Dr. Maureen McEvoy, left and Laura Graafland, Clinical NP
By Dan Murphy
During Breast Cancer Awareness Month, St. John’s Riverside Hospital continued its informative webinar series on October 19 with a ‘Conversation with Breast Specialists’ Maureen McEvoy, MD & Laura Graafland, Clinical NP. The two shared their experiences and knowledge about education and treatment options for women and men with breast cancer with moderator Denise Mananas, Vice President for External Affairs at St. John’s Riverside Hospital.
“One in eight women will get breast cancer. We are so fortunate to have the technology to screen for a very common disease. If it is caught early, the prognosis is very good,” said Dr. McEvoy.
When should someone start screening for breast cancer?
“It is recommended to start screening mammograms at the age of 40. For those patients who are at risk, they can start earlier,” said Dr. McEvoy, who explained that a screening mammogram is taken on patients with no apparent symptoms and who are coming in for their annual exam. A diagnostic mammogram is used to examine further patients who may have had a finding on a screening mammogram.
The biggest takeaway from this webinar was that women over the age of 40 should get their annual screening mammogram. “We have the ability to screen every year with a mammogram. It’s pretty quick, and it’s easy to arrange by putting it on your calendar and making it on a date that you can remember,” said Dr. McEvoy.
How do you know if you are at high risk for breast cancer?
“It’s important to know your family history. If you have a first-degree relative, your mother, sister, or even a brother, with a personal history of breast cancer, that is significant and puts you in a high-risk category. You can determine this by having a conversation with your family,” said Dr. McEvoy, who added that some ethnic backgrounds (Ashkenazi Jewish heritage) can be high risk for breast cancer, as are patients who have had a previous biopsy that showed an abnormality. “
Should Patients Consider Genetic Testing?
“If you think you are high risk, or considered high risk, then it is a good idea to consider genetic testing. This would require a conversation with a breast specialist or genetic counselor to discuss the pros and cons. The test is simple and requires a small amount of blood or saliva. It examines 7 of 47 genes to look for genetic mutations common in breast cancer. Results come back in 2-4 weeks, and genetic testing is now covered by most, but not all, health insurance plans,” said Laura Graafland, NP
“If the genetic test shows a genetic mutation for BRCA 1 or 2, for example, that increases your risk significantly for breast cancer. We then discuss the next step, either clinical breast exam or adding ultrasound or MRI,” said Dr. McEvoy. “There are also surgical intervention options that, for some patients, may be their personal choice. That discussion about surgery is personal, and as surgeons, we are here to facilitate.”
A mastectomy is a surgery that completely removes the breast. Dr. McEvoy said that there are different types of mastectomies with or without reconstruction that breast cancer patients can consider. “There is a big trend towards no reconstruction, having the patient be flat or using a prosthetic bra. For those wanting reconstruction, we can hide the incision, and together with a plastic surgeon, we can work together to rebuild the breast by using a flap or an implant.”
NP Graafland also discussed a newer technology, 3D Mammograms. “This is a low-dose X-ray that provides additional pictures and a much clearer image by creating a 3-dimensional view of the breast. This is especially beneficial for patients with dense or fibrous breasts. Ultrasound is also used for these patients using a wand on the outside of the breast that produces soundwaves to capture a picture of the internal breast.”
“3D mammogram “is becoming the standard of care,” said Dr. McEvoy. St. John’s Riverside Hospital offers 3D Mammograms.
What is the process when a patient is referred to you? Women like to have a plan.
“Each patient is unique, but for all patients, we work to provide a kind and warm environment with Dr. McEvoy and me working as a team. We ensure we have enough time to answer your questions and provide a personalized treatment plan. If surgery is required, we do set aside more time for the patient and the family to make sure they know what to expect,” said Graafland.
Dr. McEvoy added, “We know that some of our patients are devastated by the news and are looking for answers. We go through the diagnosis and treatment plan and have them leave with a sense of control again once they have a plan. We get patients to a point where they are ready for surgery and provide follow-up for up to five years. This is a long-term relationship.”
Different Stages of Breast Cancer and Options
“Most women have the option of saving their breast and removing the tumor. If there is a large tumor, we can work with a plastic surgeon to perform a breast reduction, and rebuild the breast, and match it to the other side,” said Dr. McEvoy.
Breast cancer stage is usually expressed as a number on a scale of 0 through IV — with stage 0 describing non-invasive cancers that remain within their original location and stage IV describing invasive cancers that have spread outside the breast to other parts of the body. (Breastcancer.org.)
