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A Business & Pr Ac tice MAnAg e Me nt MAgAzine | ABout PhysiciAns | froM PhysiciAns | for PhysiciAns

Dr. Keleher Leads Multidisciplinary Team at

Vassar Brothers' Breast Center

Latest Treatment Options and Radiation Therapies Tackle Cancer

Cover Feature

dr. keleher leads

Multidisciplinary Team at

Vassar Brothers' Breast Center Latest Treatment Options

and Radiation Therapies Tackle Cancer

By Jean B. Edwards

The international TARGIT trial studies the effectiveness of a single dose of intraoperative radiation as opposed to the six-week radiation therapy that is the standard of care. The intrabeam system, pictured here with Dr. Keleher and Vassar Brothers Medical Center Chief Medical Physicist Dan Pavord, may provide patients with new treatment alternatives in the near future.

M.D., breast cancer is something that hits close to home. Her grandmother, two aunts and a great uncle were all diagnosed with the disease. Twice, her sister bravely battled the disease. Both times, Dr. Keleher was by her side -- not as a physician, but as a devoted sister, alongside the other members of her close-knit family from the Midwest. Excellent medical care, along with their steadfast support, helped her sister emerge cancer free.

or AngelA Keleher,


Making a Difference When Dr. Keleher entered medical school, she knew she was destined to become a surgeon. Which area of surgery she would specialize in remained unclear until she began to work with cancer patients. "I've always been interested in the technical aspects of surgery and in problem solving, but the opportunity to make a real difference in the lives of cancer patients is what helped me decide to become a breast surgeon," she says. Today, Dr. Keleher feels privileged to be part of a multidisciplinary team of specialists who are working feverishly to help fight the disease. "I'm very fortunate to have such a talented team to work with

Intrabeam device applicators pictured here are placed directly in the tumor bed. The applicator sizes are varied, and size is selected based on the cavity size.

in addition to having access to all of the latest tools to treat breast cancer," she says. "When I look back, I realize there isn't a week that goes by where I haven't made a real difference in at least one patient's life. How many doctors can actually say that? If I were any other type of surgeon, I probably wouldn't have much follow up with my patients," she says. "It's the special relationships I develop with my patients that are so significant to me. The ability to make a difference in people's lives when they are under great stress and are most vulnerable really helps me to get up and go to work each day. When you work with cancer patients, their disease really helps put every day into perspective. I believe if you have great passion for your work and you love what you do, your patients will pick up on your attitude, and it will make an enormous difference in their lives."

continue to increase. According to the American Cancer Society, an estimated 193,000 new cases of invasive breast cancer were expected to occur in the United States among women in 2009. The disease still remains the most frequently diagnosed cancer in women and is the second leading cause of death, just behind lung cancer. In addition to invasive breast cancer, nearly 63,000 new cases of in situ, noninvasive breast cancer were estimated to have occurred in 2009 among women. Of those, 85% were expected to be ductal carcinoma in situ -- cancer of the breast ductal cells. "Today, I believe we're seeing more cases of breast cancer because we can detect and diagnose the disease much earlier thanks to the advancements in imaging techniques," explains Dr. Keleher. "Digital mammograms are spotting more calcifications, and I also believe that consumers are more aware of the importance of yearly screenings. Today, with the availability of free screenings and outreach available through the Dyson Center, there's really no excuse for not getting a mammogram."


A Common Bond Two years ago, the fellowship-trained surgeon had an offer with the renowned Mayo Clinic and was headed to Minnesota until she got a call from Vassar Brothers Medical Center's CEO Daniel Aronzon, M.D., and community leader Rob Dyson. Dyson, who is President and CEO of the Dyson Foundation and for whom Vassar Brothers Medical Center's Dyson Center for Cancer Care is named, realized he and Dr. Keleher had a strong mutual interest. Dyson's sister had also endured breast cancer and ultimately succumbed to the disease. Dyson wanted his sister's legacy to live on by creating an all-inclusive breast center that would not only provide comprehensive care, but also renewed hope for women battling the disease. Dr. Aronzon was looking for a highly talented breast surgeon with matchless enthusiasm, determination and the critical leadership skills that would be essential to build a first-class, multidisciplinary team to fight breast cancer. It wasn't long before he persuaded Dr. Keleher to head east to Poughkeepsie. "All the resources I needed were there. Vassar Brothers just needed someone who could put all of the pieces together to create a comprehensive, state-of-the-art breast center, and I'm so excited to be part of Vassar Brothers' vision." Increase in Breast Cancer rates Despite the decrease in the number of women taking hormone replacement therapy, Dr. Keleher says that breast cancer rates

