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Pink Edition
Surgeon opts to specialize in breast disease
Thomas Heck is confident ‘we’re going to make headway’ in treatments.
Hot Topics
By Meredith Moss,
Staff Writer
Updated 7:35 PM Friday, October 23, 2009
October is Breast Cancer Awareness Month. This article is part of our month-long focus on breast cancer. To learn more or find ways to help, go to our Pink Edition Page.
ENGLEWOOD — For many years he was a general surgeon, operating on all parts of the body — from thyroids to colons.
But these days, Dr. Thomas Heck’s surgical skills are devoted entirely to breast disease, an area in which he’s always had a special interest.
“It’s a very detail-oriented field, and you’re dealing with cancers that not only affect the patients’ lives but their families’ lives as well,” he said. “It’s such a major event in a woman’s life.”
One out of eight women, he said, will face a breast cancer diagnosis in her lifetime. Over the last few years the incidence of breast cancer has remained fairly stable with a slight decrease.
“We think that’s partly due to more judicious use of hormones,” Heck said.
His decision to specialize in breast surgery, he says, was partly a result of the speed in which treatment is changing.
“It’s now so involved that if you want to stay on top of the new research and techniques, you really need to specialize,” said Heck, who typically performs three to five surgeries each day.
Among the major changes he has seen over the past 25 years are the surgical techniques employed.
“We used to do a radical mastectomy, removing the entire breast and muscles,” he said. “That’s major surgery, disfiguring and no longer performed. Today many women have the option of mastectomy or lumpectomy with radiation.”
In a mastectomy, the entire breast is removed including the nipple and areola, but no muscle is taken. In a lumpectomy, the goal is to remove the entire cancer, along with a rim of normal tissue around it, and the rest of the breast is preserved.
The surgeon, said Heck, uses the preoperative physical exam along with imaging studies as a guide. The pathologist will then report on the margin status to be certain it is adequate.
Studies have found, Heck said, that recurrence statistics are about the same with both procedures. Despite that fact, some women request mastectomies, even double mastectomies.
“They’re willing to undergo the surgery because of the fear factor,” Heck said. “They’re willing to have their entire breast removed and then have reconstruction. It’s a very personal choice.”
When lymph nodes are removed, they are usually examined by the pathologist during the operation.
“This is called a frozen section and the patient will know these results the same day. The nodes will undergo a more extensive examination by the pathologist over the ensuring four days at which time the final results will be known.”
Another major change over the years, Heck said, is the way in which care is delivered. At the Samaritan Breast Center, for example, a team comprised of surgeons, medical and radiation oncologists, and a breast care coordinator work closely together. It’s easier and more convenient, Heck said, for both the medical staff and the patients.
Years ago, a woman undergoing surgery might stay in the hospital for many days. Today, she may arrive at the health center in the morning for a lumpectomy and be back at home by 3 p.m. A mastectomy patient will typically spend one night.
Heck said early detection is critical, and that it’s important for women to get their mammograms, continue to do self-exams and have a physician’s exam once each year.
He also recommends programs that target high risk patients, such as the High Risk Breast Cancer Program at Good Samaritan North.
“There are simple questions a woman can answer that will determine whether she should follow up with a consultation,” he said. “It’s not just about her mother and siblings, we look at the entire family tree.”
Heck said when a woman is identified as high risk, a variety of options may be considered ranging from genetic testing, to medication and breast MRI.
For every 100 women, he said, a man will develop breast cancer as well.
When it comes to the future of breast cancer treatment, he remains optimistic.
“With new drugs and treatments, different ways of giving radiation, we’re going to make headway,” he said. “Unfortunately, it’s not as quickly as we’d all like.”
Heck says the most difficult part of his job is having to inform a patient that her breast biopsy is positive.
“I think the waiting time between being told she has cancer and the actual operation is extremely difficult on the patient,” he said. “Although she will have had extensive discussions with her surgeon, she will still face intense anxiety and fear until the operation is finally over and the pathology reports are available.”
Heck said the support of family and friends is extremely important to the patient during that period.
“Just be there to console, to cry, to encourage and to let her know she is not alone.”
And what’s the most rewarding part of his job?
“It’s when I see my breast cancer patients in follow up and they are leading normal, healthy lives with no evidence of the disease.”
Contact this reporter at (937) 225-2440 or MMoss@DaytonDailyNews.com.
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1:36 PM, 10/25/2009