BY MICHELLE TALSMA EVERSON
W hen a patient is first diag-
nosed with breast cancer —
or even suspects the disease
— there are often more questions than
answers. However, through Banner
MD Anderson Cancer Center’s compre-
hensive breast cancer program and its
top-of-the-line screening and diagnos-
tic imaging tools, women are able to get
their questions answered and rapidly be
on the road to treatment if necessary.
“Patients with breast symptoms are
frequently and justifiably worried, but
when we explain our imaging findings
to them or explain what to expect dur-
ing a diagnostic procedure, it results
in a less intimidating experience,” says
Dr. Vilert Loving, a board-certified
radiologist who specializes in breast
imaging and diagnosis at Banner
MD Anderson Cancer Center.
Loving explains that the Women’s
Imaging Center at Banner MD Anderson
has a myriad of screening and diagnostic
tools available to patients seeking
everything from annual screening
mammograms to diagnostic testing
and procedures.
3D TOMOSYNTHESIS3D tomosynthesis, commonly known
as a 3D mammogram, is one of the imag-
ing center’s latest tools—the FDA just
approved its clinical use last year.
“3D tomosynthesis examines the
breast from multiple, different view-
JUNE 2012A PUBLICATION FOR COMMUNITY PHYSICIANS
View to a cureCutting-edge imaging tools offer women more choices — and chances — in the fight against breast cancer
Dr. Vilert Loving stands by the 3D Tomosynthesis equipment. It is the newest imaging technology for screening mammograms.
INSIDE3 Know the code4 What’s Happening at Banner MD Anderson
Cancer Center5 Advancing the treatment of cancer
6 Effective surgical techniques for melanoma7 Changing the way doctors treat cancer8 Introducing Banner MD Anderson physicians
2 JUNE 2012 ROUNDS
points,” Loving says. “A conventional
mammogram looks at the breast from
two viewpoints, while the 3D tomo-
synthesis shows multiple angles by
moving in an arc around the breast.
This provides the radiologist with
more information and confidence in
finding abnormalities.”
While the most effective use of
the 3D tomosynthesis is still being
decided, Loving said that the center
has so far found it most useful for
women seeking routine screening
mammograms to distinguish normal
overlapping breast tissue from true
abnormalities. It has also been helpful
to fully characterize disease in some
patients’ diagnostic mammograms.
He adds that the center has the only
3D mammogram he knows about in
the East Valley and one of the few
in the state.
BREAST MRIAnother stand out series of instruments
that help patients to prevent or detect
cancer are the center’s MRI tools.
In addition to MRI biopsy, the
Women’s Imaging Center utilizes
advanced MRI technology to screen
high risk patients or to evaluate cancer
in patients who have already been
diagnosed, according to Loving.
“In general with MRI, the stronger
the magnet, the better the image. We
have a 3T magnet which is the best that
is clinically available. Many centers
employ a 1.5T magnet or lower,” Loving
says. “Our MRI images are very good;
they are better than a mammogram for
finding breast cancer. MRIs are best
used for screening higher risk patients
and in some patients who already have
a cancer diagnosis to determine the full
extent of disease in the breast.”
Loving adds that, while the images
taken by a high-powered MRI are often
“noisier” (meaning harder to read),
Banner MD Anderson works closely
with a physicist to clear the noise
Comprehensive care for breast cancer patients
Banner MD Anderson Cancer Center’s Comprehensive Breast Cancer Program provides the full range of medical care and support needed with a breast cancer diagnosis. The medical team includes medical oncologists, breast surgeons, reconstruction surgeons, radiation oncologists, radiologists and additional clinical and support staff. The program also offers beneficial support services to women in every stage of their breast cancer treatment.
