Healthy and at Home

It is perhaps four of the most frightening words a woman could hear: “You have breast cancer.” It’s a club of more than two million women that no one wants to join. And yet breast cancer survival is improving, in large part because of advanced technologies and treatments — many of which are offered at hospitals right here in New Hampshire.

Elliot Hospital is one of them. Dr. Andrea McKee, who is board certified in radiation oncology, says the Breast Cancer Center there is using a lot of advanced imaging diagnostic tests to screen for breast cancer. “We have digital mammography, which is more accurate in younger women and can really be an advantage over reading a mammogram,” she says. “Although it’s the same for the patient, the processing of the information and the detectors in the machines provide a better picture.”

Another area where McKee says Elliot is “way ahead of the curve” is in breast MRIs. “Dr. Dalton [who has been named to New Hampshire Magazine’s Top Docs six years in a row] has been at the forefront of when breast MRIs were just starting to be used to diagnose patients with breast cancer. [Dr. Dalton and his team] were doing it before it was recognized by the American Cancer Society as an important tool for the newly diagnosed.”

In terms of radiation treatment after surgery, Elliot offers MammoSite radiation therapy, a high-dose rate partial breast irradiation. How this works is a ‘”balloon” of sorts is placed in the breast during surgery, and the patient then receives high-dose radiation to the cavity where the tumor had been as opposed to the entire breast, which is the current standard of care, according to McKee. “The advantage to the patient is that less normal tissue is irradiated, and the heart and lungs are spared more by just treating the portion of the breast affected.” It is given as a high dose over just five days twice a day as opposed to 6 1/2 weeks, which is the norm now. Other innovations include “a whole slew of drug trials” that are an important piece of cancer care, says McKee — some of which are available here but not necessarily even in Boston.

At the Norris Cotton Cancer Center at Dartmouth-Hitchcock Medical Center in Lebanon, they also have all-encompassing treatments for breast cancer. According to Kari Rosenkranz, assistant professor of surgery at Dartmouth Medical School and a breast surgeon at the center, they offer oncoplastic surgery, where surgeons remove the cancer and restore the natural shape and appearance to the breast, sparing the patient from waking up without a breast or one that is altered. Also coming this fall for select patients is the nipple-sparing mastectomy, says Rosenkranz.

Like the Elliot, they offer MammoSite radiation therapy, as well as External Beam radiation, which can be done in five days as well, “but without the balloon, which is a nice selling point,” says Rosenkranz. And like other hospitals around the state, the Norris Cotton Cancer Center is involved with a number of national drug trials and screening tests.

New Hampshire hospitals are also taking into consideration the issue of surviving cancer. As with anyone who has had the disease, breast cancer survivors have to learn to deal with issues that come up even after treatment. Things like body image, fertility, sexuality and the ever-present fear of “Will it come back?” are all addressed through “survivorship” programs around the state at medical centers that include support groups, music therapy and massage therapy. “This is just as important as the new technology,” says McKee.

Corinne Foreman, age 58, from Pembroke, has experienced New Hampshire’s breast cancer treatment options firsthand through the Breast Care Center at Concord Hospital. Diagnosed with Stage 1 breast cancer last October, Foreman chose to have a lumpectomy and radiation locally rather than travel to Boston for treatment. “Once I was diagnosed, I had a fit of panic. But the surgeon and the breast care center came highly recommended. I heard that their reputation was excellent, and the process is so long [30 days of radiation five days a week] that I didn’t want to go anywhere else if they had good people from here.”

Foreman, a high school guidance counselor, was able to schedule her radiation treatments in the afternoon so that she only had to take a quarter of the school day off. “I couldn’t have done that if I had sought treatment farther away,” she says.

Sometimes what type of treatment a patient gets is simply a matter of logistics. “Women who live in Berlin are five hours away from the nearest radiation center. To travel for six and a half weeks for radiation is simply not an option for them. They didn’t have a choice but to have a mastectomy,” says McKee. “Now, with radiation over a short course of time, there are even hotels for somebody who does want to stay for five days that can do so at a reduced rate.”

Occasionally a patient or their family members may want to go to Boston to seek a second opinion. Both McKee and Rosenkranz encourage this — especially if it will help to ease the patient’s anxieties. However, McKee says, “There are very few things that I feel we need to send a patient down to Boston for, which is a nice change. It hasn’t always been that way.”

Rosenkranz echoes that sentiment: “We have the level of expertise and access to the new technologies and protocols that are being used in Boston, but in Boston patients are fighting traffic and crowds to get to their treatment. And treatment is not a one-time shot. Particularly for chemotherapy and radiation, there’s a lot to be said for being near the comfort of home and near people that can help.” NH