Speaking with >>

Timothy Scherer, MD

Timothy Scherer, MD, is a gastroenterologist at Dartmouth-Hitchcock Nashua and serves as Chair of the SNHMC Cancer Committee.

How do patients benefit from our relationship with the Massachusetts General Hospital (MGH) Cancer Center?

Our patients have speedy access to highly skilled specialists and clinical trials. Because we have a close working relationship with MGH doctors and their staffs, we can expedite referrals and appointments, share findings and treatment options, and provide a seamless continuum of care. This agreement has included the presence of oncology specialists at our tumor conferences. Such a collegial relationship has had a positive effect for our patients and enriches our resources for patient education. To visit the MGH Cancer Center, click here ►

Maryanne Mercier, RN, CHPN, helps to improve communication between patients & providers. She is also a great resource for her patients and their families, as she is the person with whom they can “touch base” when they need help keeping their bearings straight. She has done an exceptional job in her first year and is excited about her future in this important position. To learn more about Maryanne, click here ►

The deNicola Breast Health Center recently earned a unique distinction. Please explain.

In September 2007, the deNicola Breast Health Center was designated as a Breast Imaging Center of Excellence by the American College of Radiology (ACR) - one of only two awarded in New Hampshire and the only one in the Nashua area. Our ACR accreditations in mammography, stereotactic breast biopsy, breast ultrasound, and ultrasound-guided breast biopsy are accomplishments that benefit our patients and inspire our staff.

The deNicola Breast Health Center is the center of our approach to breast care. At SNHMC, all mammograms are read by a radiologist with the assistance of computer aided detection (CAD.) Although mammography can miss 10% of breast cancers, it is still the best screening test we have. In October 2007, two full-field digital (computerized) mammography units “went live,” providing our radiologists with better tools to detect more cancers. Additional upgrades enable deNicola technologists to digitize prior mammograms and make them more easily accessible through the new Picture Archiving and Communication System (PACS). To learn more about the deNicola Breast Health Center, click here ►

How do SNHMC quality initiatives, such as the e-QuIP study and order sets, improve patient care?

We improve the quality of care for our patients by comparing processes, experiences and outcomes with national benchmarks. One such example is SNHMC's participation in the Commission on Cancer e-QuIP study, with the goal of examining data to identify opportunities to improve care and treatment for our cancer patients.

We research our practices by evaluating outcomes and paying attention to patient satisfaction surveys. We set improvement goals accordingly, and our progress is measured by objective, evidence-based, quality standards. For example, chemotherapy order sets have been developed by a Southern New Hampshire Health System (SNHHS) health care team, with physician, pharmacist and nurse representation. Such order sets include nationally recognized best practice elements to ensure medication safety and comfort for our patients. To learn more about addional quality initiatives at SNHMC, click here ►

Helen Corbett, MD, FACS

Helen Corbett, MD, FACS, is a surgeon with Foundation Surgery at SNHMC and serves as Physician Liaison of the SNHMC Cancer Committee.

How many women are diagnosed with breast cancer in New Hampshire and at SNHMC?

The statistics are familiar, and hard to ignore: one in eight women will develop breast cancer. It is the number two cause of female cancer deaths, accounting for one in four cancers diagnosed in women, excluding skin cancers. (Only 1% or less of breast cancers occur in males.)

In the state of New Hampshire, the American Cancer Society estimated 890 female breast cancers would be diagnosed in 2006. That year, 104 women were diagnosed with and/or treated for breast cancer at The Medical Center. This means that about 11 - 12% of all the female patients with breast cancers diagnosed in the state of New Hampshire were seen here at The Medical Center.

How can we reduce the risk of breast cancer?

We think of cancer in terms of prevention, detection, and treatment. However, there is no standard approach for breast cancer prevention. In general, we don’t even call it prevention: we call it risk reduction—a semantic distinction but perhaps also the medical profession’s way of not wanting to raise false hopes. The main forms of breast cancer risk reduction are life style modifications; tamoxifen; and mastectomy. The Cancer Committee and the deNicola Breast Health Center will continue to make risk reduction a priority as more evidence becomes available.

How does the timeliness of care at SNHMC, from screening to biopsy, compare nationally?

To enhance patient satisfaction and ensure timeliness of care, SNHMC submits data to the National Consortium of Breast Centers Quality Initiatives. SNHMC results compare favorably with other breast centers. Measuring the time from screening to diagnostic mammogram, SNHMC reported 2.4 days vs 6.8 days for all breast centers. Time from diagnostic mammogram to needle/core biopsy was reported as 6.4 days for SNHMC vs. 6.8 days for all breast centers.

Because early detection is such a priority, it is inevitable that the majority of biopsies will have benign results. In 2006, 16,679 imaging studies were performed at SNHMC. Of those, 614 were recommended for biopsy, with 106 of those cases added to the cancer registry.

Why is early diagnosis important?

The objective of screening is to diagnose breast cancers as early as possible: the lower the number stage (stage 0-stage 4), the earlier the breast cancer. This directly correlates with a better prognosis or outcome for the woman with breast cancer. 24.5% of our breast cancers are diagnosed as a stage 0. This compares with a 22% rate on the national level. 65% of breast cancers diagnosed here are diagnosed as stage 0 or stage 1 – a localized breast cancer. The national statistic is around 63%. These numbers suggest SNHMC is doing a good job in screening to find breast cancers at an early stage. 

Beginning in 2008, in an effort to improve the number of women who have a screening mammogram, letters will be sent to 40-year-old patients via their Foundation Medical Partners (FMP) primary care physicians, reminding them it is time to have a baseline mammogram. This initiative is undertaken by the FMP Quality Department. In addition, the deNicola Breast Health Center offers online scheduling for mammography appointments.

There is some evidence that breast cancer in the woman under 40 may be more aggressive. Here at SNHMC, about 8% of all breast cancers diagnosed in 2006 were in this under 40 age group. Nationally, that statistic is slightly lower at 5%. At SNHMC the median age of those diagnosed with breast cancer is in their 50's, while nationally it is 61. Why we appear to have slightly younger women being diagnosed with breast cancer is unknown.

What treatment options are available today?

For the vast majority of breast cancers, a woman has a choice between a lumpectomy and a mastectomy. The majority of women with breast cancer whom we treat here choose to have a lumpectomy. A smaller number opt for mastectomy, and an even smaller number choose to have no surgery. Two-thirds of women who choose to have a mastectomy at SNHMC do not choose to have reconstruction. We are not able to say why, except that most women just do not want more surgery.

What about second opinions?

We encourage women who feel the need to seek a second opinion. Our close relationship with the Massachusetts General Hospital Cancer Center can facilitate rapid, high quality second opinions. Our association also makes it easier for the health care providers here to get an informal second opinion to ensure a smooth continiuum of timely care.

What do we know about survivors?

As an institution, we do better than the New England average in terms of survival for stages 0, 1 and 2 breast cancers. Patients in Stages 3 and 4, the more advanced cancers, are both seen less often here and do not do as well as the New England average for survival. Our recognition of this survival question leads us to encourage more second opinions for these women. Our patients have seamless access to specialized care at other hospitals, and unless they return to SNHMC later, we may not know their outcome. This is another instance where our partnership with MGH becomes very helpful.  We want every patient to have an optimal chance for survival, no matter the stage.