St. Clair Hospital HouseCall_Vol IV Issue 4

VOLUME IV ISSUE 4

inside Raye J. Budway, M.D. Helps Family Successfully Fight Breast Cancer I Ask The DoctorFeatures Of The New Breast Care Center I The Benefits Of Mammography I Genetic Link Breast Reconstruction Surgery I The Newly Expanded UPMC/St. Clair Hospital Cancer Center

HouseCall

ST. CLAIR HOSPITAL OPENS NEW BREAST CARE CENTER

Family AffairSisters Take On Breast Cancer

PatIENt ProfIlE

Sisters, from left, Lori Hawthorne, Cindy Bartram and Linda Russell enjoy an after-work dinner at Papa J’s Ristorante on E. Main St. in Carnegie.

2 I HouseCall I Volume IV Issue 4

Volume IV Issue 4 I HouseCall I 3

Elegance. It’s a word that suggests sophisticated style and

refinement. It’s often used to describe icons like Grace

Kelly or Audrey Hepburn. It’s not a word that is typically

associated with breast cancer. But to breast surgeon

Raye J. Budway, M.D., director of the St. Clair Hospital

Breast Care Center, elegance is exactly the right word to describe her

patients, the Resnik sisters. The Resnik women— Lori, Cindy and

Linda, and their late sister Dianna — are siblings in a family that has

been impacted by breast cancer in a rare and almost unbelievable way.

Lori, the oldest, recently had breast cancer surgery and is receiving

ongoing treatment; Cindy is a breast cancer survivor; Dianna died of

breast cancer in 2001; and Linda is cancer-free but high-risk, and, in

September, had prophylactic bilateralmastectomy to prevent breast cancer.

Each of the sisters has had to confront breast cancer in a different

way and each one, individually, is an inspiration. Together, they are a

powerhouse: a formidable and unstoppable force, eloquent and honest,

deeply wounded but heart-strong. They are gentle warriors, fighting for

each other, for their children and for all women, with the hope that, by

publicly sharing their very private experiences, they can educate others.

Their goal, say the sisters, is that women will read about them and will

not be afraid to be tested and treated for breast cancer.

In their response to their extraordinary circumstances, the Resnik

sisters are indeed the epitome of elegance: graceful, dignified and classy.

Lori Resnik Hawthorne, Cindy Resnik Bartram and Linda Resnik

Russell all work in the greater Pittsburgh area and reside with their

respective families in nearby Weirton, W.Va. They are a trio who would

command attention in any setting. Each sister is beautiful, vivacious

and engaging. They laugh and chat easily, glowing with a vitality that is

contagious. Their medical history is unique and fascinating, and their

personal stories are compelling and moving. With courage, candor and

great generosity, the sisters, along with Dr. Budway, have chosen to tell

their story to honor National Breast Cancer Awareness Month, to pay

tribute to their sister Dianna, and to enlighten others about the critical

importance of breast cancer screening and early detection, the keys to

higher survival rates. Here are their stories.

Continued on page 4

These women share Their experiences in hopes They may serve as a source of

supporT To oThers whose lives have been affecTed by breasT cancer

and as a reminder of The imporTance of mammography screening.

Their sTories, like Those of Thousands of oTher breasT cancer survivors,

are why sT. clair hospiTal’s new breasT care cenTer is helping

raise awareness in The baTTle againsT breasT cancer.

ASisters’ StorySiblings face battle against breast cancer together

PatIENt ProfIlEContinued from page 3

lorI—thE lEaDErLori Hawthorne, 49, is the oldest of the four sisters, who were

born over a span of just seven years. Married to Blake, with one

daughter, 17-year-old Erin, Lori has a busy and satisfying life. She

works as a Legal Assistant for the Mt. Lebanon law firm of Riley,

Hewitt, Witte and Romano. Like a typical oldest sibling, Lori is the

spokesperson and organizer in the family.

Lori is also the sister who has breast cancer right now. Her cancer

was found by mammography in March of this year and, despite having

two sisters with breast cancer, she was shocked by her diagnosis.

That’s because Lori had been tested for the BRCA2 (breast cancer

gene) mutation, the one that caused her sister Cindy’s cancer, and

had tested negative. “I thought I was safe,” she explains. “I’ve always

been in perfect health. I believed that I was the lucky one, that it had

bypassed me, because I didn’t have the gene mutation that Cindy

had. But I was tested for the other gene mutations and it turned out

that I had a BRCA1 mutation.”

According to Dr. Budway, this is almost unheard of. “Lori’s gene

mutation may actually be spontaneous rather than inherited. To find two

different gene mutations in a single family — it just doesn’t happen.”

BRCA1 and 2 refer to genes that a woman inherits from either parent.

When these genes contain an abnormality, or a mutation, the woman

is at much higher risk of developing breast and ovarian cancer. Most

of the time, women who develop breast cancer have no family history

of it. But when there is a history, it may be that the BRCA1 or BRCA2

mutation has been passed from generation to generation. (Please

“I thought I was safe. I’ve always been In perfect health.

I belIeved that I was the lucky one, that It had bypassed me …”BREAST CANCER PATIENT LORI HAWTHORNE

risk factors1 in 8 women will be

diagnosed with breast cancer in their lifetime. Most significant risk factors are getting older

and a family history of breast cancer.


