Breast cancer treatment has always been big in Orange County, which has more than its share of affluent, educated women possessing above-average interest in healthcare issues. But it has picked up steam in recent years, with certain events serving as catalysts.
For example, there were “two galvanizing events” a couple of years ago leading to an emphasis on breast health at the Chao Family Comprehensive Cancer Center at UCI Medical Center, according to Dr. Frank Meyskens, the cancer center’s director. Those include UCI Medical Center’s decision to develop a breast health unit within the Chao center, and a $1 million award from the Avon Breast Cancer Care and Research Foundation, Meyskens said.
“We had never had a formal breast health center” prior to those events, Meyskens said, mentioning that the Avon award allowed the operation “to really develop research and bring it to fruition.”
The Chao center is named after the Chao family, whose members include Allen Chao, chief executive of Watson Pharmaceuticals Inc., a drug maker headquartered in Corona.
As for research, Meyskens mentioned projects covering optical methods of diagnosing breast cancer, which can complement mammography, and the genetics of breast cancer.
“Orange County is largely an affluent community. The incidence is somewhat higher,” Meyskens said when asked about why breast cancer efforts carry weight. In particular, he said, screening and early detection efforts “are quite active” in the area.
Breast cancer research is also one of the focal points of Fountain Valley Regional Hospital and Medical Center’s Orange County Regional Cancer Center. Fountain Valley Regional is one of 10 OC hospitals owned by Tenet Healthcare Corp. of Santa Barbara.
“This is the only institution in Orange County that has a National Cancer Institute designation,” said Dr. Glen Justice, Orange County Regional’s medical director, noting there are roughly between 40 and 50 research protocols going on.
Besides research, the Orange County Regional Cancer Center also offers a range of breast cancer screening and treatment options, ranging from mammograms to chemotherapy and surgery. On surgery, Justice mentioned a change in how doctors are approaching breast cancer.
“We do not like mastectomy. We’re pro-conservation,” said Justice, who has practiced in OC for 24 years and is the president of the American Cancer Society’s local region.
Approximately 1,740 newly diagnosed cases of breast cancer are expected in Orange County this year, according to the American Cancer Society’s California Cancer Facts and Figures 2001 report. The society also predicts that there will be 330 breast cancer deaths in Orange County this year.
Breast cancer mortality, however, has declined by about 25% since the late 1980s, thanks mainly to early-stage diagnosis, according to the American Cancer Society.
“There’s been a dramatic increase in survival,” said Dr. Robert Dillman, a medical oncologist and director of Hoag Memorial Hospital Presbyterian’s Cancer Center in Newport Beach. Dillman cited improved chemotherapy, widespread acceptance of screening tools and the emphasis on breast conservation as factors in the change.
Meanwhile, the American Cancer Society warned in its report that “breast cancer incidence rates may begin to rise in the next decade as the large number of women born after World War II reach the age where breast cancer becomes more common.”
Perhaps with that in mind, local hospitals are responding by refining and expanding their breast cancer programs. Specific steps include introducing new screening and treatment technologies and pharmaceuticals, increasing psychosocial services and beefing up marketing efforts, because economic issues surrounding cancer care often require increased patient volumes.
When it comes to the economics of cancer, reimbursements for the disease are not generally considered as good as say, heart disease. In particular, Medicare has been reducing how much it will pay for screening mammograms, among other things.
Fountain Valley’s Justice referred to cancer economic issues as “the Bosnia of healthcare. That’s how I look at it.” The doctor said he’s often had to battle insurance companies to get reimbursement for chemotherapy drugs and believes “there is a semi-crisis in medical oncology.”
“This is not a money-making service. This is part of our mission,” said Joan Taylor, director of business development at St. Jude Medical Center in Fullerton. St. Jude operates a breast center across the street from its main campus on Valencia Mesa Drive.
St. Jude, responding to requests from its local patient population, opened its breast center in January 1997. Since its opening, around 40,000 mammograms have been performed and 113,000 mammograms have been read, according to Taylor.
“We’ve had a 30% growth in volume since we opened,” Taylor said about the center. Today, however, Taylor said that the center expects to see between 5% and 7% growth in patient volume.
Breast cancer also tends to be a disease of the aging. For example, St. Jude’s Taylor said that 64% of patients diagnosed with breast cancer at the hospital’s breast center were between 40 and 69 years of age, while 31% were 70 years of age and older.
By contrast, only 5% of St. Jude Breast Center’s diagnoses last year were in patients between 25 and 39 years of age. Most physicians and health experts recommend that women start receiving screening mammograms around age 40, unless there is a family history of breast cancer.
St. Joseph Hospital-Orange, St. Jude’s sister facility, has also seen its breast cancer diagnostic numbers go up, according to Marie LaFargue, the hospital’s executive director of breast services. “It’s at the very top in terms of newly diagnosed cancers,” said LaFargue, who noted that the hospital saw around 420 newly diagnosed breast cancer cases in 1999.
St. Joseph has seen an increase of about 15% of newly diagnosed breast cancers over a two-year period, LaFargue said. She noted that St. Joseph’s approach to diagnosis includes a specific breast tumor board, which includes radiologists, surgeons, nurses and social workers, among other professionals.
At Hoag, “breast cancer has been the most frequent cancer this decade,it makes up 20% of all the invasive cancer we treat,” Dillman said. Hoag treated 408 invasive breast cancer cases in 1999, up from 378 in 1998, 340 in 1997 and 332 in 1996, according to Dillman, who didn’t have figures for 2000 available. n
