WBHC Annual Review 2013-14

Women’s Breast Health Centre
Annual Review
April 2013 - March 2014
Dr. Jim Watters, Medical Director
Jennifer Smylie, Clinical Manager
The Ottawa Hospital
Women’s Breast Health Centre
Women’s Breast Health Centre (WBHC) is dedicated to providing the highest quality care for the
breast patients across the Champlain Local Health Integration Network (LHIN). It is a comprehensive breast centre that offers expertise in breast imaging, diagnosis, risk assessment, surgical planning and psychosocial support for patients and their families in a caring and efficient environment.
Summary of Activities:
 36,863 diagnostic breast
examinations and procedures
 2851 breast biopsies
 4598 breast clinic patient visits
 1857 referrals to the Breast
Clinic: more than 750 diagnosed
breast cancer patients
 Implementation of:
 TEAM Program
 Prophylactic Mastectomy
/ Immediate Reconstruction Program
TOH Breast Centre Tree of Life Fundraiser
People:
Inside:
Breast Imaging
2
Education and CME
2
Breast Clinic Highlights
3
New Programs
3
Psychosocial Support
4
Awards
4
Research Highlights
4
Partnerships
4
Looking Ahead
4
Drs. Raman Verma, Andrew Scott-Moncrieff, and Cressida Brennan, all breast subspecialty fellowship
trained radiologists, were welcomed to the WBHC Breast Imaging Department in July 2013. Susan
Domina joins the Breast Imaging team as the new Breast Imaging Corporate Manager. Kathy Knight,
after years of dedication and contribution to the Breast Imaging Department is taking on new challenges
within Medical Imaging. Dr. Marina Lozano, a family physician, brought her much valued experience in
women’s Kealth to the WBHC Clinics in August 2013. We also welcome two new surgeons to our team
this year, Dr. J. C. Gauthier, a general surgeon at the QCH, and Dr. Carolyn Nessim, a surgical oncologist
at TOH, in August and September 2013 respectively. Dr. Audley Bodurtha retired at the end of October
having provided many years of leadership in the WBHC and established the Regional Breast Cancer
Community of Practice. Audley has been a teacher and a mentor for countless colleagues and students,
and is renowned for his abilities with even the most challenging clinical problems. His expertise and guidance will be missed. With his departure, Dr. Justine Davies has taken on sole physician responsibility for the WBHC High Risk Clinic. Sandra Kim Lowry RN, who
oversaw the High Risk Clinic for many years among her other nursing responsibilities, is taking on new challenges at the Ages Cancer Assessment Clinic at the
General Campus as of March 2014. Lynne Kroeger RN, joins the WBHC Clinical
team from Obstetrics, Gynecology and Newborn Care. Her years of experience in
nursing will be much appreciated. Linda Corsini has moved to TOH Mental
Health program. Thank you Linda for all your contributions to WBHC. We were
fortunate to have Esther Doucette, Social Worker, join us for a few months.
Presently, Tamzin Cathers, Social Worker, has joined our team from the Psychosocial Oncology Program. A plastic and reconstructive surgeon has been recruited
Diag 2. Location of the
to join Dr. Kirsty Boyd beginning in July 2014.
new Breast Centre
Page 2
Women’s Breast Health Centre
Breast Imaging
New Faces
at WBHC
Dr. Jean Seely, Head of Breast Imaging
Susan Domina, Corporate Manager Breast Imaging
Dr. Jean Seely has been appointed as the Head of the Regional OBSP Program for the Champlain
LHIN, and as a member of the provincial Mammography Expert Panel advising the CCO-CPSO Quality
Management Partnership. Dr. Seely was also nominated for the Physician Leadership Award at the
Ottawa Hospital. The volume of diagnostic images continues to increase (see chart) at TOH. This is
reflected by increases in numbers of diagnostic mammograms, breast ultrasounds, and breast biopsies, using stereotactic and ultrasound guidance. In spite of this, wait times for imaging have been
largely unaffected, by increased staff and scheduling to accommodate this increase at the WBHC. The
average wait times for a breast biopsy of a RADS patient was 0.5 week, 1 week for a BIRADS 5 and 2
weeks for BIRADS 4B patients. Work to improve wait times for patients included scheduling additional
hours of work, including evenings and Saturdays to accommodate the added volume.
