ROANOKE TIMES
Copyright (c) 1996, Roanoke Times
DATE: Sunday, March 10, 1996 TAG: 9603080038
SECTION: BUSINESS PAGE: G1 EDITION: METRO
SOURCE: SANDRA BROWN KELLY STAFF WRITER
THE atmosphere is spa-like. In addition to the original art on the walls (it's for sale), women have a choice of fluffy terry cloth or monogrammed cotton robes.
The monogram is the logo of Lewis-Gale Breast Center, where lotion and deodorant are also provided because women coming in for mammograms are asked to not apply either before the X-ray is done.
Since the first of the year, two breast care centers have opened in the Roanoke Valley, and a third facility began making changes toward a center.
This boomlet, which follows a national trend, has been sparked by several factors - from increased awareness about need for early detection of breast cancer to the development of technology that allows an office procedure to replace a surgical one.
Only about half of the 1.3 million Virginia women who should be getting regular mammograms - X-rays of the breast - actually have the test, but numbers are increasing.
Also, the first swell of baby boomers is moving into the over-50 age group where breast cancer most often strikes. That's predicted to increase demand for services related to breast cancer detection and treatment.
But while the breast centers have roots in prudent business, they represent something even better. They simplify a potentially terrifying experience for a woman.
The centers promise faster diagnoses for women facing the possibility of breast cancer, and they bring treatment specialists in to counsel women who learn they have malignancies.
Good medicine means good business, said Dr. Alan Henry, a surgeon who opened the Breast Care Center of the Blue Ridge in Roanoke last month.
"We're all interested in being aggressive in diagnosis and treatment of breast cancer," he said. "If we do a good job for our patients, we can do all right" financially.
Henry said he began thinking about a center five years ago because he was frustrated by what a patient had to go through if her mammogram showed an abnormality indicating a possible cancer. A woman might spend several tense weeks of further testing, including a biopsy, before she learned if the tissue was benign or cancerous.
So, when Community Hospital of Roanoke Valley - where Henry practiced surgery - decided that only radiologists could do a new breast biopsy procedure, Henry opened his center with the help of a partner, Dr. Kevin Maxwell, a radiologist.
The center was set up at Henry's office on Second Street in Roanoke's Old Southwest district.
Similar to Lewis-Gale's breast care center, mauve is the reigning color at Breast Center of the Blue Ridge. It's even the color of a special table constructed so that a woman can lie on her stomach - instead of having to sit up - while a stereotactic biopsy is done on one of her breasts.
In the stereotactic biopsy, computer imaging is used to guide a hollow needle into the suspect tissue. The needle routs out the tissue in slender "plugs," which are checked by a pathologist to determine if they contain cancer cells.
The stereotactic biopsy takes about an hour, requires injections to numb the breast and leaves a small, bandage-sized puncture wound. It can be used in about half the cases where a biopsy is called for, replacing the open surgical biopsy in which a patient must have a general anesthetic.
The stereotactic biopsy also costs less, an average of $1,000 compared to about $3,000 for traditional surgical removal of the tissue.
Only about 5 percent of the 25 million mammograms done annually in the United States end up revealing suspicious tissue. Of that 5 percent, most biopsies yield benign tissue, but doctors can't tell that without doing them, Henry said.
"I hated doing [surgical] breast biopsies on all these women," he said. "You'd do eight or nine and find just one" that was cancerous.
Henry, who is a board member of the newly formed American Society of Breast Surgeons, spent much of the past two years being trained to do the stereotactic biopsies, which are also called core biopsies.
The high-tech biopsies are also done at Lewis-Gale and Community hospitals, but neither has the equipment that allows the patient to recline.
The centers are a whole lot more than just one biopsy technique, however. They are an attempt to provide one-stop shopping for a woman concerned about breast cancer.
Their simplest service is the screening mammogram, a procedure that costs somewhere from $50 to $150 and which is available at a variety of places, including some doctors' offices. What the centers also provide a woman, however, is a nurturing atmosphere where she can learn more about breast care or where she can consult with specialists about various treatments if she finds she has cancer.
The centers hope to eliminate the need for a woman to trek from one specialist's office to another. Deciding a course of treatment for breast cancer generally involves a surgeon, medical and radiation oncologists who can discuss chemical (drug) and radiation therapies and even a plastic surgeon to explain what kind of reconstructive surgery is possible if a woman's breast must be removed.