Build It and They Will Come A lot has happened in the two years since Dr. Keleher left Western Pennsylvania Hospital, where she was a respected breast surgeon and chief of surgical breast oncology. Through her steadfast leadership and contagious optimism, Vassar Brothers Medical Center's Breast Center offers patients in the Hudson Valley all-inclusive care from a team of radiologists, surgeons, radiation oncologists, medical oncologists, pathologists, genetics counselors, nurses and support staff who cater to each patient's unique, personal needs. Vassar Brothers Medical Center, a 365-bed facility, is an affiliate of the Health Quest health care system, which provides service to more than 1 million people who reside in Columbia, Dutchess, Ulster, Orange, Putnam and northern Westchester counties.

Before and after surgery, Dr. Keleher works closely with patients to ensure they understand all aspects of their care and the treatment plan in her Dyson Center for Cancer Care office. In addition, she and her team have expanded their service to meet with patients at Northern Dutchess Hospital in Rhinebeck.

Cover Feature

Dr. Russell Karp and Dr. Keleher review the latest imaging results for one of her patients. Having all aspects of a patient's care located in one building allows a multidisciplinary approach to cancer care, in which all the specialties involved in a patient's care can easily confer.

At the Breast Center, patients receive highly coordinated care all in one place, including nutritional counseling, gynecologic oncology care, rehabilitative therapy, radiation oncology, a comprehensive infusion center and breast reconstruction. High-tech imaging, including digital mammography, nuclear imaging, CT, MRI and ultrasound scans and biopsies, sentinel lymph node and stereotactic breast biopsies, are also available.

International Trial for radiation Treatment Vassar Brothers Medical Center is one of only 15 institutions in the nation that is currently participating in the Targeted Intraoperative Radiation Therapy (TARGIT) trial, an international, prospective, randomized clinical trial to evaluate single-dose intraoperative radiotherapy as an alternative to conventional postoperative radiotherapy for treatment of early-stage invasive breast cancer. With intraoperative radiotherapy, women who undergo a lumpectomy can receive radiotherapy at the time of their breast cancer surgery while still under anesthesia. The experimental treatment takes about 20-45 minutes and, if proven effective, could replace the need for a six- to seven-week course of radiotherapy that's currently given after surgery. If proven equivalent to current treatment, intraoperative radiotherapy may enable women to complete their cancer treatments sooner and return to normal activities faster. The TARGIT trial could offer new options for women with early-stage breast cancer. In addition to the 15 institutions in the United States, the TARGIT trial is also being performed in

institutions throughout Australia, England and Germany. Dr. Keleher and her colleague Dan Pavord, M.S., Chief Medical Physicist at Vassar Brothers Medical Center, were both trained for the prestigious TARGIT trial at the University College London. "We're currently in phase three of the trial, which Vassar Brothers Medical Center began in June 2009. So far, we've had great success in implementing the research study, and we hope to have preliminary data on the trial soon. Providing targeted radiation therapy immediately in the operating room when we have identified a tumor could be a win-win situation. It may be the ideal time because the experimental treatment may work better when you have a fresh blood supply and no scar tissue to worry about," explains Dr. Keleher. "The outcomes will provide critical answers to help Vassar Brothers' providers determine the best and shortest course of treatment," she adds. "It's exciting to be involved in this kind of cutting-edge treatment. Our patients who participate in these trials are true pioneers in my mind."

latest radiation Therapies Patients have access to the very latest radiation therapies at the Breast Center, such as stereotactic radiosurgery for metastatic disease, intensity modulated radiation therapy (IMRT) and image-guided radiation therapy (IGRT). IMRT uses computergenerated images to plan and deliver tightly focused radiation beams to cancerous tumors -- or even to specific areas within the tumors -- than is possible with conventional radiotherapy.

