Dedicated to the diagnosis and treatment of breast cancer, Nidhi Sahgal, MD, FACS, breast surgeon at Yonkers Radiation Therapy — a practice of 21st Century Oncology — employs her fellowship training and more than a decade of experience to best serve patients in Westchester County.
More than 15,000 women and 150 men in New York face a new diagnosis of breast cancer annually, according to the New York State Department of Health. Factors influencing a patient’s risk include age, family history, genetics, hormones, history of breastfeeding and radiation exposure. Recognizing the need to provide the most advanced, minimally invasive diagnostics, Dr. Sahgal focuses on delivering expedited, empathetic care to patients facing a potential breast cancer diagnosis.
“Thankfully, cancer is not actually a predominant diagnosis,” Dr. Sahgal says. “The majority of cases we see are patients with lumps in the breast or with an abnormal mammogram, MRI or ultrasound. The referring physician and patient want to determine whether or not the abnormality is a concern, and I typically become involved at that point to determine if cancer is present.”
Specialized Breast Care with Compassion
Dr. Sahgal reviews imaging prior to radiation therapy treatment.
Dr. Sahgal’s team at Yonkers Radiation Therapy works to minimize patients’ fears and unease with accelerated scheduling for appointments and diagnostic procedures.
“We move forward quickly with seeing the patients, completing a biopsy and expediting pathology results within two to four days,” Dr. Sahgal says. “Our system is designed to benefit patients. Other breast surgeons may see patients for the first time after a cancer diagnosis has been confirmed, but in my practice, I am involved from the beginning.”
Dr. Sahgal also works to ensure that she and every member of her team provide patients with a comforting setting and an empathetic partner in their care.
“Patients are scared of a breast cancer diagnosis, so we have to be understanding,” she says. “We always have to be supportive and find the best way to meet their needs.”
Minimally Invasive Diagnostics
Dr. Sahgal and Alexander Finkelstein, DO, review biopsy samples to determine a tailored treatment plan.
A minimally invasive stereotactic breast biopsy, which utilizes ultrasound-imaging guidance, is the first step in the diagnostic process Dr. Sahgal employs in the determination of cancer.
“Needle biopsies are performed using advanced imaging guidance to attain a sample from the precise location identified in the mammography study,” Dr. Sahgal says. “Needle biopsies are a safe and efficient way to make a breast cancer diagnosis. The procedure can be completed in the office in five or 10 minutes, which further facilitates the pathology report.”
The stereotactic breast biopsy procedure requires a minor Novocaine injection for numbing the patient’s breast. After acquiring an accurate location from the imaging study, Dr. Sahgal uses a hollow-core needle and vacuum-powered device to collect the breast tissue. Afterward, patients receive results rapidly.
“The lab results have a turnaround time within two days,” Dr. Sahgal says. “My focus is to advance the process as much as possible, because patients are nervous and scared of this diagnosis. I call them personally with the report, and we can move forward with a plan if necessary.”
Lumpectomy vs. Mastectomy
For patients diagnosed with breast cancer, Dr. Sahgal can tailor surgical intervention to best meet the patient’s needs with either a lumpectomy or mastectomy.
A 2013 study published in the journal Cancer cites lumpectomy with radiation treatment as an effective breast-conserving therapy for early-stage breast cancer patients regardless of age or hormone receptor status, noting an 89 percent five-year survival rate.
“At 21st Century Oncology, we expedite the exam, biopsy and results within 24 to 48 hours to bring peace of mind to patients and help determine the next step in their care. I would gladly perform a thousand normal breast exams to identify and successfully treat one patient who has cancer.”
— Nidhi Sahgal, MD, FACS, breast surgeon, Yonkers Radiation Therapy and 21st Century Oncology
“I am a strong believer in breast conservation,” Dr. Sahgal says. “The lumpectomy has to be followed with radiation treatments; however, mastectomies are much bigger operations, and the odds of the cancer reoccurring are the same. For the lumpectomy, the key is to make sure the margins are adequate so that all of the tumors and cancer cells are removed completely, leaving only normal tissue.”