"Breast cancer used to be very straight forward. You got breast cancer; you got your breast off," said Sherry Moses, coordinator of the Lewis-Gale Breast Center. "Now there are lots of options."
The center is an education source for anyone who wants to know more about breast cancer, she said. Just off the waiting room in the Lewis-Gale center is a cozy education room where a woman can practice the technique of breast examination using molded breasts that conceal various sized lumps.
The American Cancer Society recommends that a woman get a screening mammogram between ages 35 and 40, have one annually, or at least every two years, from age 40 to 50. After age 50, the test is recommended once every year. The cancer organization also recommends that every woman examine her breasts once a month.
Many women still shy away from this, Moses said.
Breast cancer is just behind lung cancer as the main cause of death for women. The causes of breast cancer haven't been pinned down, but health specialists do know that finding the cancer early after its development increases a woman's chances of survival.
Patients have five-year survival rates of 95 percent if a cancer is found early, when it is not more than one-quarter inch in size, said Dr. Mary Ella Zelenik, a radiologist with Lewis-Gale Hospital.
Four years ago, Zelenik, and Dr. Carol Reichel, a plastic surgeon with the doctor-owned Lewis-Gale Clinic that shares the hospital site, began an experiment that led to the hospital's new breast center.
Reichel began spending every other Tuesday on duty in the radiology department to consult with women who came in for diagnostic mammograms. These were women who faced the possibility of breast cancer.
Soon, the demand grew so that Reichel was in radiology every Tuesday.
The setup was not great, she said, because not all the facilities were physically together. Women still had to "run across the hall" from X-ray labs to her office.
But they got answers, Reichel said.
The time it takes for a woman to get the results of breast studies can now be reduced to one day for most women, she said.
Lewis-Gale opened the center in January but will have its formal open house sometime next month. The hospital remodeled the quarters creating examining and X-ray rooms and the radiologists' work area as well as the reception and education rooms.
A new exterior entrance has been created for the center and the renovated radiology department, which is just down the corridor from it.
Moses claims the center is the most comprehensive in Southwest Virgnia, and from the viewpoint of staffing, it is.
Surgeons are on duty Mondays, Tuesdays and Wednesdays to consult with women. Within 48 hours, a woman can have a diagnosis and have seen the specialists who will be involved in her breast cancer treatment.
As at Lewis-Gale, a woman also pushed hardest for the changes that have been made at Community Hospital in Roanoke as a prelude to a breast center for the chain of Western Virginia hospitals owned by Community's parent, Carilion Health System.
Stephanie Higgs, a registered nurse certified in radiology technology, took a lead role in the expansion of Community Hospital's breast diagnostic services. Higgs has been doing mammograms at Community Hospital since 1977, and prides herself on keeping up with new technology and new thinking in her field.
So far, the Community Hospital project has been modest, she said.
An employee team on which Higgs served took over a doctors' lounge to increase examining room space and provide quarters for a radiologist to work in the department. The staff in the hospital's radiology department rotate duty in the department.
The quarters were fancied up with new paint - pink. Chairs are being reupholstered and art added.
The team also persuaded the hospital to give the mammography department its own receptionist who could field telephone calls so that the clinical staff could be free to work with patients.
"We're not all the way there, but this is the greatest thing we've done," Higgs said. She never forgets, she said, that every woman who comes to the hospital for breast diagnostics "could be me."
LENGTH: Long : 179 lines ILLUSTRATION: PHOTO: 1. Dr. Carol Reichel gives a follow-up exam to Ireneby CNBLawson at Lewis-Gale's Breast Center. color
2. Radiologist Dr. Mary Ella Zelenik examines breast X-rays. She has
been a leader in setting up the breast center at Lewis-Gale. color
CINDY PINKSTON/STAFF
3. & 4. STEPHANIE KLEIN-DAVIS/Staff At the newly opened Breast Care
Center of the Blue Ridge (above), patients can get mammograms, have
detailed studies done if needed and have outpatient stereotactic
biopsies in place of in-hospital surgery. Among the staff are (left
in photo at left) Dr. Kevin Maxwell, radiologist; Mary Lou King,
technician; and Dr. Alan Henry, surgeon. color
5. CINDY PINKSTON/Staff Stephanie Higgs, a registered nurse
certified in radiology technology, has been doing mammograms at
Community Hospital since 1977, and prides herself on keeping up
with new technology and new thinking in her field. color
6. Sereotactic biopsy - Shown here is the piercing tip and speicmen
collection chamber color