With decades of technological firsts and a unique multidisciplinary partnership, the Dr. Hadley J. Falk Breast Health Center at Crouse Hospital continues its pioneering approach to breast care.
Seated: James E. Sartori, MD, Tammy J. Congelli, MD Standing: Katie Tindall, NP, William E. Schu, MD, Stephen Montgomery, MD
When the Falk Breast Health Center at Crouse Hospital acquired a state-of-the-art prone tomosynthesis table, the facility became the only one in Central New York to offer prone mammogram-guided biopsies using this technology. The table helps radiologists and surgeons locate and biopsy minute lesions revealed by 3D mammography, which detects about 40% more cancers than conventional 2D, according to Stephen Montgomery, MD, Director of Breast Imaging at the Falk Breast Health Center.
The imaging and biopsy technology at the Falk Breast Health Center is top of the line, and includes 3D digital mammography and breast MRI with computer-aided detection, as well core biopsies, including ultrasound-guided, MRI-guided, mammogram-guided and now tomosynthesis-guided.
“We’re the first all-tomo department in Central New York,” Dr. Montgomery says.
The tomosynthesis table is just the latest in a long list of “firsts” posted by the Breast Care Program, the region’s pioneer in breast health. The Falk Breast Health Center is the first program in the area to be designated as a Breast Imaging Center of Excellence by the American College of Radiology, and it has a long track record of innovation — not just as an early adopter of leading-edge technology, but also for the unique multidisciplinary partnership through which it delivers high-level, comprehensive breast care to patients from throughout the region.
“We didn’t need a new affiliation. We have great oncologists and really talented surgeons dedicated to breast care. And Crouse Hospital has the newest technology. Breast Care Partners just pulled us all together.”
— Katie Tindall, NP, breast health nurse navigator at Breast Care Partners
Breast Care Partners
With its advanced imaging and biopsy capabilities, the Falk Breast Health Center has attracted the attention of renowned breast specialists from Syracuse and beyond. In 2013, a coalition of community-based specialists formed Breast Care Partners. Crouse Hospital partnered with this organization. This virtual affiliation was designed to elevate the quality of care as well as streamline and personalize patient care. Syracuse community breast care specialists, including surgeons, oncologists, radiation oncologists, radiologists, pathologists and support services, make up the clinical ranks of the organization. Breast Care Partners is fully accredited by the American College of Surgeons’ National Accreditation Program for Breast Centers (NAPBC).
Patients who come to the Falk Breast Health Center for follow-up imaging or consultation will notice the partnership’s advantages the moment they walk through the doors. A breast health nurse navigator guides patients from testing to treatment and follow-up care, freeing them from the logistical and bureaucratic burdens that typically fall to the patient.
The benefits of this integrated system of care are also obvious to the breast specialists who practice within it, says William Schu, MD, Medical Director of Breast Care Partners and general surgeon with Central New York Surgical Physicians.
“Before, we were separate entities that practiced quality care, but one can only practice at the highest level within an integrated system,” Dr. Schu says.
Breast Care Partners requires excellence from it members by holding them to the rigorous standards required for NAPBC accreditation.
“We attend national conferences at least once a year and hold biweekly tumor boards where we present patient cases for discussion. We also review radiologic studies and treatment plans. It’s a good opportunity to communicate with our fellow breast surgeons throughout the city,” says James Sartori, MD, Managing Partner with Central New York Surgical Physicians.
“The program that Breast Care Partners has put together is completely integrated, with a computer system that links all of the offices together. That way, records are easily accessible to all. We provide one place for anything our patients might need.”
— Stephen Montgomery, MD, Director of Breast Imaging at Dr. Hadley J. Falk Breast Health Center
A Leader in Breast Health
Much of the regional expertise in breast care has roots at the Falk Breast Health Center, thanks in large part to Dr. Montgomery, who has dedicated 25 years to patient care at the facility. Under his leadership, the Falk Breast Health Center was the first breast program in Central New York to offer stereotactic core biopsies and ultrasound-guided biopsies, the first to go all digital and 3D, and then the first to launch an MRI program.
“I’ve spoken with physicians at other centers where MRIs are a relatively new addition to their set of tools,” Dr. Sartori says. “Yet, we’ve used MRIs for as long as I can remember.”
Drs. Sartori and Schu have served the Central New York region for more than 30 years, and together they have witnessed the evolution of breast cancer treatment in the area.
The Crouse Hospital Breast Care Program’s early adoption of core biopsy, a procedure that revolutionized breast cancer diagnosis, provides Dr. Montgomery and his team at Crouse Radiology Associates elevated professional credibility in that area.
“We rarely, if ever, need to do an open biopsy to make a diagnosis now, and the information we get from Dr. Montgomery’s team with the core biopsy is the first step in planning a patient’s definitive surgery,” Dr. Sartori says. “That’s been the advantage to practicing here — that and the ability to detect small cancers we couldn’t see before.”
Tammy Congelli, MD, general surgeon and breast surgery specialist with Central New York Surgical Physicians, says the consistently high quality of the radiologists’ technique and interpretation makes her job easier.
“We still look at patient mammograms, too, but we have the utmost confidence that when a radiologist reads a mammogram, we’re getting an expert reading as well as an accurate diagnosis when they are performing biopsies,” Dr. Congelli says.
Dr. Montgomery sees his team’s expertise reflected in the data. He says the program meets and exceeds all national benchmarks for detection rates.
“Crouse Hospital and Dr. Montgomery were never afraid to take on new technology or learn new techniques, and believe me, there’s a learning curve to all these things. It takes some guts to say, ‘We’re going to do this for our patients.’”