Mary Cianfrocca, D.O., F.A.C.P., the director of the breast cancer program, says that support services help to “pro-vide better care in the long run.” Some of these services include:
• Undiagnosed Breast Clinic, for women who may have an abnormal finding but do not have a confirmed cancer diagnosis
• Clinical nurse navigators who lead patients through the system of care
• Wellness activities and support groups
• Clinical Cancer Genetics Program• The Boutique of Hope, which helps
women who have undergone mastectomies or other treatments to feel better about themselves
• Lymphedema therapy, which helps to reduce lymphatic swelling during treatment
• Palliative care, which can help patients manage pain
• Other unique offerings like nutritionists and weight loss programs for breast cancer survivors
“The wonderful thing about these support programs is the ability to offer so many diverse services in one location with the ultimate goal of caring for the whole person.” Cianfrocca says.
To learn more, visit BannerMDAnderson.com.
Physician Phone NumbersSchedule a mammogram – 480-543-6900Undiagnosed Breast Clinic – 480-256-3433Refer a patient – 480-256-3433
and maximize the picture — mean-
ing clearer images and better patient
results.
DIGITAL MAMMOGRAPHY AND DIAGNOSTIC TOOLSThe Women’s Imaging Center also
utilizes digital mammography, which
is similar to traditional mammogra-
phy, but provides a crisp digital image.
“Digital mammography has been
shown to be advantageous for younger
people in their 40s,” Loving says.
In addition to state of the art
imaging technology, the center of-
fers a wide array of diagnostic tools,
including: different types of biopsies
(ultrasound guided, stereotactic and
MRI), breast ultrasound, cyst aspira-
tion, needle localization, lymph nodes
biopsy, and more.
To refer a patient to Banner MD An-derson for a screening mammogram or more extensive diagnostic testing, please call (480) 543-6900. Patients may also call this number directly to schedule an appointment.
Dr. Mary Cianfrocca, director of the breast cancer program.
BannerMDAnderson.com 3
BY JAKE POINIER
The Human Genome Project
was completed in 2003, but The
University of Texas MD Anderson
Cancer Center had begun integrating
genetics into care plans for cancer pa-
tients in the mid 1990s, when two breast
cancer genes, BRCA1 and BRCA2, were
discovered. With other cancer genes
subsequently identified, the understand-
ing of the relationship between cancer
and our genetic code has continued to
progress—with implications for screen-
ings as well as treatment. The longstand-
ing work in genetics in Houston is now
benefitting patients in Arizona at Banner
MD Anderson Cancer Center.
“There are primarily two popula-
tions of patients we see in our clinic,”
said April O’Connor, a certified genetic
counselor and the genetics program
coordinator of the Banner MD Ander-
son Clinical Cancer Genetics Program
in Gilbert. “Those who currently have
cancer, and those who are healthy but
concerned about their cancer risk.”
The clinic’s goal is to determine
whether there is a hereditary predis-
position to a patient’s cancer—which
occurs in about 5 to 10 percent of
cases—or if it is sporadic. The distinc-
tion is critical: Hereditary cancers may
react differently to treatment, and be
more aggressive, which could change
the protocol for treatment options.
“If someone has hereditary breast
cancer, they have a much higher chance
of recurrence in the other breast, about
40 to 60 percent,” O’Connor said. “If
it’s sporadic cancer, then it’s only 2 to
10 percent. It makes a difference in
whether you’d consider a prophylactic
mastectomy of the other breast, versus
just monitoring by screening.”
Genetics program offers new insights into screening for and treating cancerKnow the code
GENES AND SCREENSScreening protocols for people with a
genetic predisposition for breast cancer
have changed in recent years as well.
Mammograms once a year for individu-
als over 25, or individualized based
on the youngest cancer diagnosis in
the family, now can be supplemented
every six months with MRI scans for
improved detection.
Colon cancer is another case in
which genomics also may affect the
screenings. A full colonoscopy will likely
take place earlier, around age 20-25,
to assess for any polyps or cancers.
While genes that cause ovarian cancer
are known, diagnosis is more difficult
because the ultrasound and blood test
screening results are not as definitive,
and the tumors are often fast growing.