Lori Resnik Hawthorne

S t . C l a i r H o s p i t a l B r e a s t

see ‘It’s All In The Genes’, page 12.) In the Resnik family, breast

cancer has been present for at least three generations; a paternal

aunt and even their grandfather had breast cancer. “When Dianna was

diagnosed, we thought it was an isolated case,” says Lori. “We didn’t

know our family history. Our story shows how important it is to talk to

your older relatives and find out. My aunt made a ‘cancer tree’ from

our family tree and we were shocked to see how much cancer

there was.”

Lori had bilateral mastectomy and breast reconstruction surgery

in April. Her cancer is the HER-2 positive type, which is a protein that

identifies the cancer susceptible to a targeted chemotherapy. She is

receiving chemotherapy and the drug Herceptin. Despite this, she is

continuing to work full time. “The treatment is the harder part,” she

says. “The surgery was not that bad. You don’t need to be afraid to

have a mastectomy. You can get a reconstruction, get the breast size

you want, get your nipples reconstructed and even get areolas tattooed

on. The skin and muscles are stretched in a gradual process in which

saline is injected into the implants.”

Lori’s husband Blake has been her rock, supporting her through

her surgery, recovery and continuing treatments, and attending every

appointment with her.

CINDY—thE BEaCoNMay 2012 was a busy month for 47-year-old Cindy Resnik Bartram,

the second oldest sister. She is a mother of two — Justin, 20, and

Kristen, 17 — with a demanding job as Office Supervisor for the

regional headquarters of McDonald’s Corporation in Robinson Township.

Early in that month, she was a beautiful and beaming bride, walking

down the aisle with her groom, Gary. One week later, with her

extended family, she participated in the Susan G. Komen Race for the

Cure, a family tradition since Dianna’s diagnosis in 1999. For Cindy, all

this activity is standard—she is a dynamo who simply forges ahead

with whatever challenges life presents. That intrepid spirit has served

her well as she has coped with breast cancer for the past two years.

Cindy was diagnosed shortly before Christmas 2010.

She was already in the care of Dr. Budway,

having been referred to her by her

gynecologist. “My OB/GYN felt that

I needed to be followed by a

breast specialist, because my

breast density and my

history — especially having

a sister who died of

breast cancer — made

me high-risk. So I

had been seeing

Dr. Budway for

several years,

and she was

sending me

every six

months for


“we’re not anxIous people In my

famIly and that comes from our

parents. to us, strength means

beIng realIstIc, practIcal and

posItIve. Just deal wIth It —

whatever It Is. we belIeve In

makIng the best of It.

”BREAST CANCER PATIENT CINDY RESNIK BARTRAM

Cindy Resnik Bartram

C a r e C e n t e r , 4 1 2 . 9 4 2 . 3 1 7 7

Continued

on page 7

World-Class

Cancer Care

Close To Home

Breast cancer treatment, as well as other cancercare, has been enhanced at St. Clair Hospitalwith the recent addition of a state-of-the-art

linear accelerator to the Hospital’s growing arsenal of advanced cancer-fighting weapons.The new accelerator is the second at the UPMC/

St. Clair Hospital Cancer Center and expands St. Clair’scapabilities and elevates the patient experience. An accelerator delivers high-energy X-rays to patients’

tumors with precision. The new accelerator was first used to treat cancer patients at the center in August. The center, located on St. Clair Hospital’s main

campus in Mt. Lebanon, is a joint venture between St. Clair and UPMC CancerCenter, a partner with University of Pittsburgh Cancer Institute. The joint venture constructed a 1,885-square-foot

addition to the existing 8,000-square-foot center tohouse the new multi-million dollar accelerator. Radiation oncologists at the center work with

referring physicians and other cancer care specialists todeliver the latest therapy, close to home. The high-tech

radiation delivery systems and imagingtechnologies available at the center are

designed to help treat canceroustumors while preserving healthysurrounding tissue.

ROBERT WERNER, M.D.Medical Director, UPMC/St. Clair Hospital CancerCenter; Radiation Oncologist

Dr. Werner earned his medical degree at the University of Pennsylvania School of Medicine,Philadelphia, and an undergraduate degree atCornell University, Ithaca, N.Y. He completed his residency at Memorial Sloan-Kettering Cancer Center, New York City. Dr. Werner isboard-certified in radiation oncology.

To contact Dr. Werner, please call 412.502.3920.

St. Clair’s state-of-the-artlinear accelerator.


Capabilities Include:

Intensity-Modulated Radiation Therapy (IMRT)

IMRT gives radiation oncologists the ability to more precisely“custom sculpt” the shape of a tumor, delivering the rightamount of radiation with more accuracy and helping to preserve healthy tissue around the tumor.

Image-Guided Radiation Therapy (IGRT)

IGRT uses two- and three-dimensional imaging during thecourse of radiation treatment to direct radiation therapy to thecoordinates of the radiation treatment plan. Like IMRT, IGRTis designed to deliver radiation with precision and protecthealthy surrounding tissue.

