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Woman to Woman

Sylvester’s female clinicians and researchers use their leadership roles to provide outstanding care to breast and gynecologic cancer patients and further the knowledge of tumor biology

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any have been fascinated by science since childhood. Some are motivated by the loss of a loved one or a powerful desire to give back to the community. A few feel a deep personal connection between their career as a researcher or surgeon or pathologist and their sense of their own womanhood.

Regardless of background, however, the women specializing in women’s cancers at Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine are united by a strong commitment to provide their patients with the best possible care. It’s an unspoken covenant they don’t take lightly.

“A cancer diagnosis is frightening,” said Carmen Calfa, M.D., medical co-director of Cancer Survivorship at the Braman Family Breast Cancer Institute and assistant professor of clinical medicine. “It affects the entire family and beyond. They trust that I will provide the best care possible and that I will turn over every stone to find the best treatment, not only to make them live longer, but also to live a better life.”

Breast cancer affects 1 in 8 women and is the leading cause of cancer death for women worldwide. In addition, about 47 in 100,000 women in the U.S. are diagnosed with a gynecologic cancer each year.

Sylvester’s breast and gynecologic cancer experts, who are part of the only NCI-designated cancer center in South Florida, have a clear advantage when fighting this formidable foe. The NCI designation, which places Sylvester in the top tier of cancer centers across the country, recognizes institutions with the highest level of research, collaboration, and positive impact on communities.

“Working as a breast pathologist at an NCI-designated cancer center allows me the privilege of caring for our patients with all the possible resources I may need at my fingertips,” explained Carmen Gomez-Fernandez, M.D., director of Breast and ENT Pathology Services at Sylvester and professor of pathology.

Because breast cancer is such a heterogeneous disease, Dr. Gomez-Fernandez considers pathology work to be critically important. Zeroing in on a tumor’s distinct biology is the best way to establish that “the right treatment is provided for a patient’s specific tumor. We must ensure that our patients are benefitting from the most current information regarding their risk assessment, diagnosis, and therapeutic management.”

Her colleagues agree that their roles as physician scientists go beyond providing top-notch clinical care. They must also further scientific discoveries and provide future clinicians with the tools to help the patients of tomorrow.

It’s precisely this kind of challenge that attracts so many to the field. Reshma L. Mahtani, D.O., sees her role as comprising three pillars that are inextricably intertwined: patient care, clinical research, and medical education.

“I chose a career in oncology because I knew I would never be bored,” said the director of the Breast Program in Sylvester’s Deerfield Beach clinic. “It is an exciting, rewarding, and rapidly evolving area of medicine. The increasing use of new therapies specific to the patient’s tumor are resulting in better clinical outcomes. The specialty is evidence-based, which means there is a commitment to continued learning, and this appeals to me as I consider myself a life-long student. There is a good grounding in general medicine, so you never feel far removed from general care.”

“My primary research goal is to elevate women’s health by expanding my division’s developmental therapeutics and clinical trial programs to offer novel personalized therapies in gynecologic malignancies,” said Marilyn Huang, M.D, M.S., director of Translational Gynecologic Oncology Research and associate professor in the Division of Gynecologic Oncology. “I am focused on developing innovative investigator-initiated studies to address health equity in the delivery of cancer care.”

“The purpose is getting their life back. A life not defined by cancer but filled with joy, love, and caring family and friends.”
— Carmen Calfa, M.D.

Leading the charge

Research and clinical trials, which study the molecular mechanism of tumors and the potential treatments that may result from this knowledge, are essential to improving patient outcomes, but are especially critical in the case of more aggressive (and deadly) cancers. At the Braman Family Breast Cancer Institute, women lead the charge in investigating a treatment-resistant subtype of breast cancer that is more prevalent in young and African American women. This “Triple Negative” Breast Cancer (TNBC) accounts for about 15% percent of all breast cases but disproportionally contributes to more than one-third of all breast cancer deaths. Novel biomarkers and therapeutic targets are needed to tackle this serious disease.

To that end, the Molecular Oncology laboratory of Karoline Briegel, Ph.D., an associate professor in the Department of Surgery and investigator at the Braman Family Breast Cancer Institute and Tumor Biology Program, has identified a molecular determinant that explains TNBC’s aggressiveness.

“We recently showed that inhibiting this protein significantly attenuates both primary tumor formations and metastasis of human TNBC cell line mouse models in vivo,” Dr. Briegel explained.