TESTING, TESTINGPrior to any testing, genetic counsel-
ing thoroughly examines family and
personal history. Taking into account
cancer at early age, rare forms such
as male breast cancer, or two dif-
ferent types of cancer in the same
individual, clinicians look at risk
models that indicate the likelihood of
a genetic mutation. If testing is per-
formed, the results come in within
two to three weeks.
Although genomics has come a long
way in the past two decades, there are
still gray areas, since not every cancer-
causing gene has been identified. “You’re
not always going to get a definitive
answer,” said O’Connor. “But even if you
learn you’re negative for the most likely
gene, you’ve checked something signifi-
cant off the list of possible causes.”
Reading your genesTo refer a patient to the Clinical Cancer Genetics Program at Banner MD Anderson Cancer Center, please call (480) 256-3433. Patients may also self refer by calling (480) 256-6444.
April O’Connor, cooridinator of Banner MD Anderson Cancer Center’s Clinical Cancer Genetics Program.
4 JUNE 2012 ROUNDS
We have
reached
the six
month mark since
the opening of
Banner MD Ander-
son Cancer Center.
And it has been a
busy six months! I am
pleased to share that we have more
than 60 physicians now working with
the cancer center, each highly special-
ized in their fields of expertise.
We have established several compre-
hensive disease specific programs.
In this issue of Rounds, you will read
about our Comprehensive Breast
Cancer Program. This program encom-
passes all aspects of breast cancer, from
prevention and diagnosis to treatment
and support. Our team of physicians in-
cludes radiologists, medical oncologists,
breast and reconstruction surgeons,
What’s Happening at Banner MD Anderson Cancer Center
BY DR. EDGARDO RIVERA, MEDICAL DIRECTOR
cancer center. Most recently we have
welcomed Dr. Diljeet Singh, a gyneco-
logic oncologist who is developing our
prevention and integrative medicine
program. Finally, we have begun to
open clinical trials for our patients. We
are participating in a breast cancer trial,
and will be opening trials for chronic
lymphocytic leukemia, colorectal and
pancreatic cancers shortly. A number
of additional trials are currently in the
review process. In addition, we are
developing a process to offer selected
trials from The University of Texas MD
Anderson Cancer Center in Houston
on our campus. This will give Arizona
patients access to many more clinical
trial opportunities.
As always, please contact me if you have any questions about Banner
MD Anderson Cancer Center or referring a patient. I can be
reached at (480) 256-3335.
radiation oncologists and pathologists.
They are supported by an excellent
nursing and support staff, and the latest
in diagnostic and treatment modalities.
In the Undiagnosed Breast Clinic,
women with a suspect mass or an
abnormal mammogram receive further
evaluation to determine the presence or
absence of a malignancy. This diagnostic
process is accelerated to provide a timely
diagnosis, often with 24 to 48 hours. We
hope this will reduce anxiety for many
women, and will assist you with expe-
dited diagnoses for your patients.
This issue also features our mela-
noma team. A medical oncologist and
surgical oncologist work together to
provide the latest treatment options
for people diagnosed with melanoma.
We continue to welcome
new physicians to our
BannerMDAnderson.com 5
As a radiation oncologist at
Banner MD Anderson Cancer
Center, Emily Grade, M.D.,
has access to the most advanced and
state-of-the-art equipment in the
world. The cancer center was built
with careful planning to provide
excellent care and a positive patient
experience. In addition, everything
a patient might need is provided in
one location.
Grade also knows that while
having access to the best equipment
is essential, it is just as important
to have regular communication
with the other treating physicians
about the health, treatment and
care of each and every patient.
TEAM APPROACH“I came here from a community prac-
tice, and when I arrived, the first thing
I noticed was how the entire team of
doctors communicates regularly and
works together to help our patients,”
she says.
In addition to meeting with the
team of doctors at the Gilbert facility
twice a week, Grade says the radiation
oncologists meet via a regular phone
conference with the physicians at
The University of Texas MD Anderson
Cancer Center in Houston.
“We are constantly talking about
our cases as a community,” she says.