On-Board Imager® (OBI)

This is an imaging technology used in conjunction with radiationdelivery systems prior to treatment to ensure that a patient andthe tumor are in the same place as originally planned.

Respiratory Gating

During a radiation treatment, a patient’s tumor may change position due to the patient’s breathing cycle or other involuntarymovements. In a respiratory gating treatment, a tracking device“watches” the tumor’s position and briefly shuts off the radiationtreatment device when the tumor moves beyond a certain point.

Rapid Arc®

This advanced equipment rotates 360 degrees around a patient’sbody, providing radiation precisely sculpted to the tumor. RapidArcdelivers treatment in two to three minutes, compared to otherconventional treatments, which may take up to 30 minutes.

Brachytherapy

Brachytherapy is the general name for a type of radiation treatment in which radioactive seeds, smaller than a grain ofrice, are implanted inside or near the area requiring treatment. Radiation oncologists at the center use prostate seed implants —a low-dose rate brachytherapy — to shrink a tumor.

Diagnostic Services

The center also offers the latest diagnostic services to improvetumor detection and localization, patient management, therapyplanning and assessment of response to therapy. Services includeonsite PET/CT (positron emission tomography/computed tomography)imaging services to assist radiologists in determining any abnormalcell activity and in pinpointing the location of cancerous tissue soa biopsy can be performed.

To contact the UPMC/St. Clair Hospital Cancer Centerregarding radiation treatment services, please call 412.502.3920between 8 a.m. and 4:30 p.m. Monday through Friday. n


alternating breast MRIs and mammograms. I didn’t let myself get

worked up about it; it became a habit. And it paid off: thanks to

Dr. Budway’s vigilance, we caught my breast cancer early.”

Patients are often eager to get treatment initiated once they are

diagnosed, says Dr. Budway. “We treat this like an emergency, getting

them in for the initial consult right away. It’s essential to convey a sense

of empathy at the first visit and to begin educating them immediately

about how breast cancer happens and what the treatment options are.

I also ‘open the door’ regarding chemotherapy and radiation, with basic

information. I believe that education helps women make better choices,

and they do have choices. Treatment can be individualized.”

In January 2011, Cindy had bilateral mastectomy, performed by

Dr. Budway, followed by immediate breast reconstruction, performed

by St. Clair Hospital plastic surgeon Robert W. Bragdon, M.D. Cindy

says she felt confident. “Both surgeons prepared me very well.

Dr. Budway wrote out, by hand, five pages of explanations and drawings.

She educated me in a personal way; she didn’t hand me a

pre-written brochure. She made sure I understood

everything that was going to happen. She gave

me lots of time and made me feel like I was

her only patient.” Cindy says that her

husband Gary was beside her every step

of the way and has played a key role in

her recovery.

Cindy has also undergone removal of her ovaries and is now in her

second year of Tamoxifen treatment. She has experienced no side effects

like hair loss or mood swings. “Cindy has estrogen-receptor positive

breast cancer, which means that her cancer is accelerated by the

presence of estrogen,” Dr. Budway says. “She is being treated with

Tamoxifen for five years. She is doing great.

“Among the sisters, Cindy is the beacon. After she was diagnosed,

the others ‘fell into line.’ Her attitude has been incredible.

She knew how high-risk she was and once she was

diagnosed, she handled her situation with such grace.

She has met every hurdle with strength and dignity.

tamoxifenTamoxifen, an “anti-estrogen,”is the most commonly used hormone therapy for the

treatment of breast cancer. Tamoxifen slows or stops the

growth of cancer cells.

“both surgeons prepared me very well.

dr. budway wrote out, by hand, fIve

pages of explanatIons and drawIngs.

she educated me In a personal way;

she dIdn’t hand me a pre-wrItten

brochure. she made sure I understood

everythIng that was goIng to happen.

”BREAST CANCER PATIENT CINDY RESNIK BARTRAM

Lori and Cindy lean on eachother for strength and support.


Continued on page 9

St. Clair Hospital Breast Care Center, 412 .942 .3177

The Benefits of Mammography

st. Clair Hospital’s new Breast Care Center providesa convenient location for women to receivecomprehensive breast care services, including

the most advanced diagnostic imaging technologies. “Ourgoal in opening this center is to bring the best technologiesto St. Clair Hospital in order to offer women the highestquality breast care services,” says Sherri H. Chafin, M.D.,a St. Clair diagnostic radiologist who specializes in breastimaging. “We have the most advanced imaging equipment,including digital 3D breast tomosynthesis, which is similarto a CT scan. Rather than taking a single picture, it captures

several images in ‘slices’ of breast tissue. It helpseliminate callbacks for repeat studies due toshadows. We also offer breast MRI andultrasound at the center.”

The all-digital center enables womento have their mammograms completed in30 minutes. Dr. Chafin hopes that suchefficiency will make it easier for busywomen to make time for this essentialannual screening. “We understandthat women want to get in and out,as quickly as possible. We’re tryingto make it easier for them to takegood care of themselves. We are ableto give same-day results and if a more

extensive work-up is necessary,we’re able to offer thatright away.”