The work of Sylvester researchers is already being implemented in the broader community, transforming the way women are screened, diagnosed and treated. For example, Sylvester breast oncologist Judith Hurley, M.D., began studying racial disparities in breast cancer rates in 2002. She had observed that her Bahamian patients were developing pre-menopausal breast cancer at an unusually young age. So, she joined forces with Sophia George, Ph.D., an associate professor in the Department of Obstetrics, Gynecology and Reproductive Sciences, and other researchers in Toronto and the Bahamas to find out why.

Together they discovered that more than a quarter of the women with breast cancer in their study had mutations in one of two genes, BRCA1 and BRCA2, which protect against cancer by repairing broken DNA during cell replication. In the U.S., these mutations account for less than 5% of breast cancer cases. The research team also found that the average age of breast cancer onset in Bahamian women was 42 — about 20 years younger than for American women. These groundbreaking findings led to changes in the guidelines for breast cancer screenings for women of Bahamian descent — the new recommendation is that women who have a first-degree relative who has had breast cancer are advised to begin breast cancer screening in their mid-20s, instead of in their 40s.

Of course, research is not the only setting in which Sylvester women have taken the lead.

“As the director of Breast Surgical Oncology at Sylvester, I’m constantly striving to improve the quality of our breast cancer surgery,” said Susan Kesmodel, M.D. “One of my goals is to continue to optimize the local and regional treatment of breast cancer and to further decrease the morbidity of our surgical interventions.”

Nilza Kallos, M.D., director of Women’s Imaging at The Lennar Foundation Medical Center, has made it her mission to use multimodality tools and genetic testing to prevent and spot breast cancer early. She has also taught nutrition and meditation at an integrated health center and founded the first multi-modality breast center in South Florida.

“For me, fighting breast cancer is not a profession, it is my passion,” Dr. Kallos explained. “I want to treat my patients as I would like to be treated myself, with compassion and expertise to let them know I really care and that their lives matter to me.”

More than a professional bond

As women diagnosing and treating other women, the relationship transcends that of traditional medical-professional connection to patients. It often becomes deeper, strengthened by a healthy dose of empathy and compassion.

“As a woman treating a breast cancer patient, I can relate to issues of motherhood, hormonal changes, the change in appearance of a breast — a body part which can at times physically define a woman,” said Laura Freedman, M.D., director of Radiation Oncology at Sylvester at Deerfield Beach and associate professor of radiation oncology. “I laugh with my patients as they discuss the good times and want to cry with them when there are setbacks. However, I always feel connected to their journey, as much of their journey is connected to their womanhood, something I share with them.”

Office conversations aren’t always limited to tumors and treatment, either. Dr. Calfa often finds herself speaking to patients about the topics that give texture to the everyday lives of women, such as careers, relationships, or parenting. There’s intent behind these non-medical conversations, however. What might seem like small talk has a purpose closely tied to healing.

“The purpose is getting their life back,” Dr. Calfa added. “A life not defined by cancer but filled with joy, love, and caring family and friends.”

Sylvester’s female clinicians and researchers recognize that their personal experiences give them helpful insight when caring for other women.

“As a mother, wife, and woman, I have the unique opportunity to understand many of the fears my female patients go through when deciding on life-changing surgery or treatments that could affect their self-body image, their sexuality, their fertility, chances of breastfeeding, or their hopes of being there for their children and families,” acknowledges Mecker G. Möller, M.D., a surgical oncologist, associate professor of surgery and associate program director of the Breast Surgical Oncology Fellowship. Dr. Möller believes in offering innovative technologies to her breast cancer patients, such as intraoperative radiation therapy at time of lumpectomy for patients who qualify.

“Becoming a confidante of their fears or concerns helps me know my patients on a personal level and creates a strong bond based on empathy and understanding,” she said.

Many echo those sentiments. Catherine Welsh, M.D., associate professor of clinical medicine, recognized she has a “special perspective on the anxieties and challenges” women face in breast cancer care. Elisa Krill Jackson, M.D., an assistant professor of medicine, admitted that she connects with her patients “over our concerns common to all women: family, children, work, body image.” And Monica M. Yepes, M.D., Sylvester’s director of Breast Imaging Services and associate professor of radiology, believes it is her “duty and privilege” to nurture and give hope when patients may have succumbed to the emotional toll of disease.

As Dr. George succinctly expressed: “I see them, I hear them, I am them.”