“It’s the idea of having collective
minds working together and pooling
our brain power that makes a big
difference here, even more so than
the best equipment.”
SPECIALIZED TREATMENTIn addition to the “many heads are
better than one” approach to patient
care, Grade says another way the
center is advancing the treatment of
cancer is by specialization. In other
words, the doctors focus on specific
cancers and become experts in that
cancer treatment. This specialization
is done similarly at MD Anderson
in Houston.
While Grade appreciates being
part of a medical team that values
communication, sharing patient
information, and working collabora-
tively to be sure that each and every
patient is given the best treatment
possible, she says the state-of-the-art
oncology equipment does definitely
help them in their work.
“Delivery of radiation has become
more sophisticated. Here we can now
pinpoint very accurately where we are
delivering the dose, and we can avoid
nearby organs and healthy tissue more
easily,” she says.
“We can also choose to utilize a
PET scan as part of the therapy treat-
ment design, so we can see where
the cancers are active and where they
are not.” This would allow the field
of treatment to be more accurate.
The Radiation Oncology de-partment provides a wide array of radiation treatments with the latest technologies. Physicians may refer patients for radiation treatment by contacting the radiation oncology department at (480) 256-4500.
Advancing the treatment of cancer Oncologists at Banner MD Anderson Cancer Center meet regularly to discuss their patients and compare charts, notes and ideas
BY ALISON STANTON
Dr. Emily Grade, a radiation oncologist at Banner MD Anderson Cancer Center.
6 JUNE 2012 ROUNDS
BY STEPHANIE CONNOR
W ith shorts and tank-top sea-
son upon us, it’s incumbent
upon primary care physicians
and dermatologists to check patients for
melanoma and other skin cancers.
“Once a melanoma is identified,” says
Mark Gimbel, M.D., a surgical oncologist
at Banner MD Anderson Cancer Center
who specializes in cutaneous tumors,
“physicians should be appropriately
aggressive in their surgical approach.”
Gimbel offers a few reminders for
treating melanoma.
First, he says, Mohs surgery isn’t ap-
propriate for melanoma, so reserve that
technique for basal and squamous cell
carcinomas. Because melanoma requires
a wider margin, he says, Mohs surgery
could result in missing part of the can-
cerous tissue or any satellite lesions.
Effective surgical techniques for melanoma
IMPORTANCE OF MARGINSSecond, make sure the margins around
the melanoma are wide enough. “If the
margins aren’t wide, there’s a higher
chance of residual disease and an in-
creased likelihood of local recurrence,”
Gimbel says.
Treating melanoma surgically, he
explains, requires an aggressive approach.
“The size of the excision is based on
the depth of the tumor,” Gimbel says.
“The deeper the tumor into the skin, the
wider the excisional margin needs to be.”
He offers this example: “A melanoma
could be up to 1 mm in depth. You need a
1 cm margin. So, that could end up being
an excision that’s 2½ cm in diameter.”
Because particularly wide excisions
can be disfiguring, he says that orient-
ing the original biopsy or excision ap-
propriately for the area is essential.
BEYOND THE EXCISION “We also have to look at the pathologic
evaluation of the tumor,” Gimbel says.
By looking at the thickness, ulceration
and the mitotic rate of the tumor,
pathologists can effectively stage the
primary melanoma.
It’s also essential to evaluate the
regional lymph nodes if the melanoma
grows beyond a specific depth. The risk
of spread to the lymph nodes increases
as the depth of the melanoma increases.
Typically, for melanomas greater
than one millimeter in depth, a lymph
node evaluation is recommended. For
lymph nodes that can be palpated a full
nodal dissection is performed. However,
for patients without palpable nodes, in-
stead of removing all of the lymph nodes
in a regional basin (axilla/neck/groin),
only one or two sentinel nodes are re-
moved at the time of the initial surgery
to see if the melanoma has spread.
Still, Gimbel says, with all the ad-
vances in treating melanoma, the most
important thing for any doctor is to
help catch it early.
