BY MICHELLE TALSMA EVERSON

W hen a patient is first diag-

nosed with breast cancer —

or even suspects the disease

— there are often more questions than

answers. However, through Banner

MD Anderson Cancer Center’s compre-

hensive breast cancer program and its

top-of-the-line screening and diagnos-

tic imaging tools, women are able to get

their questions answered and rapidly be

on the road to treatment if necessary.

“Patients with breast symptoms are

frequently and justifiably worried, but

when we explain our imaging findings

to them or explain what to expect dur-

ing a diagnostic procedure, it results

in a less intimidating experience,” says

Dr. Vilert Loving, a board-certified

radiologist who specializes in breast

imaging and diagnosis at Banner

MD Anderson Cancer Center.

Loving explains that the Women’s

Imaging Center at Banner MD Anderson

has a myriad of screening and diagnostic

tools available to patients seeking

everything from annual screening

mammograms to diagnostic testing

and procedures.

3D TOMOSYNTHESIS3D tomosynthesis, commonly known

as a 3D mammogram, is one of the imag-

ing center’s latest tools—the FDA just

approved its clinical use last year.

“3D tomosynthesis examines the

breast from multiple, different view-

JUNE 2012A PUBLICATION FOR COMMUNITY PHYSICIANS

View to a cureCutting-edge imaging tools offer women more choices — and chances — in the fight against breast cancer

Dr. Vilert Loving stands by the 3D Tomosynthesis equipment. It is the newest imaging technology for screening mammograms.

INSIDE3 Know the code4 What’s Happening at Banner MD Anderson

Cancer Center5 Advancing the treatment of cancer

6 Effective surgical techniques for melanoma7 Changing the way doctors treat cancer8 Introducing Banner MD Anderson physicians

2 JUNE 2012 ROUNDS

points,” Loving says. “A conventional

mammogram looks at the breast from

two viewpoints, while the 3D tomo-

synthesis shows multiple angles by

moving in an arc around the breast.

This provides the radiologist with

more information and confidence in

finding abnormalities.”

While the most effective use of

the 3D tomosynthesis is still being

decided, Loving said that the center

has so far found it most useful for

women seeking routine screening

mammograms to distinguish normal

overlapping breast tissue from true

abnormalities. It has also been helpful

to fully characterize disease in some

patients’ diagnostic mammograms.

He adds that the center has the only

3D mammogram he knows about in

the East Valley and one of the few

in the state.

BREAST MRIAnother stand out series of instruments

that help patients to prevent or detect

cancer are the center’s MRI tools.

In addition to MRI biopsy, the

Women’s Imaging Center utilizes

advanced MRI technology to screen

high risk patients or to evaluate cancer

in patients who have already been

diagnosed, according to Loving.

“In general with MRI, the stronger

the magnet, the better the image. We

have a 3T magnet which is the best that

is clinically available. Many centers

employ a 1.5T magnet or lower,” Loving

says. “Our MRI images are very good;

they are better than a mammogram for

finding breast cancer. MRIs are best

used for screening higher risk patients

and in some patients who already have

a cancer diagnosis to determine the full

extent of disease in the breast.”

Loving adds that, while the images

taken by a high-powered MRI are often

“noisier” (meaning harder to read),

Banner MD Anderson works closely

with a physicist to clear the noise

Comprehensive care for breast cancer patients

Banner MD Anderson Cancer Center’s Comprehensive Breast Cancer Program provides the full range of medical care and support needed with a breast cancer diagnosis. The medical team includes medical oncologists, breast surgeons, reconstruction surgeons, radiation oncologists, radiologists and additional clinical and support staff. The program also offers beneficial support services to women in every stage of their breast cancer treatment.