40000
34587
32920
36863
34326
TOH — FY2013/2014
35000
30000
25000
6774
6809
6956
6274
5991
6277
6916
0
2528
1900
Diagnostic
Ultrasound
Mammo
6774
9225
18%
MRI
25%
2078 - 6%
10000
5000
Dr. Andrew Scott-Moncrieff
Radiologist
15935
15929
16723
15692
20000
15000
Susan Domina
Breast Imaging Manager
9225
2861
2346
2685
1946
2851
2078
Biopsy
Screening
Mammo
2851
8%
15935
FY2010/11
MRI
FY2011/12
Biopsy
Diagnostic Mammo
FY2012/13
Ultrasound
FY2013/14
Screening Mammo
Dr. Cressida Brennan
Radiologist
43%
Total
Diag 4. Breast Diagnostic Imaging
Diag 3. Areas of Growth
A multidisciplinary team of breast surgeons, radiologists, radiation oncologists, and pathologists met
to review the evidence for routine preoperative breast MRI in patients with biopsy proven breast
cancer. The summary of the consensus was presented at the Breast Community of Practice and
approved for use in June 2013. The effect is shown in the two pie charts demonstrating the change in
number of indications for breast MRI. A decrease in number of preoperative Breast MRIs is noted,
with an increase in the number
of high-risk screening breast
MRIs, which is an appropriate
use of breast MRI. This is in
agreement with the theme of
“Choosing Wisely” for appropriate use of diagnostic tests in
Canada.
TOH Breast MRI Indications 2009
Kayla Keats
Technologist
TOH Breast MRI Indications 2014
Preop MRI
40%
Screening MRI
OBSP
Problem solving
MRI
Oncology
surveillance
Nipple
discharge
Implants
Preop MRI
Screening MRI
Problem solving
MR and FU
11%
Diag. 5
Annik Blanchette
Technologist
LABC
Diag. 6
Education and CME
In January 2014, Dr. Jean Seely planned a 2-hour evening educational event for 200 family physicians
entitled “The Impact of Early Diagnosis of Breast Cancer” in collaboration with Cancer Care Ontario,
and the Academy of Medicine Ottawa. The event was teleconferenced to reach remote areas. Dr.
Seely spoke about the benefits of breast cancer mortality reduction and the role of breast imaging in
diagnosis of breast cancer. Dr Angel Arnaout spoke about the different surgical management strategies for early versus advanced breast cancer. Reviews from this event were outstanding; the recurrent
themes were ”Why haven't we heard this before, and this has encouraged me to screen, screen,
screen”.
WBHC • Civic Campus • Maurice Grimes Lodge 5th Floor • 200 Melrose Avenue • Ottawa, ON K1Y 4K7
Dr. Raman Verma
Radiologist
Erin Wilson
Technologist
2013-2014 Annual Review
New Faces
at WBHC
Dr. Carolyn Nessim
Surgeon
Dr. Marina Lozano
Physician
Page 3
Clinic Highlights
In November, Dr. Angel Arnaout accepted the
Ontario Ministry of Health and Long Term Care
2013 Award for Novel Advances in Cancer Care in
recognition of the validation of the ‘Rapid Diagnostic
and Support (RADS) Clinic’ program, on behalf of
the team which included Dr. Jean Seely, Dr. Susan
Robertson, Jennifer Smylie, Kathy Knight, Patricia
Gorman, Antonella Iaderosa, Kelly Legallais, and Dr.
James Watters. As part of our continuing quality
initiative, key clinical wait time intervals and clinic
activities are reported monthly. The number of new
consultations continues to increase: current data
indicate there will have been more than 750 newly
identified breast cancer patients in FY 2013-14 and
more than 1000 patients with diagnostic, risk management and/or other clinical questions. A number
of measures have led to a considerable reduction in
wait times from referral to WBHC surgeon consult
and in markedly improving compliance with
Decision-to-Treat to TOH surgery wait time targets.