Dr. Sahgal also understands the decision-making process for her patients, which often involves family or loved ones.
“The decision about which surgery to have is extremely important, not just for patients but also for their families, in particular for their spouses,” she says. “For some women, breasts are a sexual organ, and there are social dynamics that play into the decision for any operation involving the breast. With a diagnosis of cancer, the whole family is involved, so we try to take them through the process step by step, employing community resources available through the American Cancer Society.”
Advanced Radiation Therapies
Dr. Sahgal and the Linac machine, which is used to deliver radiation therapy
For breast cancer patients choosing lumpectomy, Dr. Sahgal and the multidisciplinary team at Yonkers Radiation Therapy create an individualized treatment plan in which advanced radiation therapies follow breast-conserving surgery.
“Radiation therapy significantly decreases the chance of a cancer reoccurrence,” Dr. Sahgal says. “We work directly with the radiation oncologist to determine the best course of treatment for each patient.”
Advanced radiation therapies beneficial in the treatment of breast cancer, according to Dr. Sahgal, include:
- Accelerated partial breast irradiation. This course of radiation — lasting from five days to six weeks — is delivered internally through a catheter left in place after surgery at the tumor site.
- Breast brachytherapy. This five-day course of radiation is delivered twice per day through a balloon placed into the breast at the time of the lumpectomy.
- External beam radiation therapy. A radiation beam is aimed directly at the breast with imaging guidance that is geared to protect the heart and lungs from any unnecessary exposure in sessions occurring over the course of a six-week period.
“Another type of radiation — intraoperative radiation — can be performed as part of clinical trial study protocols,” Dr. Sahgal adds. “However, intraoperative radiation is more experimental and not performed within the office setting.”
Tracking Outcomes to Minimize Surgery
Dr. Sahgal participates in the American Society of Breast Surgeons Mastery of Surgery program, in which patient data of biopsies and surgeries is collected and analyzed.
“We track our data to determine our lumpectomy rate, so we can document our clinical performance in patients at risk of breast cancer,” Dr. Sahgal says. “There are many things that may look like cancer of the breast, and experience can help us recognize them and avoid unnecessary surgeries. Once patients are diagnosed and treated for breast cancer, we follow up with imaging every six months for three years and annually thereafter.”
Partnering with Primary Care
Dr. Sahgal and the Yonkers Radiation Therapy team can partner with primary care physicians to most effectively follow cases for patients with any type of breast abnormality or those in a high-risk category for breast cancer.
The 21st Century Oncology team includes, from left, Alba Alfaro, Medical Assistant; Gilliam Palao, Practice Manager; and Lizeth Alfaro, front desk/registration.
The American Cancer Society and American Society of Breast Surgeons recommend women undergo mammography annually beginning at age 40. Patients in higher risk categories may need other forms of testing.
“An ultrasound is performed at the discretion of the physician, but is especially recommended for patients with dense breasts — those whose X-rays are more white than black, which makes them much more difficult to read and analyze,” Dr. Sahgal adds. “Ultrasounds can result in more false positives, which is challenging, but they can lead to a candid discussion between the patient and physician to determine how to proceed.”
Breast MRIs are used for high-risk breast cancer patients as additional screening tools, notes Dr. Sahgal.
“A breast MRI is approximately 95 percent sensitive, and the challenge remains for false positives,” she says. “That’s the challenge with all forms of breast cancer imaging, but most women who are in these high-risk categories would rather know than not know.”
Dr. Sahgal also urges community physicians to ask patients about any nuances in breast development, such as alterations in color, size or skin texture, or the appearance of a lump.
“Whenever patients perceive a change of any kind in their breasts — particularly those with a first- or second-degree family history of breast cancer, or ovarian cancer or other risk factors — they should be followed closely,” she says.
For more information about Yonkers Radiation Therapy and 21st Century Oncology, visit 21stcenturyoncology.com.