Power in Pink: Breast Cancer Awareness Month Blog Series: A Surgeon’s Perspective

Dr. EassonFor our second Breast Cancer Awareness Month Blog, we have the pleasure of introducing Dr. Alexandra Easson, a surgical oncologist practicing at Princess Margaret and Mount Sinai Hospitals. She specializes in surgical treatment of Breast Cancer, Colorectal Cancer, and Melanoma. In addition to her extensive clinical work, Dr. Easson is also involved in a number of research areas.

We are excited to hear her professional insights into how cancer research has altered her practice and what work is still needed to enhance patient treatment.

This interview was conducted by R.I.O.T member Nathan Schachter.

NS: How did you get into this field and how many years have you been active?

AE: I went into general surgery because I wanted to do surgical oncology. A large part of what we do in general surgery is breast cancer and colon cancer and that’s what I became interested in. I have been doing this for the past 15 years.

NS: What is the most challenging part of your job? What is the most rewarding part?

AE: It’s busy and it’s hard work. There is a balance, right? If I am really tired or getting burnt out, I know I am not doing a good job. That’s the most challenging part, because it is completely engaging- but it is also the most rewarding part.

NS: Do you find it hard to turn it off?

AE: Sometimes, yes. But I think that is true of anyone doing something intensely. I find the most rewarding part is knowing that we have helped people. That’s why we do it. It gets you up in the morning. You have to make the best decision based on incomplete information. You don’t know what the outcome is going to be and you have to be able to live with those consequences.

NS: Just back to the first question, why did you choose medicine per say over any other field in science?

AE: I wanted to be a doctor. I wanted to help people. I watched MASH- I didn’t know I was going to be a surgeon but I wanted to be the person to help people.

I didn’t know there were fields in medicine until I walked into it. I like to say that surgery chose me because I can’t see myself doing anything else.

NS: In such a delicate field, how is your relationship with your patients? How do you stay positive?

AE: My relationships with patients are probably the most important and the best part of the job. When patients come diagnosed with cancer, they are at a real crisis time in their life and are very scared. You have to get to know them very quickly and develop a trusting relationship with them; it doesn’t work otherwise. Once you develop that relationship it stays forever.

Well [when you asked] ‘how do you stay positive’, why wouldn’t you? Even if they don’t do well, I am still going to be their doctor and still look after them. I didn’t go into cancer thinking cancer treatment is going to cure everybody, that’s just the reality of life. You can still maintain a good relationship with someone who is dying and still be their doctor. I probably remember those relationships more than many of the other ones because they meant so much.

NS: What are some common questions you receive from women recently diagnosed with breast cancer and how do you answer them?

AE: Well I think the first question that most people think about when they get a diagnosis is ‘Am I going to die from this?’ and most women will not- that’s the first thing. When a women is first diagnosed you don’t know what their actual course is going to be. Fortunately, if it is caught early, most people do very well.

And then the next question often is ‘Why me? Why did that happen to me?’ and outside of genetic reasons, there aren’t a lot of really good reasons.

And then the third one of course is ‘What are we going to do about it?’. Depending on their presentation we go through the treatment steps and move on.

A lot of women with young kids [ask me] how do I tell my kids, that’s a very common question.

NS: How do you answer that?

AE: We actually have a pretty good resource that publishes information on how to talk to your kids. The thinking is that kids know that something is going on and if you don’t tell them something, then their imagination could make it worse. If you’re going through treatment, you don’t know what the outcome is going to be and it’s okay to say that. So telling them something, because they can sense the anxiety, is important.

It is a life altering event, there is no question. There is going to be a new normal. There are very few women that go through this experience not changed in some way.

NS: How have cancer treatments changed during your years of practice and how has that affected your work?

AE: Oh there have been a lot of changes over the years. There is a lot of research being done and it is changing all the time. Not just in breast cancer but in all cancers. And in general the treatments, the surgical treatments, have gotten smaller and yet in some other ways they have gotten bigger. Breast Cancer, for example, we can cure with a lot less surgery than we used to. We don’t routinely remove lymph nodes underneath the arm for example.

NS: Is that a consequence of advances in imaging though?

AE: No, advances in our understanding of what’s going on. Primarily, refinements and appreciations in systemic therapies and radiation therapy.

On the other hand we are seeing a trend toward preventative mastectomies so a lot of women are getting both breasts removed when there is very little evidence for it1: So more surgery.

All sorts of things have changed and you can’t really do this job without always going to conferences and making sure you’re up to date on the literature. We go to rounds every week. It achieves a consensus on how things are managed. A big change in the last year has been the use of oncotypeDX2 – where tumors are being sent off to determine this. And for sure, for sure, the oncotype is changing the way women are getting chemo. Some women who would have for sure gotten chemo from their medical oncologists are not anymore. But that kind of change only happens by talking to people and knowing what other people are doing and it’s really interesting.

We just have to be very on top of things but I feel pretty confident that I am – because every time I go to rounds I learn something new.

NS: What kind of research/therapies would you like to see focused on in the future?

AE: Well I think the focus now is to individualize treatment and I think that makes a lot of sense. Right now they are doing it based on molecular markers but I think through gene profiling, we are learning a lot more about that.

There will be a lot more variability in the way patients are treated.

NS: Thank you very much Dr. Easson. This has been a great session.

References

  1. The Canadian Cancer Society recently released a statement regarding the topic of mastectomies. If you would like to learn more please visit the following website: http://www.cancer.ca/en/about-us/for-media/media-releases/national/2015/countering-the-angelina-effect/?region=on
  2. OncotypeDX: A new diagnostic test used to more accurately treat women diagnosed with breast cancer. To find out more, follow this link – http://breast-cancer.oncotypedx.com/en-CA/Patient-Invasive
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