Lymphedema prevention and other new breast care programs on Cape Cod

Lymphedema is swelling in an arm or leg due to build-up of lymph fluid. According to the federal Centers for Disease Control and Prevention (CDC), surgery to remove cancer may also remove lymph nodes or some of the vessels that carry lymph fluid, leading to a buildup of fluid in the surrounding tissues. Similarly, radiation for cancer can also damage the lymph vessels.

Lymphedema that results from breast cancer surgery or radiation can lead to a painful swelling in the surrounding arm and chest area, said Cape Cod Hospital Breast Surgeon Jill Oxley, MD, who is medical director of Breast Care Services at the hospital. To help make sure patients don’t develop the condition in the first place, Cape Cod Healthcare Breast Surgery - Hyannis has launched a Lymphedema Prevention Program.

A new device, known as SOZO®, measures whether there is excess fluid in the area surrounding the treatment area. The device is typically used for patients who are at risk of developing lymphedema following lymph node surgery, such as sentinel node biopsy or axillary dissection, or axillary radiation, said Dr. Oxley, who is a Cape Cod Healthcare surgeon devoted solely to breast surgery, along with Naomi Kalliath, DO.

To make sure any fluid buildup does not advance into chronic lymphedema, patients who are identified by the SOZO unit as developing excess fluid are referred promptly to a breast cancer occupational therapist for lymphedema therapy. Lymphedema therapy typically consists of things like exercise of the arm, massage therapy and a compression sleeve, according to the CDC site.

The Lymphedema Prevention Program is just one of several new offerings at CCHC’s Breast Care Program, according to Dr. Oxley, whose office is located at Cape Cod Healthcare Breast Surgery - Hyannis. Other new programs include a Multi-disciplinary Breast Clinic for some newly-diagnosed patients, who can have a combined consultation with a radiation oncologist and medical oncologist before surgical intervention. Patients identified for this program can have the full picture of treatment described for them at one time. Formerly, patients had to meet with the oncologists separately, which is still the case for most patients, Dr. Oxley said.

“They get the total picture in one sitting,” she said.

The clinics are in-person at the Davenport-Mugar Cancer Center on the Cape Cod Hospital campus.

Weekly Breast Tumor Boards, as well as several other Tumor Boards for a variety of cancers, are attended by a multi-disciplinary group of providers and have been ongoing at Cape Cod Healthcare for many years, Dr. Oxley emphasized. Tumor Boards have been held remotely since the COVID-19 pandemic began, she said.

Risk Assessment Program

The High-Risk Breast Cancer Assessment Program at Cuda Women’s Health Center provides close monitoring with imaging and physical exams for women who are at increased risk of developing breast cancer, according to Stephanie Ellis, NP, who is a key member of the program.

Women who are high risk for breast cancer include those with a genetic mutation or family history of breast cancer, and those who have previously had cancer, among other risk factors. These women are followed closely by the medical team at Cuda. “I make sure that their imaging is up to date, and I review all their imaging,” said Ellis. “I update their family history every year. We calculate a Tryer-Cuzick score – a nationally-recognized scoring system that scores one’s risk for breast cancer - and then we do follow-up imaging and clinical breast exams on an annual basis.”

Wire-free Radar Localization

Another Breast Care Services offering includes the SAVI SCOUT® wire-free radar localization for breast surgery. The system helps make lumpectomies more precise and efficient, according to Dr. Oxley. In a method similar to a needle biopsy, a radiologist places a small electromagnetic wave reflector into the tumor. On the day of the lumpectomy, the surgeon takes a wand that is attached to a console and scans the breast. The wand emits non-radioactive electromagnetic waves and the console provides precise audio and visual feedback, so the surgeon can find the exact location of the tumor. Once the tumor is removed, the reflector is also removed.

The SAVI SCOUT system offers patients a simpler, often less uncomfortable, tumor placement guide. Otherwise, a wire that projects from the breast needs to be placed by a radiologist just prior to surgery. The electromagnetic reflector can be placed up to one year prior to surgery.

Oncoplastic Techniques

Oncoplastic surgical techniques continue to be offered to certain breast cancer patients at Cape Cod Hospital, said Dr. Oxley, who is trained in this technique. Oncoplastic surgery is an approach that improves cosmetic outcomes for women undergoing lumpectomies or partial mastectomies. Breast surgeons like Dr. Oxley use techniques to remove the breast tumor and repair the volume defect, in order to preserve as much of the original physical appearance of the breast as possible.

The American Society of Breast Surgeons recommends that all women over the age of 25 have a formal breast cancer risk assessment. For women identified as being at high risk of breast cancer, the Cuda Breast Care Center team provides both clinical breast exams and coordination of imaging studies through their High Risk Hereditary Cancer Program and High Risk Clinic.

“We can evaluate any benign or malignant breast disease,” said Dr. Oxley. “A woman on Cape Cod can expect to receive here anything they can get off-Cape, with the exception of some clinical trials.”