Mary Cianfrocca, D.O., F.A.C.P., the director of the breast cancer program, says that support services help to “pro-vide better care in the long run.” Some of these services include:

• Undiagnosed Breast Clinic, for women who may have an abnormal finding but do not have a confirmed cancer diagnosis

• Clinical nurse navigators who lead patients through the system of care

• Wellness activities and support groups

• Clinical Cancer Genetics Program• The Boutique of Hope, which helps

women who have undergone mastectomies or other treatments to feel better about themselves

• Lymphedema therapy, which helps to reduce lymphatic swelling during treatment

• Palliative care, which can help patients manage pain

• Other unique offerings like nutritionists and weight loss programs for breast cancer survivors

“The wonderful thing about these support programs is the ability to offer so many diverse services in one location with the ultimate goal of caring for the whole person.” Cianfrocca says.

To learn more, visit BannerMDAnderson.com.

Physician Phone NumbersSchedule a mammogram – 480-543-6900Undiagnosed Breast Clinic – 480-256-3433Refer a patient – 480-256-3433

and maximize the picture — mean-

ing clearer images and better patient

results.

DIGITAL MAMMOGRAPHY AND DIAGNOSTIC TOOLSThe Women’s Imaging Center also

utilizes digital mammography, which

is similar to traditional mammogra-

phy, but provides a crisp digital image.

“Digital mammography has been

shown to be advantageous for younger

people in their 40s,” Loving says.

In addition to state of the art

imaging technology, the center of-

fers a wide array of diagnostic tools,

including: different types of biopsies

(ultrasound guided, stereotactic and

MRI), breast ultrasound, cyst aspira-

tion, needle localization, lymph nodes

biopsy, and more.

To refer a patient to Banner MD An-derson for a screening mammogram or more extensive diagnostic testing, please call (480) 543-6900. Patients may also call this number directly to schedule an appointment.

Dr. Mary Cianfrocca, director of the breast cancer program.

BannerMDAnderson.com 3

BY JAKE POINIER

The Human Genome Project

was completed in 2003, but The

University of Texas MD Anderson

Cancer Center had begun integrating

genetics into care plans for cancer pa-

tients in the mid 1990s, when two breast

cancer genes, BRCA1 and BRCA2, were

discovered. With other cancer genes

subsequently identified, the understand-

ing of the relationship between cancer

and our genetic code has continued to

progress—with implications for screen-

ings as well as treatment. The longstand-

ing work in genetics in Houston is now

benefitting patients in Arizona at Banner

MD Anderson Cancer Center.

“There are primarily two popula-

tions of patients we see in our clinic,”

said April O’Connor, a certified genetic

counselor and the genetics program

coordinator of the Banner MD Ander-

son Clinical Cancer Genetics Program

in Gilbert. “Those who currently have

cancer, and those who are healthy but

concerned about their cancer risk.”

The clinic’s goal is to determine

whether there is a hereditary predis-

position to a patient’s cancer—which

occurs in about 5 to 10 percent of

cases—or if it is sporadic. The distinc-

tion is critical: Hereditary cancers may

react differently to treatment, and be

more aggressive, which could change

the protocol for treatment options.

“If someone has hereditary breast

cancer, they have a much higher chance

of recurrence in the other breast, about

40 to 60 percent,” O’Connor said. “If

it’s sporadic cancer, then it’s only 2 to

10 percent. It makes a difference in

whether you’d consider a prophylactic

mastectomy of the other breast, versus

just monitoring by screening.”

Genetics program offers new insights into screening for and treating cancerKnow the code

GENES AND SCREENSScreening protocols for people with a

genetic predisposition for breast cancer

have changed in recent years as well.

Mammograms once a year for individu-

als over 25, or individualized based

on the youngest cancer diagnosis in

the family, now can be supplemented

every six months with MRI scans for

improved detection.

Colon cancer is another case in

which genomics also may affect the

screenings. A full colonoscopy will likely

take place earlier, around age 20-25,

to assess for any polyps or cancers.

While genes that cause ovarian cancer

are known, diagnosis is more difficult

because the ultrasound and blood test

screening results are not as definitive,

and the tumors are often fast growing.