A responsibility beyond the clinic

Whether at bedside, by the microscope, or in the community, Sylvester’s gynecology oncologists believe the white lab coat confers a certain responsibility.

“As woman in this field who absolutely loves what she does, I hope to be a role model for young female trainees who may see how fulfilling and impactful their work can be,” Dr. Yepes said.

That responsibility can take on different forms. Frances Valdes-Albini, M.D., a breast medical oncologist who returned to the Miami area to practice after her medical education, was driven by the desire to care for the community where she grew up and where her family still lives.

“I also wanted to break down the negative stigma of a cancer diagnosis in the Hispanic community and communicate the hope that scientific advancements have brought to a breast cancer diagnosis,” she said. “As a Hispanic woman, I wanted to advocate for preventive strategies and access to health care as well as screening programs to maximize the chance for an early diagnosis and cure. I am so grateful to be part of Sylvester and its women’s health team, because we are able to deliver the best possible care, from screening and primary diagnosis to standard of care effective therapies, and clinical trials affording patients access to novel therapeutics.”

Kristin E. Rojas, M.D., a breast cancer surgeon in the Division of Surgical Oncology and assistant professor of surgery, has devoted her clinical research to studying surgical techniques that minimize pain after breast cancer surgery including hidden scars and non-opioid alternatives to treat surgical pain before it starts. She seeks to identify and prevent the detrimental effects of opioids on women with cancer, a timely concern of our era.

“I am so grateful to be part of Sylvester and its women’s health team, because we are able to deliver the best possible care.”
— Frances Valdes-Albini, M.D.

In addition to her breast surgery practice, she is a board-certified high-risk gynecologist focused on studying novel treatments for women experiencing the sexual side effects of cancer treatment. She developed the MUSIC [Menopause, Urogenital, Sexual Health, and Intimacy Clinic] Sexual Health After Cancer Program that addresses the consequences of women’s cancer treatment from a sexual health perspective. She calls this “an issue that we have not always prioritized in women’s cancer care.”

Surgical oncologist Neha Goel, M.D., assistant professor of surgery, follows a “special passion” that points her to the pursuit of health equity. “I am passionate about studying and identifying the underlying causes of why women of diverse racial, ethnic, and social backgrounds have different breast cancer outcomes,” she said.

Merce Jorda, M.D., Ph.D., M.B.A., professor and Joseph R. Coulter Chair of the Department of Pathology and Laboratory Medicine, is driven to be a game-changer in her breast pathology work.

“An accurate diagnosis is essential to ensure that the correct and most effective treatment is given,” she said. “On occasion, a second opinion on a diagnosis can change a treatment plan.”

The rewards are many

Whatever their motivation, the Sylvester women treating women’s cancers find ample rewards in their work and with their patients. Jessica Crystal, M.D., assistant professor of surgery in the Division of Surgical Oncology, balances her fascination with tumors’ complexities with the very human need to provide — and receive — comfort.

“I am driven by the smile on my patients’ faces when I can tell them their customized treatment plan cured them of their cancer, or when our research provides us with information that can help us improve patient care,” Dr. Crystal said.

“I am driven by the smile on my patients’ faces when I can tell them their customized treatment plan cured them of their cancer.”— Jessica Crystal, M.D.

Cristiane Takita, M.D., M.B.A., leader of the Proton Breast Group, co-leader of the Breast Site Disease Group and professor of radiation oncology, said she was initially drawn into the field of radiation oncology because of her fascination with technology in cancer treatment and her wish for strong connection with cancer patients.

“I always felt that my career path gave deep meaning to my adult and professional life,” Dr. Takita said. “What drives me to be a game changer in my patients’ lives is my constant desire to find ways to improve the quality of their treatment while decreasing toxicity through innovative clinical trials.”

Alejandra Perez, M.D., medical director of the Braman Family Breast Cancer Institute and associate professor of clinical medicine, explained that her patients are her “biggest source of knowledge and strength. Our team is focused on a cure, but most important, on supporting them through their journey. It is a very rewarding experience to see them surviving and thriving and building a life-long relationship with us.”

Perhaps Dr. Kallos expressed that dedication most eloquently when she quoted poet Emily Dickinson:

If I can stop one heart from breaking,
I shall not live in vain,
If I can ease one life the aching,
Or cool one pain,
Or help one fainting robin
Unto his nest again,
I shall not live in vain.

UNIVERSITY OF MIAMI MEDICINE
SPRING 2021
Spring 2021Share your thoughts

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