Dr. Chafinemphasizes thatwomen shouldcontinue to

perform monthly self breast exams, in addition to gettingmammograms. “I encourage this,” she says. “Women knowtheir own bodies best and many women find their ownbreast cancer. But it doesn’t eliminate the need formammograms; you need to use every tool.”Not all tumors can be palpated (felt) by a patient or

physician, so the screening mammogram remains the mostimportant tool for early detection. Dr. Chafin notes thatsome women might be confused by the U.S. PreventiveServices Task Force recommendation that routine screeningmammography for breast cancer was unnecessary for womenunder 50. According to Dr. Chafin, the data used in makingthat recommendation was flawed; both the American Cancer Society and the American College of Radiologists stillrecommend that the age to begin annual screeningmammograms is 40. If there is a family history of breastcancer, then screening should begin 10 years before the ageof diagnosis in the family member, but not before age 25. For patients who are reluctant to have mammograms

due to fear of pain or radiation exposure, Dr. Chafin offerssome advice: “Some women have more sensitive breasts.Compression of the breast is essential, though, to see thebreast tissue. But patients can reduce discomfort by takingAdvil, cutting back on caffeine, and scheduling mammogramspost monthly periods. As for radiation, we must alwaysweigh the risk versus the benefit. Most radiation doses thatwe receive are from natural sources referred to as backgroundradiation. A mammogram is equal to two months of back-ground radiation. Ultrasound and breast MRI do not useionizing radiation and are especially useful tools in patientswith dense breast tissue.”Financial assistance for screening mammograms

is available from The Susan G. Komen Foundation’sMammogram Voucher Program. If interested, please call888.687.0505. �

SHERRI H. CHAFIN, M.D.

Dr. Chafin specializes in diagnostic radiology at St. Clair Hospital, where sheis Vice Chair of Medical Imaging. She earned her medical degree at the PennState Hershey Medical Center and completed her residency at AlleghenyGeneral Hospital, Pittsburgh. Dr. Chafin is board-certified by the AmericanBoard of Radiology. She practices with South Hills Radiology Associates.

Early DetectionMammography will

detect about 80 percent to 90 percent of breast cancers in women without symptoms

in the U.S.


She’s one of the strongest women I’ve ever had the pleasure of

treating.” Adds her sister Lori, “Cindy is tough and capable; she can

do anything. She thinks nothing of public speaking before hundreds

of people.”

To Cindy, that strength comes naturally. “We’re not anxious people

in my family and that comes from our parents. To us, strength means

being realistic, practical and positive. Just deal with it — whatever it is.

We believe in making the best of it.” Now, as Cindy watches Lori go

through a breast cancer experience so like her own, she returns Lori’s

praise, citing her resilience. “Lori is one of the strongest people I know.

She rolls with the punches and is bubbly and upbeat, no matter what.”

lINDa—thE gIvErLinda Resnik Russell is “the lucky sister” — her BRCA testing

revealed that she has none of the breast cancer gene mutations.

“After Cindy was diagnosed,” Linda says, “I referred myself to

Dr. Budway. We discussed my risk factors and were surprised when I

scored higher than expected on the Breast Cancer Risk Assessment

(Gail Model). Dr. Budway presented me with options. One was to go on

Tamoxifen for five years. Another was to consider a surgical option—

prophylactic (preventive) bilateral mastectomy, to prevent breast

cancer, followed by breast reconstruction.” According to Dr. Budway,

“Linda has breast changes that can eventually lead to breast cancer.

In any other family, she would be offered Tamoxifen for risk reduction.

But with this history, with three older sisters with breast cancer,

prophylactic mastectomy was an important option.”

Prophylactic surgery is a risk-reducing option in which almost

all the breast tissue is removed. It can reduce risk by 90 percent to

97 percent and the younger a woman is at the time of the surgery,

the greater the benefit. Still, it is not a simple decision for a young,

healthy woman. “My breasts are not my identity,” Linda says, “but

giving them up was still stressful. At my last mammogram and

ultrasound, which took place two weeks after Lori was diagnosed, I

cried through the whole ordeal. It’s an emotional experience for me.”

Linda spoke to her mother, Sylvia Resnik, and Mrs. Resnik told her

that this was a no-brainer. “Mom was right,” Linda says. “There was

no better choice and my family agreed.” With two sisters who have

had the same surgery, Linda had experts close at hand to guide her

through it. Like Cindy and Lori, she had her surgery done by

Drs. Budway and Bragdon at St. Clair. “I know how good their work is,”

she said before the surgery. “I’ve seen my sister’s reconstructed

breasts and they’re amazing.”



“my breasts are not my IdentIty,

but gIvIng them up Is stIll stressful.

at my last mammogram and ultrasound …

I crIed through the whole ordeal.

It’s an emotIonal experIence for me.

”BREAST CANCER PATIENT LINDA RESNIK RUSSELL

Linda Resnik Russell

Continued on page 10

St. Clair Hospital Breast Care Center, 412 .942 .3177

Linda lives with her 18-year-old son, Jacob. She works as

a Human Resources Specialist for ANH Refractories Company in

Moon Township. At age 44, she is the baby of the family, but is as

strong as her sisters and is described by them as a woman with a

heart that doesn’t stop giving. “We tease her about being spoiled,

but Linda was so helpful to me after my surgery,” Cindy says.