TESTING, TESTINGPrior to any testing, genetic counsel-

ing thoroughly examines family and

personal history. Taking into account

cancer at early age, rare forms such

as male breast cancer, or two dif-

ferent types of cancer in the same

individual, clinicians look at risk

models that indicate the likelihood of

a genetic mutation. If testing is per-

formed, the results come in within

two to three weeks.

Although genomics has come a long

way in the past two decades, there are

still gray areas, since not every cancer-

causing gene has been identified. “You’re

not always going to get a definitive

answer,” said O’Connor. “But even if you

learn you’re negative for the most likely

gene, you’ve checked something signifi-

cant off the list of possible causes.”

Reading your genesTo refer a patient to the Clinical Cancer Genetics Program at Banner MD Anderson Cancer Center, please call (480) 256-3433. Patients may also self refer by calling (480) 256-6444.

April O’Connor, cooridinator of Banner MD Anderson Cancer Center’s Clinical Cancer Genetics Program.

4 JUNE 2012 ROUNDS

We have

reached

the six

month mark since

the opening of

Banner MD Ander-

son Cancer Center.

And it has been a

busy six months! I am

pleased to share that we have more

than 60 physicians now working with

the cancer center, each highly special-

ized in their fields of expertise.

We have established several compre-

hensive disease specific programs.

In this issue of Rounds, you will read

about our Comprehensive Breast

Cancer Program. This program encom-

passes all aspects of breast cancer, from

prevention and diagnosis to treatment

and support. Our team of physicians in-

cludes radiologists, medical oncologists,

breast and reconstruction surgeons,

What’s Happening at Banner MD Anderson Cancer Center

BY DR. EDGARDO RIVERA, MEDICAL DIRECTOR

cancer center. Most recently we have

welcomed Dr. Diljeet Singh, a gyneco-

logic oncologist who is developing our

prevention and integrative medicine

program. Finally, we have begun to

open clinical trials for our patients. We

are participating in a breast cancer trial,

and will be opening trials for chronic

lymphocytic leukemia, colorectal and

pancreatic cancers shortly. A number

of additional trials are currently in the

review process. In addition, we are

developing a process to offer selected

trials from The University of Texas MD

Anderson Cancer Center in Houston

on our campus. This will give Arizona

patients access to many more clinical

trial opportunities.

As always, please contact me if you have any questions about Banner

MD Anderson Cancer Center or referring a patient. I can be

reached at (480) 256-3335.

radiation oncologists and pathologists.

They are supported by an excellent

nursing and support staff, and the latest

in diagnostic and treatment modalities.

In the Undiagnosed Breast Clinic,

women with a suspect mass or an

abnormal mammogram receive further

evaluation to determine the presence or

absence of a malignancy. This diagnostic

process is accelerated to provide a timely

diagnosis, often with 24 to 48 hours. We

hope this will reduce anxiety for many

women, and will assist you with expe-

dited diagnoses for your patients.

This issue also features our mela-

noma team. A medical oncologist and

surgical oncologist work together to

provide the latest treatment options

for people diagnosed with melanoma.

We continue to welcome

new physicians to our

BannerMDAnderson.com 5

As a radiation oncologist at

Banner MD Anderson Cancer

Center, Emily Grade, M.D.,

has access to the most advanced and

state-of-the-art equipment in the

world. The cancer center was built

with careful planning to provide

excellent care and a positive patient

experience. In addition, everything

a patient might need is provided in

one location.

Grade also knows that while

having access to the best equipment

is essential, it is just as important

to have regular communication

with the other treating physicians

about the health, treatment and

care of each and every patient.

TEAM APPROACH“I came here from a community prac-

tice, and when I arrived, the first thing

I noticed was how the entire team of

doctors communicates regularly and

works together to help our patients,”

she says.

In addition to meeting with the

team of doctors at the Gilbert facility

twice a week, Grade says the radiation

oncologists meet via a regular phone

conference with the physicians at

The University of Texas MD Anderson

Cancer Center in Houston.

“We are constantly talking about

our cases as a community,” she says.

