HER Breast Cancer Program

Breast cancer in young women is biologically different than those who get it at an older age. Breast cancer in young women also typically comes HER program logowith a worse prognosis and is diagnosed with a later stage of the disease. These women face a myriad of challenges, which often aren’t talked about prior to the initiation of treatment, such as the impact of treatment on fertility or the impact a cancer diagnosis has on the patient’s young children.

The HER program at UofL James Graham Brown Cancer Center, which stands for Hope, Empower and Restore, addresses these challenges with regional experts in the management of breast cancer in young women. And offers treatment regimens that provide:

Hope for cure

Empowerment of choice in therapy and risk

Restoration after cancer treatment
 

Patients 45 and younger who are diagnosed with breast cancer are automatically enrolled in the HER program, upon referral to the UofL Brown Cancer Center. Upon an initial appointment with a medical oncologist to introduce the program and offerings, it is determined the types of services which may need an early referral: medical, research and/or support services. Read more about the specific services offered under the tabs for each of these categories.

While the same issues impact patients of all ages, they are most pronounced in this group. Younger women are more likely to be high risk and get more aggressive therapy. In addition, they are more likely to be concerned about their role at work, at home, in sexuality, attractiveness and family planning. The HER program was developed to address these issues from the beginning so the patient can continue to live life as normally as possible while undergoing treatment and be prepared to move forward as a cancer survivor.

One in six breast cancers occurs in women age 40-49. Early breast cancer has no symptoms or signs, and you may not feel a Breast Cancer Screeninglump or notice any change in your breasts. Learn more about signs and symptoms of breast cancer.

Breast imaging is the first step in the early detection and diagnosis of breast cancer. All breast ultrasounds performed at the UofL  Brown Cancer Center are performed by radiologists, the doctors who specialize in breast imaging, and not performed by technologists

Multiple studies confirm that regular screening mammography cuts cancer deaths by roughly one-third. 

Recommendations for when to begin screening vary across several medical organizations. UofL Brown Cancer Center follows the American College of Radiology, Society of Breast Imaging and American Society of Obstetricians and Gynecologists which continue to recommend annual screening mammography beginning at age 40. Annual screening mammography starting at age 40 results in the greatest mortality reduction, the most lives saved and the most life years gained. This is why the American College of Radiology and the Society of Breast Imaging recommend regular mammography in women 40 and older.

You are at average risk of breast cancer if you have:

  1. no symptoms 
  2. no personal history of breast cancer
  3. no family history of breast cancer in a first degree relative
  4. no history of mantle radiation (radiation treatment to the chest area used to treat some cancers)  

It is important for all women to be screened and even more so for those at high risk. Some women, based on individual risk factors, are recommended to begin screening before age 40. Your health care provider may use different tools to determine your risk and help you make a personalized cancer screening plan. 

You are at increased risk for breast cancer if you have:

  1. BRCA1 or BRCA2 gene mutation
  2. An ATM, CHEK2 or PALB2 gene mutation
  3. Li-Fraumeni syndrome, Cowden syndrome or Bannayan-Riley-Ruvalcaba syndrome (TP53 or PTEN gene mutation)
  4. Strong family history of breast cancer:  such as a mother or sister diagnosed at a younger age
  5. Personal history of breast cancer
  6. Personal history of high-risk lesion: such as lobular carcinoma in situ (LCIS) or ductal carcinoma in situ (DCIS)
  7. Radiation treatment to the chest area between ages 10-30


Early Screening Guideline per American Cancer Society Guidelines:

  • Women at greater than 20 percent average lifetime risk - yearly mammogram and breast MRI beginning at age 30
  • Women with history of radiation treatment to the chest between ages 10-30 - yearly mammogram and breast MRI beginning at age 30
  • Women with certain genetic mutations such as BRCA1 and BRCA2 - yearly mammogram and breast MRI beginning at age 30
  • Women with a history of a mother or sister diagnosed with breast cancer at an early age - annual mammography starting no later than ten years before the age of the earliest diagnosis in the family (but not earlier than age 25 and not later than age 40)


Your healthcare provider can discuss your individual risk factors with you and discuss screening options.  We are committed to the highest quality of care, including offering patients access to the newest technological advances in the fight against breast cancer.

What if I have dense breast tissue?

