Improved treatments and early detection have increased survival rates for breast cancer—depending on the type of breast cancer—to more than 80 percent. And with the increase in breast cancer survivors, advancements in procedures that enhance cosmetic outcomes have resulted in significant improvements in the quality of life for survivors. In her more than 30 years as a physician, Helen Pass, MD, chief of breast surgery at Perlmutter Cancer Center at NYU Langone Hospital—Long Island, has witnessed—and helped to shape—a sea change in the way breast cancer is treated.
“When I was training, the prevailing school of thought was for patients to be thankful that they were alive, with the appearance of the breast a secondary consideration,” said Dr. Pass, who joined NYU Langone Health’s Perlmutter Cancer Center in June. “Now that more women live than die from breast cancer, we are paying greater attention to their quality of life.”
Dr. Pass, a member of the Department of Surgery at NYU Grossman Long Island School of Medicine, performs oncoplastic procedures, which combine plastic surgery and cancer surgery to achieve the best treatment and cosmetic outcomes for people with breast cancer.
“I always say I don’t want my patients to survive, I want them to thrive,” Dr. Pass said. “I want to get them back to everything they enjoyed and did before their diagnosis. And whether that’s golf or tennis or gardening, I don’t want to do such a big surgery that they can never go back to what they love.”
Before joining NYU Langone, Dr. Pass was a breast cancer surgeon at Stamford Health for 11 years, where she was co-director of the Breast Center and chief of breast surgery. Her training includes a medical degree from the University of Michigan Medical School, residencies at University of Texas Health Science Center and Georgetown University Hospital, and a medical staff fellowship at the National Cancer Institute at the National Institutes of Health.
“Perlmutter Cancer Center has world-class clinicians and offers exceptional care,” Dr. Pass said. “I am honored to be here and have them as my colleagues.”
Dr. Pass treats patients with both early- and later-stage breast cancer, and she has an interest in treating patients who have a genetic predisposition to cancer by using newer techniques such as nipple- and skin-sparing mastectomies, procedures that conserve some of the skin or nipple normally lost during a mastectomy. Dr. Pass, in conjunction with reconstructive surgeons, also performs procedures that restore sensation to the breast after a mastectomy using innervated (nerve-supplying) skin flaps.
“The whole reason I enjoy breast surgery is that every woman’s size, shape, priorities, and goals are different, and the challenge for me is to incorporate all of that into the patient’s primary goal,” Dr. Pass said. “Do they want one surgery and back to full activity, or several surgeries that give them the best aesthetic outcome? Sometimes the answer is somewhere in between.”
Transitioning from “One-Size-Fits-All” Breast Cancer Treatment
Dr. Pass said when she began her medical training, the conventional wisdom was to treat people with the most treatment they could tolerate. Today, the trend is to provide people the least treatment that is effective. That includes determining which patients can forgo a major surgery and how to offer them the right amount of treatment for their cancer. For example, lymph node surgery, which is used to determine the extent of a cancer’s spread, has evolved over the years, Dr. Pass said. Full lymph node dissections used to be the norm, but now oncologists might only perform sentinel node biopsies and, in some cases, no longer need to remove any lymph nodes.
“We never used to give people treatment before surgery. Now some patients benefit from endocrine therapy or chemo- or immunotherapy before surgery,” Dr. Pass said. “It is important to determine who’s the right candidate for neoadjuvant therapy so that we can downsize their tumor. We can also learn from the response of their tumor to treatment what the best treatment will be after surgery. Sometimes patients end up getting less treatment because they are exceptional responders, and sometimes we find out that they didn’t respond very well and we need to increase our planned therapy to appropriately treat them.”
Driving Policy Changes That Look Ahead
During her career, Dr. Pass has played a leading role in developing policy and guidelines for treating breast cancer and for training fellows to become breast surgeons. She was a founding member of the National Accreditation Program for Breast Centers (NAPBC), served on its executive committee, and wrote some of NAPBC’s original guidelines. She was also a member of the executive committee of the Commission on Cancer, which sets the policy for cancer centers.
“I have always helped to draft policies and procedures that look forward to not what we need now, but what is going to benefit patients the most in the future,” Dr. Pass said.
As an example, Dr. Pass wrote the initial training recommendations for breast fellowships for the American Society of Breast Surgeons, where she served as past president and board chair. Breast fellowships, Dr. Pass said, did not exist when she began her training. It was during her surgical oncology fellowship that she developed an affinity for treating people with breast cancer.
“Fellows shouldn’t have to do two years of surgical oncology training if they only want to specialize in breast surgery,” Dr. Pass said. “As a result of the efforts of a number of organizations, including the American Society of Breast Surgeons, the Society of Surgical Oncology, and the Susan G. Komen Breast Cancer Foundation, there are now 37 breast fellowships in the United States.”
Treating Survivors and Older Patients
Dr. Pass plans to establish a survivorship clinic at Perlmutter Cancer Center—Mineola so breast cancer survivors have a place to go where they can get the specialized care they need. Breast cancer survivors need follow-up care, but they need evidence-based follow-up, Dr. Pass said. Depending on the medications they are taking, annual bone density scans could be important. In addition, educating survivors about lifestyle modifications such as diet, exercise, and alcohol intake is crucial for reducing risk of recurrence.
In addition, Dr. Pass sees the need for a clinic for people at high risk for developing breast cancer due to genetics or family history. The patients need enhanced surveillance and the same kind of education about reducing risk that survivors do, Dr. Pass said.
Although younger people are increasingly diagnosed with breast cancer, Dr. Pass is seeing an increase in older patients as well. Geriatric oncology is another area that Dr. Pass would like to see expanded on Long Island. The oldest patient Dr. Pass operated for was 103 years old.
“There is a lot that can be done for patients who are diagnosed at an advanced age,” Dr. Pass said. “They often hide their lumps until it is too late because they assume that they have no choice but to have surgery and wake up without a breast. But we have lots of choices now.”