“It’s the idea of having collective

minds working together and pooling

our brain power that makes a big

difference here, even more so than

the best equipment.”

SPECIALIZED TREATMENTIn addition to the “many heads are

better than one” approach to patient

care, Grade says another way the

center is advancing the treatment of

cancer is by specialization. In other

words, the doctors focus on specific

cancers and become experts in that

cancer treatment. This specialization

is done similarly at MD Anderson

in Houston.

While Grade appreciates being

part of a medical team that values

communication, sharing patient

information, and working collabora-

tively to be sure that each and every

patient is given the best treatment

possible, she says the state-of-the-art

oncology equipment does definitely

help them in their work.

“Delivery of radiation has become

more sophisticated. Here we can now

pinpoint very accurately where we are

delivering the dose, and we can avoid

nearby organs and healthy tissue more

easily,” she says.

“We can also choose to utilize a

PET scan as part of the therapy treat-

ment design, so we can see where

the cancers are active and where they

are not.” This would allow the field

of treatment to be more accurate.

The Radiation Oncology de-partment provides a wide array of radiation treatments with the latest technologies. Physicians may refer patients for radiation treatment by contacting the radiation oncology department at (480) 256-4500.

Advancing the treatment of cancer Oncologists at Banner MD Anderson Cancer Center meet regularly to discuss their patients and compare charts, notes and ideas

BY ALISON STANTON

Dr. Emily Grade, a radiation oncologist at Banner MD Anderson Cancer Center.

6 JUNE 2012 ROUNDS

BY STEPHANIE CONNOR

W ith shorts and tank-top sea-

son upon us, it’s incumbent

upon primary care physicians

and dermatologists to check patients for

melanoma and other skin cancers.

“Once a melanoma is identified,” says

Mark Gimbel, M.D., a surgical oncologist

at Banner MD Anderson Cancer Center

who specializes in cutaneous tumors,

“physicians should be appropriately

aggressive in their surgical approach.”

Gimbel offers a few reminders for

treating melanoma.

First, he says, Mohs surgery isn’t ap-

propriate for melanoma, so reserve that

technique for basal and squamous cell

carcinomas. Because melanoma requires

a wider margin, he says, Mohs surgery

could result in missing part of the can-

cerous tissue or any satellite lesions.

Effective surgical techniques for melanoma

IMPORTANCE OF MARGINSSecond, make sure the margins around

the melanoma are wide enough. “If the

margins aren’t wide, there’s a higher

chance of residual disease and an in-

creased likelihood of local recurrence,”

Gimbel says.

Treating melanoma surgically, he

explains, requires an aggressive approach.

“The size of the excision is based on

the depth of the tumor,” Gimbel says.

“The deeper the tumor into the skin, the

wider the excisional margin needs to be.”

He offers this example: “A melanoma

could be up to 1 mm in depth. You need a

1 cm margin. So, that could end up being

an excision that’s 2½ cm in diameter.”

Because particularly wide excisions

can be disfiguring, he says that orient-

ing the original biopsy or excision ap-

propriately for the area is essential.

BEYOND THE EXCISION “We also have to look at the pathologic

evaluation of the tumor,” Gimbel says.

By looking at the thickness, ulceration

and the mitotic rate of the tumor,

pathologists can effectively stage the

primary melanoma.

It’s also essential to evaluate the

regional lymph nodes if the melanoma

grows beyond a specific depth. The risk

of spread to the lymph nodes increases

as the depth of the melanoma increases.

Typically, for melanomas greater

than one millimeter in depth, a lymph

node evaluation is recommended. For

lymph nodes that can be palpated a full

nodal dissection is performed. However,

for patients without palpable nodes, in-

stead of removing all of the lymph nodes

in a regional basin (axilla/neck/groin),

only one or two sentinel nodes are re-

moved at the time of the initial surgery

to see if the melanoma has spread.

Still, Gimbel says, with all the ad-

vances in treating melanoma, the most

important thing for any doctor is to

help catch it early.

