My many years of education and training — including graduating summa cum laude from Pomona College, earning a master’s degree in Statistics, receiving my MD from Harvard Medical School, and completing my surgical training at Cornell University and Memorial Sloan Kettering — prepared me for the challenges of caring for women with breast cancer. I have been honored for many years by being listed in “America’s Top Doctors,” “America’s Top Doctors for Cancer,” “New York Super Doctors,” and in New York Magazine’s “Best Doctors in New York.”
My research interests include exploring diagnostic and treatment options for patients with ductal carcinoma in situ (DCIS), in which cancer cells are confined within the ducts of the breast and have not invaded into the surrounding breast tissue outside of the ducts. The diagnosis of DCIS has increased exponentially over the past decades. Yet, the recurrence rates for women with DCIS treated with breast-conserving surgery has not been as low as that of women with the more common invasive breast cancer.
In women with DCIS treated with breast-conserving surgery (BCS), I found that women of younger ages are at higher risk for local recurrence. I also published the largest series to date examining the influence of margin width on the risk of recurrence of DCIS treated with BCS, and participated in a Consensus Conference establishing guidelines for margin width for DCIS treated with BCS and radiation. Fortunately, analyses of our data also showed that the risk of recurrence for a woman with DCIS treated with BCS alone has decreased over the decades by a substantial degree.
Putting together these findings and others regarding the various factors that influence the risk of local recurrence after BCS for DCIS together, I created a risk prediction model, called a nomogram, to help clinicians and patients estimate the risk of recurrence for an individual patient. This DCIS nomogram has been validated in at least 6 different populations in the US and internationally and is available free-of-charge online to help clinicians and women weigh the various treatment options for DCIS. I also showed that this tool apparently performs better than a commercially available $4600 test that is marketed as a risk prediction tool for DCIS.
Together with colleagues from Dana Farber, I examined over 3000 women who underwent a mastectomy for DCIS and showed that while recurrence rates are extremely low, the youngest women are at higher risk.
Another area of special interest is sentinel lymph node biopsy. This is a method in which the breast tissue is “mapped” to identify one or a few nodes to which a woman’s breast cancer would first metastasize (spread). I developed another nomogram predictive tool that calculates the likelihood of additional lymph node metastases in breast-cancer patients who have metastasis in a sentinel node. This additional node nomogram has been widely used and validated at dozens of institutions around the world. We also developed a nomogram to help a woman with breast cancer predict the risk of having sentinel node metastases. This risk of nodal metastasis nomogram can help a woman understand her risk after she’s had a breast biopsy but before the results of the sentinel node biopsy are available.
In order to share information that we have learned about breast cancer at Memorial Sloan Kettering, I have lectured extensively, both nationally and internationally, and authored many manuscripts on topics in breast cancer. You can view a listing of my publications in PubMed by clicking on the PubMed icon below.