— William Schu, MD, Medical Director of Breast Care Partners and general surgeon with Central New York Surgical Physicians
The mutual respect among the members of Breast Care Partners is the product of longstanding professional relationships. Central New York Surgical Physicians regularly worked with Hematology-Oncology Associates of CNY long before the partnership was official. And the fact that both Central New York Surgical Physicians and Crouse Radiology Associates were located in Crouse Hospital resulted in “a vertical system of care that makes things flow more easily,” Dr. Schu says.
For example, Central New York Surgical Physicians can see a patient, send her downstairs for a same-day biopsy, and get the results in less than two days — a significantly shortened time frame for testing and diagnosis. Since the addition of the new tomosynthesis table, the vast majority of the surgeons’ biopsy referrals can be accommodated without leaving the Crouse campus.
From its technological upgrades to the redesign of the breast center, Crouse Hospital has always been responsive to the surgeons’ input.
The establishment of Breast Care Partners six years ago turned independent entities that worked well together into a single, integrated system in which information is automatically shared and communication is constant.
Crouse Hospital has facilitated communication by serving as a physical and virtual meeting place for the multidisciplinary team.
“We meet with the oncologists, radiation oncologists, pathologists and radiologists on the Crouse campus to discuss patients every other week,” Dr. Sartori says. “That’s a really valuable format for us.”
As the first specialists to receive patients into care, surgeons need that sort of integrated structure in place at the outset, especially when they’re dealing with complex cases.
“Before we had this coordinated system of care, we did a good job with patients, but when we get together and review all these cases, other team members learn a lot about our surgery considerations, we learn a lot from the other experts in the room and everyone benefits,” Dr. Schu says. “We all feel that our level of care and breast cancer expertise have continued to increase exponentially over time.”
“From the time you decide you need a biopsy to the time the patient gets their first result, we provide a very efficient system.”
— James Sartori, MD, Managing Partner at Central New York Surgical Physicians
Navigating the System
Katie Tindall, NP, exemplifies the longstanding professional relationships that built Breast Care Partners and the benefits of its coordinated approach to patient care. After working for several years as a registered nurse with Hematology-Oncology Associates of CNY, Tindall joined Breast Care Partners at its inception and is now a nurse practitioner at Central New York Surgical Physicians, where she continues to provide care to patients at Breast Care Partners. As a result, she is uniquely positioned as a liaison between the two practices, patients and specialists.
“I can get information to patients much quicker if the surgeon can’t talk to them directly,” Tindall says.
As the program’s first breast health nurse navigator, Tindall draws on her experience not only as an oncology nurse, but also as the daughter of a patient with breast cancer. When her mother went through the diagnostic process, Tindall says, one of their biggest stressors was all the time they spent in limbo — waiting for appointments to be scheduled, waiting for test results and waiting for answers.
“It was all so frustrating. Even if it’s a simple question, waiting for an answer can cause so much anxiety and fear,” Tindall says. “Getting people the information they need can be reassuring.”
Tindall’s first goal, therefore, is to accelerate the process that leads to diagnosis and treatment. She’s often the first person a new patient sees at the Falk Breast Health Center, and by then she will have spoken with the surgeon about preliminary plans for consultation and testing and begun putting those pieces in place.
“The patient won’t come in for her first visit and be told, ‘We’ll call you with an appointment,’” Tindall says. “We schedule appointments ahead of time so she’s not waiting for days and weeks when she knows something is wrong.”
Tindall and Sandra Rookey, another nurse navigator for Breast Health Partners, schedule patient testing and specialist appointments and handle insurance approvals as well.
“Whether a patient has already had a biopsy and a diagnosis when she comes to the Center, or whether we’re sending her for a biopsy and then follow-through, she doesn’t have to make phone calls for herself once she’s here,” Dr. Congelli says.
During and after treatment, patients can rely on nurse navigators to connect them to a variety of professional support services on and off the hospital campus. Crouse offers psychological counseling and access to wigs and post mastectomy prosthetics; Central New York Surgical Physicians offers genetic testing and counseling; and Hematology-Oncology Associates of CNY, located off campus, offers nutritional services.
The nurse navigators can also direct patients to community-based resources like CancerConnects, which offers informational and emotional support for cancer patients throughout Central New York. They have also partnered with local nonprofits like the YMCA to provide child care and transportation to the hospital so patients can get to their appointments. Through these partnerships, as well as grants and other sources of financial aid, the Falk Breast Health Center helps patients overcome obstacles involved with the prevention, diagnosis and treatment of breast cancer.
“We’re trying to pull those resources together so our patients can take advantage of them,” Tindall says. “Women are busy. They’re mothers, sisters, wives, bosses and employees. Just taking time out of the week to come here can involve a lot of barriers.”
“Once patients are here, we guide them through the system. They don’t have to think about where to go or who to contact.”
— Tammy Congelli, MD, general surgeon and breast surgery specialist at Central New York Surgical Physicians
No Typical Breast Patient
Women aren’t the only patients the Falk Breast Health Center serves. While breast cancer affects one in eight women in the United States, men account for 2,670 new diagnoses every year. There is no typical patient, and the center’s individualized approach to care reflects that fact.
“Whether patients are dealing with a benign condition or cancer, whether they’re young or elderly or whether they’re female or male, we have a high-level, integrated, coordinated system to bring patients through every step of care, from testing through treatment,” Dr. Sartori says.
For more information about the breast care services offered at the Dr. Hadley J. Falk Breast Health Center at Crouse Hospital, visit crouse.org/breasthealth.