“I couldn’t lift my arms post-op and she helped me with everything,

doing things I never even asked of her. Now, she’s doing the same

for Lori.”

The role of caregiver is a familiar one for Linda, whose husband

had a brain tumor, a glioblastoma, in 2008. When Dianna was

diagnosed, Linda lived next door, so she was available to help in

any way she could. She was especially close to Dianna; they grew

up sharing a room and had many of the same friends. “I know that

the role of caregiver is tough, so I wanted to help my mother and

brother-in-law when Dianna was sick. I was around for a lot of it,

and sometimes I felt so helpless. A loss like this wakes you up;

you understand that life is short and fragile.”

DIaNNa—thE INsPIratIoNIn 1999, Dianna Resnik Orsini was a happy 33-year-old wife

and mother with a toddler named Sean and a new baby on the way.

She and husband Tony were building their family and looking

forward to life together. But early in her pregnancy, she was diag-

nosed with breast cancer—a shock for her entire family. She had

a lumpectomy, followed by chemotherapy during the pregnancy

and, later, radiation. Despite significant risks, Dianna and Tony

continued the pregnancy, relying on their solid faith that the baby

would be okay. She was: Dianna gave birth to a full-term, healthy

girl and they named her Faith.

But Dianna was not okay. The hormones of pregnancy had

accelerated the growth of the cancer and it spread throughout her

body. When she became very ill, her mother asked Tony to move

with Dianna and the children into her home, so she could care for

her daughter. “It was a homecoming for Dianna,” recalls Lori.

“We all helped, taking care of her and her babies.” But in June 2001,


The Resnik women in 2000 during the Race for the Cure. From left, Lori, Dianna, Sylvia, Cindy and Linda.

10 I HouseCall I Volume IV Issue 4 S t . C l a i r H o s p i t a l B r e a s t

Dianna lost her battle. Linda says that her death made the sisters

even closer. “We talk almost every day, about everything, and get

together often. My sisters are my favorite people.”

Every Mother’s Day, the family gathers for the Race for the Cure in

Pittsburgh, followed by lunch at the Green Tree Olive Garden. On their

t-shirts, they wear signs that say, “In Memory of Dianna Orsini.” More

recently, they added “In Honor of Lori and Cindy” to those signs. Lori,

Cindy and Linda speak of their sister often; to them, Dianna remains

a constant presence and they have remained close to Tony and the

children. “Dianna means so much to us. She never complained, never

asked, ‘Why me?’ Not even once,” says Cindy. “She was young, she

had a toddler, she was pregnant— but there was no self pity. She

gave us a great example. Dianna is our inspiration.”

sYlvIa—thE MatrIarChThe sisters grew up in the rural hills surrounding Weirton, next to

the farm that has been in their mother’s family since the 1870s. It was

an idyllic childhood in a beautiful setting, in a family with a strong

work ethic. The girls were expected to help out, baling hay, planting

gardens and mowing the grass. The isolation

of farm life was not a problem; the sisters

had each other as playmates.

Church was an essential

aspect of their lives, and they

still attend the Pleasant

Valley United Methodist

Church, a country church

with a small congregation.

That church remains a

source of support for Sylvia

Resnik, matriarch of the

Resnik clan. Healthy and active

at 71, she has watched her

children endure daunting trials with

breast cancer. She could not be more

proud of them.

“My girls give me and my late husband, Larry, credit for their

strength but it’s not me, it’s them. They have such a positive attitude.

They never ask, ‘Why me?’ but I do. Why them? Why three of my

daughters? I’m 71, why can’t it be me? And Linda, having the courage

to have her breasts removed. It’s the right choice, but it’s still hard.

Dianna was so young; she had two little children. It’s horrible to watch

your child go through that. I wanted to take care of her, and Tony

worried that it would be too hard on me. But it was my honor. Dianna

was wonderful, wonderful, just like her sisters.”

Mrs. Resnik supports her daughters’ decision to share their story.

“It’s a simple message: you have to get mammograms. No excuses.

There are ways to get free mammograms if necessary. Early detection

can save lives.”

Dr. raYE BuDWaY—“thE fIfth sIstEr”

“This family is unusual,” says Dr. Budway. “They are unique as a

medical case and exceptional in their attitude. Cindy, once she was

diagnosed, was amazing in how she came through all her hurdles.

She and her sisters have a graceful presence that they bring to dealing

with this disease. They make smart decisions, not emotional decisions.

They’re generous in their desire to educate others. They’re full of life,

a testament to how successful breast cancer treatment can be. No

matter how bad you think it might be, breast

cancer is both treatable and survivable.

Who better than these three women

to carry that message to the

women of this region?”Prevention

Can breast cancer be prevented?There is no definitive way to prevent breast cancer. Eatinga healthful diet and beingphysically active might help

reduce the risk.


“It’s a sImple message: you have to get

mammograms. no excuses. there are ways

to get free mammograms If necessary.

early detectIon can save lIves.

”SYLVIA RESNIK, MOTHER OF BREAST CANCER PATIENTS

Continued on page 12

The matriarch, Sylvia Resnik

C a r e C e n t e r , 4 1 2 . 9 4 2 . 3 1 7 7


“no matter how bad you thInk

It mIght be, breast cancer Is

both treatable and survIvable.

who better than these three

women to carry that message

to thIs regIon?

