New trends in breast reconstruction

Women making a decision about breast cancer surgery should include a plastic surgeon in that discussion. Several options for breast reconstruction give women choices, with each choice carrying its own risks and benefits.

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October is Breast Cancer Awareness Month.

“The decision tree is complicated. A plastic surgeon ultimately has to walk through the choices with patients and help them consider which option is best for their individual situation and preferences,” says Adeyiza Momoh, M.D., assistant professor of plastic surgery at the U-M Medical School.

As more younger women at high risk of breast cancer choose to have their breasts removed before cancer develops, a procedure called a DIEP (Deep Inferior Epigastric Perforator) flap has become increasingly popular. The technique involves transplanting tissue from the woman’s abdomen into her chest. But unlike traditional tissue reconstruction, called a pedicled TRAM flap, where the entire rectus muscle was included with the flap, a DIEP flap involves a complex approach to dissecting out the small blood vessels and leaving the muscle behind. The blood vessels are then reconnected to blood vessels in the chest.

The technique preserves the abdominal muscle function and typically has fewer abdominal complications. Continue reading

Clearing the confusion about mammograms

The bottom line: Mammography saves lives. Various organizations may not agree perfectly on screening recommendations, but don’t use that as an excuse to throw up your hands and do nothing.

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October is Breast Cancer Awareness Month. This year, an estimated 209,060 Americans will be diagnosed with breast cancer; more than 40,000 will die from the disease.

“Mammography is one of the few screening tools that has been proven to save lives. Every woman over 40 should at least begin a discussion about screening with her doctor,” says Mark Helvie, M.D., director of breast imaging at the U-M Comprehensive Cancer Center.

Here’s what everyone does agrees on:

  • All women 50-74 should receive regular mammograms.
  • Mammography may be the right choice for women in their 40s. While many groups, such as the American Cancer Society and the National Comprehensive Cancer Network, continue to recommend routine screening, others advocate a discussion between women and their health care providers.
  • Yearly or every other year? Many groups continue to recommend annual exams. The difference of opinion comes down to a balance between benefit and harm. Annual screening saves more lives but at a cost of more harms. Talk to your doctor about your options.
  • Women at very high risk for breast cancer may benefit from additional screening with MRI. Continue reading

Patient & Family Advisory Board provides opportunity for input at the U-M Cancer Center

Laura Galunas and Anne Marshall meet with Karen Hammelef.

Laura Galunas and Anne Marshall meet with Karen Hammelef about the Patient & Family Advisory Board.

On the day of her first appointment at the University of Michigan Comprehensive Cancer Center, Anne Marshall remembers pulling into the parking lot, nervous and afraid. She had been to the center many times before with her mother, who was diagnosed with breast cancer in 2006; but pulling into the circle drive felt different when the breast cancer diagnosis was her own.


Then she met Cleon Abrams, a longtime parking attendant at the Cancer Center.

“I was surprised he remembered me,” said Marshall, who is a social worker. “He just had this perfect smile and said, ‘Be encouraged.'”

Those two words made all the difference to Marshall. Not only did they give her the boost she needed at that moment, but it led her to become more engaged in the Cancer Center and its efforts to provide the ideal patient care experience.

Recently, Marshall was a member of a task force to establish bylaws for the Cancer Center’s new Patient & Family Advisory Board. The board is designed to offer patients and families a formal role in providing input into the institution’s initiatives and operations. Continue reading

U-M pharmacists, doctors collaborate to ensure patients get drugs they need, despite shortages

After Shawn Burr became a patient at the University of Michigan Comprehensive Cancer Center, his doctor asked an unusual question: Would he be able to bring his own chemotherapy drug?

The Cancer Center — like many institutions throughout the country — was facing a daunting shortage of cytarabine, a generic chemotherapy drug that is instrumental in treating acute myeloid leukemia, the form of cancer Burr has. Two of the three companies that make cytarabine had run into manufacturing problems: One couldn’t obtain the raw materials necessary; the other had to recall batches because of quality concerns. The third company couldn’t keep up with the resulting demand.

And so, when it became clear to Sherry DeLoach, a pharmacist who coordinates drug purchasing for the U-M Health System, that stocks were running low, she notified the oncology pharmacists. They, in turn, met with the doctors whose patients use cytarabine to develop a strategy to ensure that every patient who needed the drug received it. One piece of this plan, among many others, was to ask newly referred patients if they could obtain the drug from their current health-care provider.

U-M would have provided Burr with the drug regardless of his answer. But Burr’s care team at St. Joseph Mercy Port Huron Hospital was able to lend U-M enough cytarabine to accommodate his treatment.

“It’s a pretty hopeless feeling,” Burr said. “Usually, you think health care is all about money, but when it comes to generics, there’s not a lot you can do if drug companies decide they aren’t going to make a drug anymore. There needs to be some policy put in place to protect patients.”

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