Banner MD Anderson oncologist recommends an aggressive approach

Banner MD Anderson physicians Dr. Mark Gimbel, (left) surgical oncologist, and Dr. Jade Homsi, medical oncologist, specialize in the diagnosis and treatment of melanoma. They work as a team to provide a multidisciplinary approach to treating the disease.

BannerMDAnderson.com 7

BY GREMLYN BRADLEY-WADDELL

When it debuts this fall at Ban-

ner MD Anderson Cancer

Center, the Cancer Preven-

tion and Integrative Medicine pro-

gram will take a “whole person, whole

patient” approach to healthcare, says

Diljeet Singh, M.D., DrPH.

NEW WAY OF THINKINGFor some, the “integrative” approach

may be a new way of doing things, says

the newly minted program director

at the Gilbert hospital, where she also

serves as program director of gynecolog-

ic oncology. That’s because traditional,

Western-based allopathic medicine

tends to focus on diseases, diagnoses

and treatments and often does not take

much else, like a person’s lifestyle, into

consideration. In her first-floor clinic,

however, Singh and her staff will take the

time to educate the public about healthy

living and disease prevention and, when

treating cancer patients, incorporate –

integrate, in other words – the myriad

factors that affect wellness, like nutri-

tion, stress and physical activity.

“And, if you are someone who does

not have any diagnoses, it’s our job as

physicians working in prevention and

integrative medicine to ask, ‘How do we

keep you that way?’ ” Singh adds.

ABOUT DR. SINGH An energetic type who studied under the

well-known physician Andrew Weil at his

Arizona Center for Integrative Medicine

Changing the way doctors treat cancerBanner MD Anderson Cancer Center to introduce new prevention and integrative medicine program

more, followed by three years’ worth

of fellowship training in gynecologic

oncology at The University of Texas MD

Anderson Cancer Center in Houston.

Her doctoral degree in cost analysis is

from The University of Texas School of

Public Health.

CONCENTRATED CARESingh envisions the clinic as a welcom-

ing place for cancer patients to get an

integrative medical consultation and

to see any one they need: a doctor,

nutritionist, physical or rehabilitation

therapist, social worker or psycholo-

gist. Some of the modalities she ex-

pects the clinic to offer include Eastern

medicine, massage and acupuncture,

all of which she says have benefits

when used and managed properly.

“For example, we’ve proven acu-

puncture decreases chemotherapy-

related nausea, equal to the amount

that a drug can, and with fewer side

effects,” she says.

On the prevention side, she says

the clinic will be a place where cancer

survivors can learn about their future

health risks and ways to avoid further

disease. Those not affected by the

disease can also benefit from the clinic

by getting a health assessment based

on family history and genetics and by

learning about behaviors that put them

at risk for the disease.

SAFE TREATMENTWhile she knows holistic medicine has

gotten some bad press, Singh makes it

clear that the Banner clinic won’t offer

treatments that haven’t proven to be

effective and will run clinical, safety and

efficacy trials on any new treatment

before it is even considered for use. If

anything, the local medical community

has truly embraced the clinic – and she

wouldn’t expect otherwise.

“I think everybody in medicine

is for doing everything we can for

people,” she says.

at University of Arizona in Tucson, Singh

recently relocated to the Valley from Chi-

cago and the Robert H. Lurie Compre-

hensive Cancer Center of Northwestern

University. She held an academic ap-

pointment as assistant professor of Ob-

stetrics and Gynecology at Northwestern

University Feinberg School of Medicine

and was a co-director of the Northwest-

ern Ovarian Cancer Early Detection and

Prevention Program.

As for her training, Singh earned

her medical degree from Northwest-

ern University and a master’s in public

health from Harvard University School

of Public Health. She completed her

residency in obstetrics and gynecology

at the Johns Hopkins School in Balti-

Dr. Diljeet Singh heads up Banner MD Anderson Cancer Center’s Prevention and Integrative Medicine Program.