”DR. RAYE J. BUDWAY, DIRECTOR, ST. CLAIR HOSPITAL’S BREAST CARE CENTER


RAYE J. BUDWAY, M.D.

Dr. Budway earned her medical degree at Hahnemann University in Philadelphia. She completedher residency training in general surgery at The Western Pennsylvania Hospital and a fellowshipin surgical critical care at The University of Pittsburgh Medical Center. She served as the SiteSurgical Clerkship Program Director for Temple University School of Medicine, Site ProgramDirector for the Allegheny General Hospital General Surgery Residency Program, and Director of the Surgical Breast Disease Program and Surgical Intensive Care at West Penn Hospital.She is board-certified in surgical critical care and general surgery. She is a Fellow of the American College of Surgeons and serves on the Fellowship’s Commission on Cancer.

To contact Dr. Budway, please call 412.942.5600.

Beating

the oddsThere are 2.9 million

breast cancer survivors in theU.S. today — the largest group

of all cancer survivors.

Lori, Cindy and Linda like to refer to Dr. Budway as “the fifth

sister” and are grateful to her for her skillful care and compassion.

“Dr. Budway is like family to us,” says Lori. “We love her. She’s

honest, positive and open; you can talk to her. Even her staff

treats us like family.”

Dr. Budway is a Pittsburgh native and a medical school graduate

of Hahnemann University in Philadelphia. As a breast care

specialist, she directs St. Clair’s Breast Care Center, which offers

women a range of advanced diagnostic, treatment and support

services. Dr. Budway says that the incidence of breast cancer has

stabilized: “Breast cancer peaked in the early 2000s with 225,000

cases per year nationwide, but now it’s down to 200,000. This is

due to our understanding of the impact of estrogen replacement

therapy on breast health. At St. Clair, we get excellent outcomes.

We believe that survivorship has multiple dimensions and we

offer women many resources.”

Dr. Budway is an emphatic advocate of education.

“The more you know, the better off you are. Women need

to educate themselves about screening, including breast

self exam and mammogram. Early detection and diagnosis

makes an impact, increasing the odds of survival.”

Like the Resnik family and thousands of others, Dr. Budway

participates in the Komen Race for the Cure every year. For her,

it’s a day of intense and conflicting emotions. “The worst feeling

for me is to see the name of one of my patients on the back of a

t-shirt, below the words “In Memory Of” — I can’t even explain

how that feels,” she says. “But the best feeling, 100 times better,

is to see a patient who is alive, thriving and healthy. That is

the absolute best feeling in the world.”�


DNA in the human genome is arranged into 24 distinct

entities called chromosomes, which are large molecules

that physically resemble convoluted spiral staircases.

Each chromosome contains many genes, which are the basic

physical and functional units of heredity. “Base pairs” of

molecules constitute each step of the spiral staircase. Genes are

specific sequences of base pairs that encode instructions to make

proteins; the proteins in the cells perform most life functions and

even make up the bulk of cellular structures. Proteins are large,

complex molecules composed of amino acids; chemical properties

that distinguish the 20 different amino acids cause the protein

chains to form structures that define their particular functions

in the cell.

Cancer develops when abnormalities called mutations occur

in specific genes, resulting in uncontrolled cell growth that

eventually forms a tumor. These mutations can be acquired over

one’s lifetime, or they can be inherited. The BRCA1 and BRCA2

are two genes that have been associated with hereditary forms of

breast and ovarian cancer. Everyone has these genes. BRCA1 and

BRCA2 are believed to be tumor suppressor genes, meaning that

when they are functioning normally, they code for proteins that

suppress the growth of cancerous cells. Women who have certainmutations along these genes, however, have an elevated lifetime risk

of developing breast and ovarian cancer because their ability to

suppress cancerous growth has been reduced. A woman with a

BRCA mutation faces a 36 percent to 85 percent chance of

contracting breast cancer and a 16 percent to 60 percent chance

of ovarian cancer. BRCA mutations are also linked to breast and

prostate cancer in men.

“Abnormalities in each gene lead to differing clinical

manifestations,” explains Raye J. Budway, M.D., director of

St. Clair Hospital’s Breast Care Center. “For example, families

with BRCA1 mutations have not only the increased risk of

breast and ovarian cancer, but also a risk of pancreatic

cancer that is more than twice the normal risk in both men

and women. Women with BRCA1 have a slightly higher risk of

other cancers in the abdominal cavity such as colon, stomach

and fallopian tube cancer. Men have an increased risk of

prostate cancer in the younger population. BRCA2 mutation

carriers have a higher risk of melanoma.”

Genetic testing, on a blood sample, is available to check for the

presence of BRCA1 and BRCA2 mutations. Dr. Budway recommends

genetic counseling to explain the results and their implications for

breast cancer screening and preventive treatment options. In families

with a history of breast or ovarian cancer, it is helpful to first test a

member who has either of those cancers; if that person has

BRCA1 or BRCA2 mutation, then other members should be tested

to see if they, too, have the mutation.

