Dr. John Cutrone relocated to Columbus from the West Coast earlier this year to become the medical director for the Center for Breast Health at St. Francis Hospital.
In his nine months on the job, Cutrone has been struck by something he did not expect to find.
“What I will tell you is I have practiced the past 20 years in Southern California at very busy breast centers in Los Angeles and the Palm Springs area,” Cutrone said during an interview earlier this week. “I can tell you for the same number of examinations that we did, we see much more breast cancer here compared to there.”
Cutrone said he does not know how to explain the larger numbers of the disease here, nor does he have exact numbers.
“I don’t know, honestly,” he said. “There must be some environmental factor or some other dietary factor that would cause that,” he said. “Just in general, I just see there is more of an instance of it here, but I don’t know the exact cause. ... It’s very interesting and very alarming, but I am still trying to figure out exactly why. I don’t think I am doing anything different here than I was doing there. But it just amazes me that there are more cancers we are diagnosing here.”
October is National Breast Cancer Awareness month. One in eight women in the U.S. will be diagnosed with breast cancer in her lifetime, according to the National Breast Cancer Foundation. Each year it is estimated that more than 252,710 women in the U.S. will be diagnosed with breast cancer and more than 40,500 will die of the illness.
Dr. Kenneth L. Smith is a fellowship trained breast surgeon who came to Columbus in 2001 after completing a fellowship at Stanford University. The last five years he has worked at the John B. Amos Cancer Center. Smith handles about 150 breast cancer cases a year. The Amos Cancer Center sees between 350 and 400 new breast cancer cases a year from the 13-county Piedmont Columbus Regional service area, Smith said.
On average, Smith treats about three new cases per week.
“There will be weeks where you don’t see any, then the next week six or eight, then the next week one or two,” Smith said.
The first time Smith sees a patient, the message is usually clear and he urges them to take a planned approach to the treatment options.
“First and foremost, I tell them this is not an emergency and we don’t have to rush off to the operating room today, tomorrow or even next week,” he said. “We have got the time to get the information they need in order to make the decision that they are willing to live with.”
Because St. Francis does not offer cancer treatment, many of the cases that are diagnosed at the Center for Breast Health end up across town at Piedmont for treatment.
“You have to remember that a lot of the women they see over at Amos are women who have been diagnosed with breast cancer here at St. Francis and end up going over to Amos for their treatments,” Cutrone said. “At St. Francis, we have a very busy breast detection program and a very busy breast surgery practice, but as far as other treatment that may happen, most notably radiation and chemotherapy that is offered over at Amos. ... We have very complimentary programs.”
Catching breast cancer early is critical, Cutrone said.
“When it comes to breast cancer, size is the most important attribute,” Cutrone said. “The smaller we find the breast cancer, the easier it is to treat and the lower the mortality is. When we find a breast cancer that is small — and I consider small anything less than 15 millimeters in diameter — it’s much more likely that the patient can have a lumpectomy rather than a mastectomy. And it’s much more likely that the patient can be treated with local radiation rather than to have to take chemotherapy.”
And a mastectomy is not always the best option, Smith said.
“Usually, they don’t have to lose their breast to get more than adequate treatment,” Smith said. “Lumpectomy with radiation as opposed to mastectomy has through numerous research protocols shown that they are equivalent in survival. We used to to think there was a higher risk of the cancer reoccurring in the breast if you did a lumpectomy, but more recent studies show the chest wall recurrence risk after mastectomy is roughly equal to the in-breast recurrence.”
This translates to more options for women facing the difficult choices that come with breast cancer, Smith said.
“Decades ago, it was one-size fits all,” Smith said. “You came in for a biopsy, since we were doing mainly surgical biopsies, you signed two consents at that time. One for the biopsy and if they found it was cancer, you would go on to the mastectomy. There were not a lot of options short of that. Then with studies that came out of this country and out of Italy back in the mid to late ’70s and early ’80s demonstrated the ability to get equal results with a lesser degree of an operation.”
Women should start annual mammograms at age 40, Cutrone said.
“While some people recommend to start screening at age 50, that is really an arbitrary number where we know in general the greatest rise in breast cancer risk is around age 40. That’s why I continue to recommend to all doctors that we start screening at age 40.”
Smith holds a monthly free clinic through the West Central Georgia Cancer Coalition where he treats women who do not have insurance or the financial resources to be treated for breast cancer. It is usually held late in the afternoon on the last Tuesday of the month at Smith’s office in the Amos Cancer Center.
“We will see women who are under insured and can’t meet their co-pay to see their private physician or are uninsured,” Smith said. “They will come in and we will examine them to order whatever appropriate imaging studies are necessary to get an answer for them.”
Georgia is one of the states that offers women who have a beast cancer diagnosis the opportunity to qualify for Medicaid.
“You still have to fill out paperwork, obviously, but it’s a lot more convenient and lot easier process than it is in Alabama, or say, talking to my colleagues across the country, any other state,” Smith said. “Georgia has been very forward thinking.”
Smith stops short of calling the work he does with low-income patients the most rewarding work he does, but he did say it was “sometimes the gratifying.”