Additional targeted funding and the efforts of Dr.
Kirsty Boyd and colleagues have allowed combined
mastectomy and immediate reconstruction to be
offered more widely. Gaining a more sophisticated
Volume of Referrals
and their Clinical Diagnosis
2000
1857
1694
1530
1500
1000
1077
953
833
500
780
741
646
0
FY2011/12
FY2012/2013 FY2013/2014
Cancer
Diagnostic
YTD
Diag. 7
understanding of patient experience in the
WBHC is a priority. This is recognized as a
priority, particularly as we plan for the new
Breast Centre and focusing on patientcentred care.
Marilyn Dupuy-Mbuluyo
Outpatient Clerk
New Programs
TEAM Program
Dr. Jean-Claude Gauthier
Surgeon
ThE Advanced Multidisciplinary (TEAM) program, led by Dr. Arnaout, started formally in January 2014
with the goal of reliably identifying at time of referral, women who may have locally advanced or inflammatory breast cancer. By identifying this cohort, the TEAM will provide them with expedited and appropriately-tailored care, including nursing support and early involvement of medical and radiation oncology consultants. Such patients typically have systemic therapy initially which may be followed by surgery. Delays in their care may arise if the diagnosis is not recognized early on. This project, targeting
the unique needs of these advanced breast cancer patients, is made possible by the support of Roche.
Riverside Combined Prophylactic Mastectomy/Immediate Reconstruction Program
Lynne Kroeger
Registered Nurse
An innovative program utilizing side-by-side operating rooms was initiated at The Riverside Campus in
November 2013. Women at very high lifetime risk of breast cancer, most often carriers of a BRCA gene
mutation, may elect to undergo prophylactic mastectomies combined with immediate reconstruction.
The Riverside program addresses the challenge of making this care available in a timely way through
dedicated operating room time, outside the cancer surgery stream. The program utilizes two adjacent
operating rooms at the Riverside Campus, allowing both breast and reconstructive surgeons to be fully
occupied by alternating back and forth between the two operating rooms.
Radioactive Seed Localization
Leah LaButte
Technologist
A stakeholder group met in March 2014 to begin to explore the use of radioactive seeds to localize
non-palpable breast cancers (RSL) for surgical excision, in place of the traditional wire localization procedure. RSL will allow the procedure to be done conveniently prior to the day of surgery and should
provide important patient experience, scheduling, and operational efficiencies, particularly once the
breast surgery program consolidates at the General Campus.
WBHC • Tel • 613-761-4400 Fax • 613-761-4994
Psychosocial Support
Tamzin Cathers
Social Worker
A breast cancer diagnosis creates high anxiety and significant changes to a person’s family and work life. The
WBHC offers a six-week support group for people recently diagnosed with breast cancer. The “Stepping Stones”
group is run by the WBHC Social Worker. Through the group, our Social Worker provides education about how to
cope with breast cancer, teaches skills for stress management, and helps women and men process the emotions
related to having breast cancer. Peer support is a very important aspect of the group; many groups continue to
meet informally on their own in the community long after the formal group sessions have ended. The evaluations
and long term impact of this group have been excellent, with approximately 80 women attending the group each
year. As part of TOH Psychosocial Oncology Program (PSOP), the social worker also provides individual counselling
to people diagnosed with breast cancer.
Awards
First place Junior Resident Presentation by Dr. Ching Yeung and her supervisor Dr. Angel Arnaout at The University of Ottawa
General Surgery Research Day 2013: “Breast Cancer Biomarker Discordance Between Primary and Metastatic Sites – a Systematic Review”.