Banner MD Anderson oncologist recommends an aggressive approach
Banner MD Anderson physicians Dr. Mark Gimbel, (left) surgical oncologist, and Dr. Jade Homsi, medical oncologist, specialize in the diagnosis and treatment of melanoma. They work as a team to provide a multidisciplinary approach to treating the disease.
BannerMDAnderson.com 7
BY GREMLYN BRADLEY-WADDELL
When it debuts this fall at Ban-
ner MD Anderson Cancer
Center, the Cancer Preven-
tion and Integrative Medicine pro-
gram will take a “whole person, whole
patient” approach to healthcare, says
Diljeet Singh, M.D., DrPH.
NEW WAY OF THINKINGFor some, the “integrative” approach
may be a new way of doing things, says
the newly minted program director
at the Gilbert hospital, where she also
serves as program director of gynecolog-
ic oncology. That’s because traditional,
Western-based allopathic medicine
tends to focus on diseases, diagnoses
and treatments and often does not take
much else, like a person’s lifestyle, into
consideration. In her first-floor clinic,
however, Singh and her staff will take the
time to educate the public about healthy
living and disease prevention and, when
treating cancer patients, incorporate –
integrate, in other words – the myriad
factors that affect wellness, like nutri-
tion, stress and physical activity.
“And, if you are someone who does
not have any diagnoses, it’s our job as
physicians working in prevention and
integrative medicine to ask, ‘How do we
keep you that way?’ ” Singh adds.
ABOUT DR. SINGH An energetic type who studied under the
well-known physician Andrew Weil at his
Arizona Center for Integrative Medicine
Changing the way doctors treat cancerBanner MD Anderson Cancer Center to introduce new prevention and integrative medicine program
more, followed by three years’ worth
of fellowship training in gynecologic
oncology at The University of Texas MD
Anderson Cancer Center in Houston.
Her doctoral degree in cost analysis is
from The University of Texas School of
Public Health.
CONCENTRATED CARESingh envisions the clinic as a welcom-
ing place for cancer patients to get an
integrative medical consultation and
to see any one they need: a doctor,
nutritionist, physical or rehabilitation
therapist, social worker or psycholo-
gist. Some of the modalities she ex-
pects the clinic to offer include Eastern
medicine, massage and acupuncture,
all of which she says have benefits
when used and managed properly.
“For example, we’ve proven acu-
puncture decreases chemotherapy-
related nausea, equal to the amount
that a drug can, and with fewer side
effects,” she says.
On the prevention side, she says
the clinic will be a place where cancer
survivors can learn about their future
health risks and ways to avoid further
disease. Those not affected by the
disease can also benefit from the clinic
by getting a health assessment based
on family history and genetics and by
learning about behaviors that put them
at risk for the disease.
SAFE TREATMENTWhile she knows holistic medicine has
gotten some bad press, Singh makes it
clear that the Banner clinic won’t offer
treatments that haven’t proven to be
effective and will run clinical, safety and
efficacy trials on any new treatment
before it is even considered for use. If
anything, the local medical community
has truly embraced the clinic – and she
wouldn’t expect otherwise.
“I think everybody in medicine
is for doing everything we can for
people,” she says.
at University of Arizona in Tucson, Singh
recently relocated to the Valley from Chi-
cago and the Robert H. Lurie Compre-
hensive Cancer Center of Northwestern
University. She held an academic ap-
pointment as assistant professor of Ob-
stetrics and Gynecology at Northwestern
University Feinberg School of Medicine
and was a co-director of the Northwest-
ern Ovarian Cancer Early Detection and
Prevention Program.
As for her training, Singh earned
her medical degree from Northwest-
ern University and a master’s in public
health from Harvard University School
of Public Health. She completed her
residency in obstetrics and gynecology
at the Johns Hopkins School in Balti-
Dr. Diljeet Singh heads up Banner MD Anderson Cancer Center’s Prevention and Integrative Medicine Program.
