Plan of Attack

The expert, all-female breast care team at Inova Alexandria Hospital — from surgeons and radiologists to dieticians, a genetics counselor and nurse navigators — ensures that patients feel supported every step of the way.

Receiving a diagnosis of breast cancer can be overwhelming, not to mention scary. That’s why the health professionals at Inova Alexandria Hospital (IAH) provide a high level of treatment, insight and resources that can make a significant difference in physical, emotional and medical outcomes.

Inova Schar Cancer Institute at IAH has an expert, all-female breast care team — from surgeons and radiologists to dieticians, a genetics counselor and nurse navigators — that helps patients feel supported every step of the way. Most medical members of the team are fellowship-trained, which means they have received an additional year of training in their specialties in order to master those areas of medicine. Breast cancer patients, as a result, will have the benefit of more in-depth education and experience from every professional on their care team.

Although every case has unique factors in terms of treatment plans, here are the steps that are part of Inova Alexandria’s approach to breast cancer:

Step ONE: Mammogram imaging to detect anomalies.

Mammograms are an essential part of preventive care, and if a routine screening shows abnormalities that need more in-depth examination, a patient will undergo additional screening. Results are sent to IAH’s breast radiologist, Nadia Shah, MD. “Our job is to interpret what we’re seeing, and either take more mammogram images or do an ultrasound,” she says.

Dr. Shah brings extensive experience to her role at IAH. She did fellowship work at Cleveland Clinic — one of the country’s most prominent academic hospitals — and Ellen Shaw de Paredes Institute for Women’s Imaging, a renowned women’s health practice specializing in breast imaging and breast cancer diagnosis. Dr. Shah is particularly passionate about getting younger women screened since they tend to have more aggressive tumors than those at higher risk, she says.

Step TWO: If cancer is suspected, a biopsy of the affected tissue will be done.

If Dr. Shah is concerned about potential cancer, she refers the patient to IAH surgeon Sara Bruce, MD, who specializes in women’s health and breast surgery in particular. She will do a biopsy, which means taking a small selection of tissue from the area in question so that it can be examined to determine whether it’s cancerous. Many times, a biopsy reveals that the mass is a cyst or otherwise non-threatening condition.

Dr. Bruce gained her expertise through a breast surgical oncology fellowship at Memorial Sloan-Kettering Cancer Center in New York City after training in general surgery at Georgetown University Hospital.

Step THREE: A tumor board discusses treatment and resource options.

If the mass is determined to be cancer, a team of oncology professionals will discuss the patient’s treatment plan. Every Wednesday, they meet as a “tumor board” to discuss newly diagnosed and ongoing cancer cases. Participants include radiation oncologists, medical oncologists, surgeons, nurse navigators, social workers, dieticians, a genetic counselor, lymphedema specialists and others involved in care.

“This team approach is very important for getting everyone involved in delivering the best and most customized care for each cancer patient,” says Junaid Abu, Director of Oncology Services at IAH.

Step FOUR: Cancer care is coordinated for different treatment types.

Since each treatment plan is unique, a patient may be facing chemotherapy or radiation, or both. She may need additional surgery before or after those treatments, or require endocrine therapy that focuses on her hormones. No matter what path a patient is treading, IAH’s medical oncology department will be there to help them navigate what’s next.

Medical oncologist Margaret Howard, MD, adds that a patient may be referred to genetic counselor Rebekah Moore as well as dietician Debra Rowland. Basically, whatever it is she needs, IAH is there to provide the resources and care.

“My role is to understand what you need,” Dr. Howard says. “I counsel you on all the different aspects of screening and care that can come into play. Even after surgery and radiation or chemotherapy is complete, many patients continue to see me for years, sometimes decades.”

Much like her fellow team members, Dr. Howard brings a rich background to patient care. From volunteering at the Duke Cancer Patient Support Program to attending Georgetown University School of Medicine, she has always been passionate about the importance of counseling and support for cancer patients.

“It’s so vital for patients to know what resources they have, for themselves and their family members,” she says. “I’m proud of how much IAH has in place for breast cancer patients.”

For some patients, treatment will include radiation oncology, directed by Lonika Majithia, MD, who has extensive experience with multiple radiotherapy techniques. After completing her medical training at the University of New Mexico, Dr. Majithia served as chief resident during her radiation oncology residency at The Ohio State University.

The radiation oncology department at IAH offers the most technologically advanced therapy equipment available today — delivering powerful, targeted treatment to tumor sites while minimizing exposure to healthy cells. As a result of this type of precision, treatment is faster and more comfortable for patients.

Step FIVE: Nurse navigators provide guidance for typical challenges.

If a patient has breast cancer, she will be connected to a nurse navigator network that excels at getting to know what challenges she might face. Family members, too, have unique challenges that have to be addressed for ideal at-home care.

Whatever the issue might be, nurse navigators are there. “If you’re a breast cancer patient, you will never be alone; there will be a team in place to guide you through your cancer journey,” says Abu.

Nurse navigators serve as a resource for patients, helping with everything from coordination of care to facilitating community support groups, delivering surgery recovery instructions and offering tips on medication adherence.

For example, Gerry Higgins, oncology nurse navigator, helps those who are getting radiation for their breast cancer. She works with them to identify what they need before treatment so that the process is less stressful. “We try to get ahead of what needs to be put in place so patients can feel confident and comfortable going into treatment,” she says.

Step SIX: Support groups and recovery services after treatment.

Funded mainly by donations, the Life with Cancer® program is open to everyone with cancer, even those who aren’t being treated at Inova. The program includes educational classes on topics like surgery and recovery, and has a number of support groups.

Life with Cancer isn’t just for those going through treatment; many people find the support groups helpful for post-treatment, too. As difficult as diagnosis and treatment might be, it’s the time afterward that can sometimes be the most challenging, says Carrie Friedman, oncology nurse navigator.

“Inova is a resource at every stage of a breast cancer journey,” says Friedman. “We are here to support patients and caregivers in whatever is needed.”

Expert Cancer Treatment in Alexandria, VA

Patients at Inova Alexandria Hospital (serving Alexandria City, Fairfax County and beyond) have access to the full spectrum of cancer care, including surgery, radiation therapy and chemotherapy, as well as dietary, emotional and support services essential for effective cancer care. Learn more about our cancer treatments and resources at inova.org/iahcancer.