Radiofrequency Ablation (RFA) for Treatment of Locally Recurrent NSCLC after Definitive Therapy, Vimoj Nair, J Seely, R MacRae,
W. Kendal. First Place Award for Best Fellow Research Presentation.
Canadian Association of Radiology Practice Guidelines And Technical Standards For Breast Imaging And Intervention, Chair,
Shiela Appavoo; Ann Aldis; Petrina Causer; Pavel Crystal; Benoît Mesurolle; Yolanda Mundt; Neety Panu; Jean Seely; Nancy
Wadden, Released October 2013.
Research Highlights:
Peer-Reviewed Publications
Arnaout A, Boileau JF, Brackstone M. Surgical considerations in locally advanced breast cancer patients receiving neoadjuvant chemotherapy. Curr Opin Support Palliat Care. 2014 8(1):39-45.
Arnaout A, Seely J, Smylie J, Knight K, Robertson S, Watters J. Improving Breast Diagnostic Services with a Rapid Access Diagnostic and
Support (RADS) Program. Ann Surg Oncol. 2013; 20 (10): 3335-3340. PubMed ID: 23975290
Bouganim N, Arnaout A, M Clemons. Neoadjuvant endocrine treatment for breast cancer: From bedside to bench and back again?
Curr Oncol. 2014 Feb;21(1): e122-e128.
Chiu M, Bryson GL, Lui A, Watters JM, Taljaard M, Nathan HJ, "Reducing persistent postoperative pain and disability one year after
breast cancer surgery: A randomized, controlled trial comparing thoracic paravertebral block to local anesthetic infiltration (ASO 201306-1032)", Annals of Surgical Oncology: Volume 21, Issue 3 (2014), Page 795-801
Fung-Kee-Fung M, Boushey RP, Watters JM, Morash R, Smylie J, Morash C, DeGrasse C, Sundaresan S. Piloting a regional collaborative
in cancer surgery using a Community of Practice model, Clinical Oncology 2014; 21: 27-34.
Hilton J, Arnaout A, Clemons M. Primary endocrine therapy as an approach for patients with localized breast cancer deemed to not to be
surgical candidates. Curr Opin Support Palliat Care. 2014 9(1): 53-8
Hilton JF, Bouganim N, Dong B, Chapman JW, Arnaout A, O’Malley F, Nielsen T, Gelmon K, Yerushalmi R, Levine M, Bramwell V, Whelan T,
Pritchard KI, Shepherd L, Clemons M. Do alternative methods of measuring tumour size, including consideration of multicentric/
multifocal disease, enhance prognostic information beyond TNM staging in women with early stage breast cancer? Breast Ca Res Treat
2013 142(1):143-51.
McWilliams, A, Tammemagi, MC,... Seely, JM et al. Malignancy Risk of Pulmonary Nodules Detected on First Screening CT. New Engl J
Med. Sept 5, 2013
Partnerships
Looking Ahead
Dr. Jim Watters, Regional Communities of Practice
Breast Site Lead
The WBHC serves as the hub of the Champlain Breast Cancer Community of
Practice, sharing expertise, best practices, and learning through weekly multidisciplinary rounds, regular journal clubs and an annual workshop. Web-based
video-conferencing to personal computers or other devices has been introduced
to facilitate access to our weekly diagnostic/planning rounds. The CoP has
adopted a selective approach to the use of preoperative breast MRI in the past
year. The results of this change and of work on the other priorities – enhancing
linkages with family physicians and improving access to psychosocial care for
high needs patients – will be considered at the CoP workshop in May. Increasing collaboration with medical and radiation oncology is reflected in active participation in multidisciplinary cancer conferences, varied research projects and
educational endeavours, and in innovative clinical programs such as TEAM.
The Ottawa Hospital ‘s new website • www.ottawahospital.on.ca/
The final steps in planning the physical
structure of the new Breast Centre, which
will be located at the General Campus,
included a follow-up patient focus group
held in November. The project has since
received approval from the TOH Board
and the Board of the Champlain LHIN.
The tendering process started in March
2014. Considerable work remains to ensure that operational efficiency and patient experience are optimized in the new
Breast Centre.
Editing, Layout and some photography: Salome Shin

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