PRESORTED STD
U.S. POSTAGE
PAID
LONG BEACH, CA
PERMIT NO.1677
HEMATOLOGY & MEDICAL ONCOLOGY SECTION
Tomislav Dragovich, MD, PhD, Section ChiefDigestive tract cancers including colorectal, esophageal, stomach, pancreatic, hepatobiliary
Shakeela Bahadur, MDLung, colorectal, breast cancers
Mary Cianfrocca, DOBreast Cancer Program Director
Jade Homsi, MDMelanoma, sarcoma, immunotherapy
H. Uwe Klueppelberg, MD, PhDMultiple myeloma and other plasma cell disorders, lymphomas, myelodysplastic syndrome, brain cancers, head and neck cancers, thoracic cancers
Edgardo Rivera, MD, Medical Director Breast cancer
Kerry Tobias, DOPain management, palliative medicine, physical medicine, rehabilitation
Bryan Wong, MDGenitourinary cancers
ONCOLOGY SURGERY SECTION
Judith K. Wolf, MD, Section ChiefGynecologic oncology
Mark Gimbel, MDMelanoma, sarcoma, cancer of the stomach, small bowel, colon and rectum, thyroid, pancreas, liver, breast, and other rare cancers
Christine Landry, MDPancreatic cancer, carcinoid tumors, thyroid cancer, adrenal tumors, parathyroid tumors, melanoma, sarcoma, gastrointestinal cancers, breast cancer, liver tumors
Diljeet Singh, MDProgram Director, Gynecologic Oncology; Program Director, Cancer Prevention & Integrative Medicine
Benny Tan, MDPlastic and reconstruction surgeonBreast cancer reconstruction and most forms of cancer reconstruction
Stephanie Byrum, MDBreast surgery
Rob Schuster, MDGeneral surgery
Al Chen, MDGeneral surgery
RADIATION ONCOLOGY SECTION Matthew Callister, MD, Section ChiefGastrointestinal, skin, sarcomas, and head and neck cancers
Emily Grade, MDBreast treatment including partial breast brachytherapy, prostate brachytherapy, gynecological and thyroid cancers
Terence Roberts, MD, JD Brain, lung and prostate tumors; stereotactic radiosurgery; partial breast brachytherapy
DIAGNOSTIC IMAGING SECTION
Donald Schomer, MD, Section Chief, CAQ NeuroradiologyOncologic diseases of the brain, spine, head and neck
John Chang, MD, PhDAdvanced magnetic resonance and computerized tomography imaging of gastrointestinal and genitourinary systems; imaging guided biopsies
Vilert Loving, MDBreast imaging and intervention
Harvinder Maan, MD, CAQNeuroradiologyDirector of Neuroradiology Neuroradiology and interventional spine procedures
Rizvan Mirza, MDAbdominal and pelvic magnetic resonance imaging
Susan Passalaqua, MDDirector of Nuclear Medicine and Molecular Imaging Oncologic imaging, nuclear medicine, radiology, PET/CT
Andrew Price, MD, CAQ Interventional RadiologyInterventional radiology, including percutaneous tumor ablation, chemoembolization, and radioembolization
David Russell, MD, FACPBreast imaging and intervention
CRITICAL CARE SECTION
Shiva Birdi, MD, Section ChiefJohn Jijo, MDDeven S. Kothari, MDDean Prater, MD
INTERNAL MEDICINE SECTION
Nikunj Doshi, DO, Section ChiefInternal medicine
David Edwards, MDInternal medicine
Ronald Servi, DOPulmonary medicine
PATHOLOGY SECTION
Kevin McCabe, DOSection Chief
Banner MD Anderson Cancer Center physicians are highly specialized in their fields of expertise. Below is a listing of physicians currently on our full time staff. Physicians continue to join Banner MD Anderson, so this list will continue to evolve.
To make a referral to a physician on our staff, please call (480) 256-3433. To contact a member of medical staff, call (480) 256-6444 and ask for the
physician to be paged.
Introducing Banner MD Anderson Physicians