Women who have a relative with a BRCA1 or BRCA2mutation

and women who appear to be at increased risk of breast and/or

ovarian cancer because of family history should consider genetic

counseling to learn more about their potential risks and testing.

A positive result means that the person has inherited a gene

mutation and is therefore at increased risk of developing breast orovarian cancer, but it does not predict that they will have cancer.

Both men and women who inherit harmful BRCA1 or BRCA2

mutations, whether they develop cancer themselves or not, may

pass the mutations on to their children.

Genetic testing and counseling can remove uncertainty and

enable people to make informed decisions about reducing their

cancer risk. �

The BRCA1 and BRCA2 genes have beenassociated with hereditary forms of breastand ovarian cancer.

It’s all In

tHE GEnEs

ROBERT W. BRAGDON, M.D.

Dr. Bragdon specializes in plastic and reconstructive surgery at St. Clair Hospital, wherehe is Chief of Plastic Surgery. He earned his medical degree at the University of PittsburghSchool of Medicine and completed his surgical residency training at its affiliated hospitals.Dr. Bragdon completed his plastic surgical residency training at The Western PennsylvaniaHospital. He also completed a burn fellowship at West Penn Hospital and was the first fellow in plastic surgery at Dartmouth. He is board-certified by the American Board ofPlastic Surgery. He practices with Plastic Surgical Associates of Pittsburgh.

To contact Dr. Bragdon, please call 412.572.6164.

Breast ReconstructionSurgery st. ClaIr hosPItal’s

Dr. roBErt BragDoN lEaDs thE fIElD

until recently, women who had mastectomies had no choice but to wear prosthetic breasts tucked intotheir bras to simulate natural breasts. They were

often awkward and uncomfortable, and there was constantrisk of them migrating or even falling out. Fortunately, thathas changed, thanks to advancements in technology andplastic surgery, and women who have mastectomies nowhave many post-operative options, including several types of breast reconstruction, a plastic surgery procedure that rebuilds the breast mound to replace the one that has been removed.St. Clair Hospital’s Robert W. Bragdon, M.D., one of

the Pittsburgh region’s leading breast reconstruction surgeons,believes that the procedure offers women both physical andpsychological benefits. “Breast reconstruction is a wonderfulthing,” he states. “It can reduce the trauma of the breast

cancer experience by restoring wholeness and contourto a woman’s body. That’s important, emotionallyand psychologically.”

About half of women who have mastectomies will have some form ofbreast reconstruction. “We can do implantsor autologous tissue reconstruction, usingthe patients’ own tissue,” Dr. Bragdonexplains. “Often, this is a TRAM (transverse rectus abdominis muscle) flap,which uses tissue from the abdomen tocreate and shape a breast mound. Somewomen will opt for additional surgerylater, to create nipples.” Abdominal tissueis preferred because it feels like breast tissue; patients also get the bonus

of a “tummy tuck.” Thenewly constructed breastwill look and feel natural,although it maylack sensation.

Breast implant surgery involves placing a device called a tissue expander under the chest muscle and injecting saline into it at intervals to gradually “inflate” the breast, until it has expanded to the desired size. Both implant surgery and the TRAM flap can be done immediately following mastectomy, or at a later date. Dr. Bragdon is a board-certified plastic surgeon and a

pioneer in breast reconstruction surgery who performed thefirst TRAM flap procedure in Pittsburgh. He performs up to150 breast reconstruction surgeries every year.

He is committed to helping women with breast cancer,and that commitment has a deeply personal element. Dr. Bragdon witnessed his own mother’s ordeal with breastcancer, which took her life. “Much of my motivation stemsfrom my experience with my mother,” he says. “Theopportunity to have breast reconstruction did not existwhen she was diagnosed. I’m grateful that I’m able to givethis opportunity to women. They can return to a normallifestyle, able to wear clothing without worrying about if ithangs right or if the prosthesis might dislodge. They can goswimming and play sports. They feel better about themselves.Breast reconstruction restores a woman’s image, giving herconfidence in her fight against breast cancer.”�

“much of my motIvatIon stems from

my experIence wIth my mother.

the opportunIty to have breast

reconstructIon dId not exIst when

she was dIagnosed. I’m grateful

that I’m able to gIve thIs

opportunIty to women.

”ROBERT W. BRAGDON, M.D.

Post-surgery

optionsAbout half of women who have

mastectomies will have some formof breast reconstruction, often using the patients’ own tissue.


asK thE DoCtor

BruCE A. WrIGHT, M.D.

Ask the Doctor Q

AA diagnosis of breast cancer is devastating to any

woman— and also to those who love her, particularly

her life partner. Men are often accustomed to taking an

active and lead role in defending and protecting their

wives, in alleviating fears, and in trying to make things

right. Breast cancer, however, challenges everything,

including interpersonal relationships.

While a husband’s first reaction may be to try take

control of his wife’s treatment and recovery, the best

thing he can do for his wife is to first ask what she

needs from him, allow her to consider this, and listen

attentively to her replies. Not once, but often. Be

observant also of nonverbal cues to her needs.