“Every stage of breast cancer is operable except stage four. Patients who have localized disease in the breast are surgical candidates. If breast cancer is caught early on from a mammogram, and it is located only in the breast, we can help prevent it from advancing elsewhere in the body,” said Dr. McEvoy.
Breast Cancer and Pregnancy
“It really depends on the trimester of the pregnancy. If the pregnancy is in the third trimester, we can generally get the patients to term with the baby without delaying their treatment. We can also safely do the surgery to remove a tumor after the first trimester,” said Dr. McEvoy. “If needed, it is safe to give certain chemotherapy during the second trimester. There are many options that would involve coming up with a plan with your OBGYN.”
Are there any New Research or Trials?
“We now can use the immunotherapy drug Keytruda to help patients with triple-negative breast cancer.
It has been shown in trials to significantly improve patients that have most of their cancer gone and are less likely for breast cancer to come back. Another anti-body FDA-approved treatment for triple-negative patients is Trodelvy, which is used as an IV with chemotherapy. It finds the cancer cells and injects directly into the cancer cell. There is an improved survival and cancer-free survival rate,” said Graafland.
“St. John’s Riverside Hospital is great at keeping up with newer technology, which helps patients have a more convenient process,” said Dr. McEvoy, who highlighted the use of Magseed with breast cancer patients.
“A Magseed is a very small chip that can be put in before surgery under mammogram so that patients don’t have to have another marking procedure done the day of surgery. It’s used to mark the location of suspicious breast tissue. I can detect where the seed is placed, and it guides me specifically to where the suspicious tissue is located, and I can take out less tissue. “
Exercise, Don’t Smoke, and Don’t Drink too Much
When asked what health decisions all of us can take to reduce the risk of breast cancer, “we do know that keeping your weight under control and exercising and not smoking will decrease the risk of breast cancer. And no time is too late to start, and if you drink, do it in moderation because more than 2 glasses of wine will significantly increase the risk of breast cancer,” Graafland, who added that eating soy has not been conclusively found to increase the risk of breast cancer.
“Exercise for 30 minutes three times a week has decreased the risk of breast cancer,” said Dr. McEvoy.
The compassion of both Dr. McEvoy and NP Laura Graafland shines through in everything they said. Working together, the two also have the experience to help you get through a challenging health issue.
Appointments can be made with Maureen McEvoy, MD & Laura Graafland, Clinical NP, at their Yonkers office, 1088 North Broadway, by calling 914-849-0100.
Watch the Webinar at https://youtu.be/k_hfa766-go
Dr. Maureen P. McEvoy is a Breast Surgeon at Montefiore and St. John’s Riverside Hospital, an Assistant Professor at Albert Einstein College of Medicine, and the Program Director of the Breast Surgery Fellowship. Since 2015, Dr. McEvoy has been devoted solely to caring for women and men with breast cancer. Her clinical focus is on minimally invasive and oncoplastic techniques to achieve cosmetically acceptable outcomes while treating breast cancer surgically. Additionally, she educates patients about their diagnoses and helps them explore treatment options.
She attended Albert Einstein College of Medicine, receiving her Doctor of Medicine in 2007. Her postgraduate training began in 2007 at Albert Einstein College of Medicine with a Surgical residency, which she completed in 2014. In 2011, she completed a Clinical Research fellowship at Memorial Sloan Kettering Cancer Center. Her training continued at Massachusetts General Hospital in 2014 with a yearlong fellowship in Breast Surgical Oncology. Young women with breast cancer and the prevention of lymphedema have been the main focuses of interest in Dr. McEvoy’s research.
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Laura Graafland, DNP, is a clinical nurse practitioner in breast surgery and an Assistant Professor of Nursing at Columbia University School of Nursing. In 2013 she started her career as a bedside nurse. Laura joined Columbia University in 2016, shifting her focus to breast oncology. Until 2018 she conducted clinical research trials for novel breast cancer therapies, after which she began treating women and men with breast cancer as a Nurse Practitioner in the outpatient medical oncology setting until she accepted her current position with Symphony Medical in partnership with St. John’s Riverside Hospital and Montefiore Surgical Group.
She achieved her Bachelor of Science in Nursing from Messiah University in 2013, followed by her Masters in Nursing and her clinical Doctorate of Nursing Practice from Columbia University. Since obtaining her terminal degree, she received the Faculty Award for Excellence in a Subspecialty, has published in the Journal for Nurse Practitioners, and has presented at various conferences.
