Dobbs Ferry Doctors Pioneer New Breast Cancer Treatment

Earlier this month, a groundbreaking study in the treatment of breast cancer was presented at the American Society of Clinical Oncology's annual meeting in Chicago.  Initiated in 2000, the study looked at the results of a new technique, in which on-site radiation is administered to patients during surgery so that they can avoid the often painful and uncomfortable five-day series of post-operative radiation. The technique was implemented and analyzed in only 28 cancer centers worldwide, one of which was the Ashikari Breast Center at the Dobbs Ferry Pavilion of St. John's Riverside Hospital in Dobbs Ferry.

"The results of the study were tremendously positive and exciting," Dr. Pond Kelemen, an oncological surgeon at the Ashikari Breast Center, said. "The overall message of the study was that this technique has the same cancer recurrence rate as the status quo treatment, yet is significantly less intrusive and more cost-efficient."

Administered through technology produced by Carl Zeiss Meditech, targeted radiation can be applied directly to the tumor bed during surgery, an advance Kelemen believes is an invaluable step forward.

"Ninety percent of breast cancer recurrences appear right in the biopsy region," Kelemen said. "But the current standard is to radiate the whole breast once the tumor has been removed."

According to Kelemen, many women diagnosed with less aggressive cases of breast cancer, continue to require radical mastectomies because they live too far from treatment centers to follow-through with the five days of post-operative radiation.

"With the new model we can administer the radiation at the time of surgery, and hopefully save many women from undergoing more trauma than is medically necessary,"

he said. 

The Ashikari Breast Center has already treated more than 200 patients with intra-operative radiation, and Kelemen said his patients "love the treatment option."

"The cosmetic and adverse events after surgery, we've shown to be the same as with post-operative treatment, and while the wound comparison rate appears to be a bit higher, there is no statistical difference," Kelemen said.

Since beginning his career as a surgical oncologist, Kelemen said the stigma associated with "the 'C' word" has decreased substantially as treatment options have become less intrusive.

"Breast cancer was scary in the past because treatment was almost always radical and disfiguring," he said. "Although there aren't statistics to prove it, I do believe more women are getting screened and coming for treatment earlier on because they the treatment options are more appealing."

In 2009, The Ashikari Breast Center was granted a full three-year accreditation by the National Accreditation Program for Breast Centers (NAPBC)—becoming the only medical facility in Westchester County with the prestigious recognition.

Besides Kelemen, the Center is headed by surgical oncologist Dr. Roy Ashikari, the former Chief of Breast Service at Memorial-Sloan Kettering Cancer Center, along with his son Andrew Ashikari.

Although effusive in describing his hope for intra-operative therapy, Kelemen concedes that time is needed before definitive conclusions can be made.

"A four-year trial is not enough time for the research to be conclusive," he said. "The current data is encouraging, but we need more time before this can supplant standard radiation."

The good news, though, is that the equipment needed to implement intra-operative radiation is comparatively less expensive than other medical equipment.

"We bought our own machine for about $400,000 when our practice moved exclusively to this location," Kelemen said.  "That means most cancer centers nationally will be able get them if the long-term research continues to be positive."

Even before taking part in this newest study, the Ashikari Breast Center was on the forefront of breast cancer treatment, seeing a very high number of patients with BRCA1 and BRCA2 gene mutations, which can give them up to an 85 percent risk of contracting the disease.

"Women with the mutation come to us for preventative mastectomies because such a great risk of getting cancer is too much of an onus to bear," Kelemen said. "What makes us unique, though, is that we are able to do the surgery and reconstruction in one operation, saving the natural nipples. Most centers can't do that."  

And doctors at the Ashikari Center are acutely aware that, besides fearing painful and stigmatizing surgeries, patients also avoid treatment because of the cost.

"We treat anyone who has cancer," Kelemen said.  "Even if a patient has no money and no insurance, we will treat her anyway."