Women fighting breast cancer experience strong,

numerous, and varying emotions. Her husband’s mission

is to support her, not to solve all problems. His tactic

of being her champion in this life challenge is to be

her strongest supporter in some gentler, but yet very

powerful, ways. Most importantly, he must be an

empathic listener. This is not the time to try to multi-

task, to text, write a report, or catch the latest sports

scores while conversing with your wife. Empathic

listening is being completely there for your wife, carving

out time to give only to her. Meeting her needs in the

present, whether that’s an ear to listen, a shoulder to

cry on, a hand to hold, someone to accompany her to

doctors’ appointments, or someone to help her take

a break from thinking about cancer.

While helping her to navigate unfamiliar, changing,

and rough seas, he must remember that she is the

captain of this ship. She’s lost control in a profound,

terrifying, and intimate way. Helping her to meet her

challenges on her terms and to retain, and where possible

regain, a sense of control will be one of the most loving

things he can do for her.

You can best care for her if you’re also meeting your

own needs and keeping yourself strong and healthy. It’s

important to be strong enough to ask for professional

help if you need it for yourself, your wife, or the two of

you together to chart your way and stay afloat.

There are many resources available, including

support groups sponsored by St. Clair Hospital. The

Breast Cancer Support Group meets 7 to 9 p.m. on the

third Tuesday of the month. A Cancer Support Group

meets 7 to 9 p.m. the second and fourth Thursday of

the month. And a program called “Look Good … Feel

Better,” which is designed for women in cancer

treatment who are dealing

with side effects to their

appearance, meets

10 a.m. to noon the

first Monday of every

other month. All of

the support groups

are conducted at the

Hospital and are free.

For more information,

please visit

www.stclair.org. �

my wife has just been diagnosed with breast cancer. what can

i do to help her get through this incredible challenge?


BRUCE A. WRIGHT, M.D.

Dr. Wright is chair of the Department of Psychiatry at St. Clair Hospital. He earned hismedical degree at the University of Pittsburgh School of Medicine and completed hisinternship and residency at the University of Pittsburgh Medical Center. Dr. Wrightis board-certified by the American Board of Psychiatry & Neurology. He practiceswith Associates in Clinical Psychiatry, PC in the South Hills.

To contact Dr. Wright, please call 412.347.0170.

General & Patient Information Physician Referral Service Outpatient Center–Village Square Medical Imaging Scheduling 412.942.4000 412.942.6560 412.942.7100 412.942.8150

St.Clair Hospital1000 Bower Hill RoadPittsburgh, PA 15243www.stclair.org

is a publication of St. Clair Hospital. Articles are for informational purposes and arenot intended to serve as medical advice. Please consult your personal physician.

Follow us on twitter at: www.twitter.com/stclairhospitalHouseCall

St. Clair Hospital launched a new erain women’s health care with the recentopening of its new, state-of-the-art BreastCare Center in Bethel Park. Designed witha spa-like ambience, the center offers the mostadvanced diagnostic imaging technology in an environment of comfort, convenienceand beauty. Located on the Third Floor of the

St. Clair Hospital Outpatient Center–VillageSquare, the center is a 6,000-square-footsuite that is configured to maximize patientprivacy and facilitate efficiency.

Patients will appreciate the presence of twowaiting rooms: a public reception area, anda second private waiting room near the testingarea. There are private dressing rooms,including two that are attached directly toa mammography room. Even the acousticswere addressed, with soundproofing ondoors to assure confidentiality of conversationswith doctors or technicians. Architect TamiGreene, AIA, of IKM, Inc. in Pittsburgh,says that privacy was a major considerationin planning the space. “Women will be ableto circulate through the suite without everentering a public area. This is importantwhen you are wearing an examination gownin a clinical setting.”That level of attention to the personal

experience of the patient is evidentthroughout the center. Because having amammogram is an emotional and oftenstressful event for women, the center offers

a space with a higher level of comfort andaesthetics than what is typically found inmedical settings. To achieve that, Greeneand her team utilized soft colors in lightblue, green and silver, with a luminoustouch, giving the center an elegant, feminineappeal. “There is a sparkle to the finishesin the waiting areas,” she explains. “Thelighting contains crystals and the wallcoverings have a shimmer to them. Therealso is a water feature, which provides atherapeutic effect.”The physicians and other caregivers

at the center describe it as a place wherewomen are treated with great care andcompassion. “The goal in the design of thenew center was comfort and privacy,” saysSherri H. Chafin, M.D., a St. Clair diagnosticradiologist who specializes in breast imagingand was instrumental in the center’s design.“In working with the architect, I believewe have created an environment whichemulates the warmth and caring of our staff.”The center features three mammography

rooms; two ultrasound rooms; threeexamination rooms; two mammographyreading rooms; three offices; and fourconsulting rooms. (Please see ‘The Benefitsof Mammography’, page 8.) All mammographyrooms and restrooms are ADA compliantand the doorways and halls are wideenough to accommodate wheelchairs.There is free parking, plus free valet parkingfor center clients. �

St. Clair Hospital Outpatient Center–Village Square in Bethel Park, home to the Hospital’s new Breast Care Center.

NEW BrEast CarE CENtEr Is DEsIgNED for

Comfort and Privacy

St. Clair Hospital HouseCall_Vol IV Issue 4

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