PRESORTED STD

U.S. POSTAGE

PAID

LONG BEACH, CA

PERMIT NO.1677

HEMATOLOGY & MEDICAL ONCOLOGY SECTION

Tomislav Dragovich, MD, PhD, Section ChiefDigestive tract cancers including colorectal, esophageal, stomach, pancreatic, hepatobiliary

Shakeela Bahadur, MDLung, colorectal, breast cancers

Mary Cianfrocca, DOBreast Cancer Program Director

Jade Homsi, MDMelanoma, sarcoma, immunotherapy

H. Uwe Klueppelberg, MD, PhDMultiple myeloma and other plasma cell disorders, lymphomas, myelodysplastic syndrome, brain cancers, head and neck cancers, thoracic cancers

Edgardo Rivera, MD, Medical Director Breast cancer

Kerry Tobias, DOPain management, palliative medicine, physical medicine, rehabilitation

Bryan Wong, MDGenitourinary cancers

ONCOLOGY SURGERY SECTION

Judith K. Wolf, MD, Section ChiefGynecologic oncology

Mark Gimbel, MDMelanoma, sarcoma, cancer of the stomach, small bowel, colon and rectum, thyroid, pancreas, liver, breast, and other rare cancers

Christine Landry, MDPancreatic cancer, carcinoid tumors, thyroid cancer, adrenal tumors, parathyroid tumors, melanoma, sarcoma, gastrointestinal cancers, breast cancer, liver tumors

Diljeet Singh, MDProgram Director, Gynecologic Oncology; Program Director, Cancer Prevention & Integrative Medicine

Benny Tan, MDPlastic and reconstruction surgeonBreast cancer reconstruction and most forms of cancer reconstruction

Stephanie Byrum, MDBreast surgery

Rob Schuster, MDGeneral surgery

Al Chen, MDGeneral surgery

RADIATION ONCOLOGY SECTION Matthew Callister, MD, Section ChiefGastrointestinal, skin, sarcomas, and head and neck cancers

Emily Grade, MDBreast treatment including partial breast brachytherapy, prostate brachytherapy, gynecological and thyroid cancers

Terence Roberts, MD, JD Brain, lung and prostate tumors; stereotactic radiosurgery; partial breast brachytherapy

DIAGNOSTIC IMAGING SECTION

Donald Schomer, MD, Section Chief, CAQ NeuroradiologyOncologic diseases of the brain, spine, head and neck

John Chang, MD, PhDAdvanced magnetic resonance and computerized tomography imaging of gastrointestinal and genitourinary systems; imaging guided biopsies

Vilert Loving, MDBreast imaging and intervention

Harvinder Maan, MD, CAQNeuroradiologyDirector of Neuroradiology Neuroradiology and interventional spine procedures

Rizvan Mirza, MDAbdominal and pelvic magnetic resonance imaging

Susan Passalaqua, MDDirector of Nuclear Medicine and Molecular Imaging Oncologic imaging, nuclear medicine, radiology, PET/CT

Andrew Price, MD, CAQ Interventional RadiologyInterventional radiology, including percutaneous tumor ablation, chemoembolization, and radioembolization

David Russell, MD, FACPBreast imaging and intervention

CRITICAL CARE SECTION

Shiva Birdi, MD, Section ChiefJohn Jijo, MDDeven S. Kothari, MDDean Prater, MD

INTERNAL MEDICINE SECTION

Nikunj Doshi, DO, Section ChiefInternal medicine

David Edwards, MDInternal medicine

Ronald Servi, DOPulmonary medicine

PATHOLOGY SECTION

Kevin McCabe, DOSection Chief

Banner MD Anderson Cancer Center physicians are highly specialized in their fields of expertise. Below is a listing of physicians currently on our full time staff. Physicians continue to join Banner MD Anderson, so this list will continue to evolve.

To make a referral to a physician on our staff, please call (480) 256-3433. To contact a member of medical staff, call (480) 256-6444 and ask for the

physician to be paged.

Introducing Banner MD Anderson Physicians