IGRT is at the forefront in radiation cancer treatment and is the next step beyond IMRT. The advantage of IMRT is that the radiation beam can be shaped to match the dimensions of a tumor, and a high dose of radiation can be delivered to a malignancy without harming surrounding healthy tissue. IGRT uses a variety of digital imaging techniques to pinpoint the exact location of a targeted tumor while the patient is in the treatment position and just prior to delivering the treatment. This precision is critical, since tumors are not stationary and can shift or move between treatments or even during treatments due to normal physiological processes, such as breathing. "We have a great radiology group that works closely with our team. Because we're all on the same floor, I can just walk across the hall to meet with the radiologist. I'm able to review my patients' films before their appointments, and if we need additional imaging work, it can be done the same day," says Dr. Keleher. Patients also have access to TomoTherapy, one of the very latest cutting-edge treatment options for breast cancer. It uses powerful radiation beams that are precisely sculpted around the geometry of the patient's breast tumor. The treatment can also target difficult-to-reach breast tumors, while preserving surrounding healthy breast tissue. In addition to the latest radiation therapies, patients and their family members have access to genetic counseling and testing at the Breast Center to determine if the BRCA1 and BRCA2 genes could be a factor for developing breast cancer. Women with abnormal BRCA1 or BRCA2 genes have up to an 85% risk of developing breast cancer by age 70.

The Breast surgery Program at Vassar Brothers Medical Center includes three other accomplished team members: Dr. Hank schmidt (right), nurse practitioner sara Winterleitner (left) and Dr. Gregory Zanieski (not pictured). Drs. Keleher, schmidt and Zanieski are all board certified and fellowship trained in breast surgery, an important distinction no other breast center can offer.

ac ad em ic ac h i e vem ents

AngelA J. Keleher, M.D., is a board-certified surgeon and a

Fellow of the American College of surgeons. she is the Director of the Breast Center and Director of Breast surgery at Vassar Brothers Medical Center's Dyson Center for Cancer Care. Dr. Keleher received her medical degree from the University of Illinois at Chicago and completed a clinical breast fellowship at the M. D. Anderson Cancer Center at the University of Texas in the Department of surgical oncology. she completed her residency in general surgery at The Western Pennsylvania Hospital, part of the West Penn Allegheny Health Care system, and her internship at Rush University Medical Center in Chicago. Dr. Keleher has authored numerous journal articles and has given a number of lectures and presentations on breast cancer.


Reprinted from Mid Hudson md news

Cover Feature

The dedicated staff of the Breast Center work to ensure patients and their families have access to the highest level of care. They are committed to ensuring that not only the patients, but also their families, have the support they need.

An infusion center where patients are seen at the start and end of their surgery is available, even on weekends, to provide full support for breast cancer patients. "Should patients have problems with surgical drains, for example, they don't have to go to the emergency room. Highly trained oncology nurses are available to help with any intravenous needs, pull drains and prevent and treat infections," says Dr. Keleher. Social workers and specialists skilled in treating lymphedema are also available. The center even has a boutique to help women

The Dyson Center for Cancer Care provides a full range of innovative and state-of-the-art treatment options for cancer patients offered nowhere else in the region. It was recognized with the outstanding Achievement Award in addition to its accreditation by the American College of surgeons as a Comprehensive Cancer Center as well as being the only fully accredited radiation oncology center between Westchester and the Finger Lakes in New york.

find the right prosthetics, mastectomy bras and fashionable wigs to help them feel more self confident about the way they look.

raising the Bar on Quality Dr. Keleher is quick to point out that her team is always looking for ways to improve. "Because we are a center of excellence, providing the highest quality care is our No. 1 goal. We have added a third fellowship-trained breast surgeon to our team, giving patients the ability to access the highest level of care anywhere in the region to meet the demand," she says. "We also have expanded our research department at the Dyson Center so that patients can participate in the latest national trials, and Vassar Brothers has progressed to the point where we are developing our own protocols and studies to help discover the best ways to fight cancer." state-of-the-Art Care Close to home "We believe we can offer patients comprehensive and more personalized care close to home. Patients who previously had to travel to the city to access the very latest treatment options now can get those services right here. We have the experience, the technology and the systems in place to provide the best possible outcomes, and we know our model is making a difference in providing high-quality care for our patients," says Dr. Keleher.

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