because of family history, genetic mutations, or other high-risk conditions. This has provided us with a much more powerful research tool. We can now match tissues in our tumor registry with more details about a patient’s story—for example, how they were treated and their long-term outcomes. We’re also collaborating with other cancer centers on what variables we’re looking at, so we can share more data over time. We recently did a study looking at the tumor characteristics of people who have genetic mutations in genes other than from BRCA-1 and BRCA-2. When projects like these can be done with teams at a multi-institutional level, we can provide more significant amounts of data. I believe this is part of how we can continue moving the field forward.
When you reflect on your career so far, what makes you proudest?
My patients. I’ve learned something from every patient I’ve taken care of, from every experience. And I’ve been taking care of some of my patients for more than 10 years. They tell me about their children graduating from high school or getting married, and we marvel at these moments they could hardly even imagine when we met. It’s remarkable.
People must be grateful to you.
When people whom we’ve taken care of express gratitude, my response is always the same: I’m happy to be on the team. Yes, I’m doing something good. But I’m a part of it. Everybody’s participating: the patient, the oncologist, the radiologist, and many others.
Why did you decide to focus on surgery?
I liked the technical aspects in the operating room and the quick, direct impact. People were sick; we made them better. From the beginning of my surgical rotation at NYU School of Medicine, I loved that.
Did you always know you wanted to be a doctor?
No, but I do remember being interested in science and in helping people. I grew up in Astoria, Queens, in an environment where education and achievement were encouraged. My parents were immigrants, Holocaust survivors. I went to Stuyvesant High School, in one of the first few classes that admitted girls and then to Barnard College before NYU School of Medicine.
When did you begin to specialize in breast cancer?
During my surgical oncology service, I was assigned to patients with breast cancer. From the start, it was a complex and rapidly changing field. You needed to understand genetics, medical oncology, and radiation. You also had the opportunity to develop long-standing relationships with patients. That really appealed to me. So I started focusing on it, working first in breast surgery at Columbia Presbyterian in the early 1990s and then coming to NYU Langone in 2007.
Adapted from Grapevine, NYU School of Medicine’s alumni magazine.