Dense breast tissue is common and normal. Approximately 40 percent of women over 40 have dense breasts. Dense breasts are more common in younger women.  Dense breast tissue can sometimes hide findings on screening mammography and is now being included in risk modeling. This along with other known risk factors for breast cancer is used to evaluate an individual’s lifetime risk.  It is important to note that extremely dense breasts as a sole risk factor does not put women into a high lifetime or 10-year risk of breast cancer.  If you have dense breast tissue along with other risk factors you may qualify for adjunctive screening such as breast MRI.

Screening Technologies

Digital breast tomosynthesis (DBT or 3D) mammography creates image slices through the breast, reducing overlap of normal dense tissue and thereby allowing improved cancer detection across all breast densities. Numerous studies show an improvement in invasive cancer detection.  DBT has also been shown to reduce false positive recalls across all breast densities. This means less anxiety and fewer doctor visits. The greatest reduction in recall rate was found in women with extremely dense breasts. Digital mammography is now covered by many insurance companies and can be requested when scheduling. 

Based on individual risk stratification, a young woman with dense breasts and additional risks may also qualify for additional screening with Breast MRI in addition to annual mammography. Contrast enhanced magnetic resonance imaging (MRI) is recommended for supplemental annual screening in women who are at a high risk of breast cancer based on risk modeling and, although not perfect, it is currently the most sensitive test available for detecting breast cancer. It is a vascular-based test and IV contrast is given during the examination. Breast MRI is performed in addition to and does not replace an annual mammogram. 

The HER program offers a comprehensive team of experts both in medical services ranging from oncologists and surgeons saving the woman’s life from cancer, to physiatrists and reproductive endocrinologists helping the woman cope with the side effects of treatment.

Our team also consists of supportive services including a genetic counselor, sexual health social worker, psychologist, art therapists and nutritionists.

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Elizabeth C. Riley, MD, FACP
Elizabeth C. Riley, MD, FACP
Type of Doctor
Medical Oncologist
Area of Interest
Medical Oncology and Hematology - Breast Health; Breast Cancer in Young Women; Breast Cancer and Chemotherapy; Neoadjuvant Chemotherapy; Metastatic Breast Cancer; Health Care Disparities
See full Profile
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Nicolas Ajkay, MD
Nicolas Ajkay, MD
Type of Doctor
Surgical Oncologist
Area of Interest
Breast cancer, diseases of the breast, inflammatory breast cancer, breast cancer in young women, skin-sparing mastectomy, nipple-sparing mastectomy, axillary dissection, sentinel lymph node biopsy, lumpectomy, vascular access for chemotherapy, high risk evaluation, breast cancer research and clinical trials, intraoperative radiation therapy
See full Profile
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Mounika Mandadi, MD
Mounika Mandadi, MD
Type of Doctor
Medical Oncologist
Area of Interest
Internal Medicine, Hematology/Oncology
See full Profile
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Harriet B. Eldredge-Hindy, MD
Harriet B. Eldredge-Hindy, MD
Type of Doctor
Radiation Oncologist
Area of Interest
Breast cancer, gynecologic cancers, palliative care, intraoperative radiotherapy, gastrointestinal cancers
See full Profile
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Lane M. Roland, MD
Lane M. Roland, MD
Type of Doctor
Radiologist
Area of Interest
Breast Imaging: 2D and 3D mammography and breast MRI, including high risk screening; diagnostic breast imaging with mammography, ultrasound and MRI; Breast Interventions: multi-modality core needle biopsy, cyst aspiration, fine needle aspiration, wire or radioactive seed localization for breast surgery; Patient education and access to screening mammography
See full Profile
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Sarah E. Mizuguchi, MD
Sarah E. Mizuguchi, MD
Type of Doctor
Radiologist
Area of Interest
Breast Imaging: 2D and 3D mammography and breast MRI, including high risk screening; diagnostic breast imaging with mammography, ultrasound and MRI; Breast Interventions: multi-modality core needle biopsy, cyst aspiration, fine needle aspiration, wire or radioactive seed localization for breast surgery; Patient education and access to screening mammography
See full Profile
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Stacey M. Crawford, MD
Stacey M. Crawford, MD
Type of Doctor
Radiologist
Area of Interest
Breast Imaging: 2D and 3D mammography and breast MRI, including high risk screening; diagnostic breast imaging with mammography, ultrasound and MRI; Breast Interventions: multi-modality core needle biopsy, cyst aspiration, fine needle aspiration, wire or radioactive seed localization for breast surgery; Patient education and access to screening mammography
See full Profile
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Bradon J. Wilhelmi, MD
Bradon J. Wilhelmi, MD
Type of Doctor
Plastic Surgeon
Area of Interest
Facelifts and Other Aesthetic Plastic Surgery, Breast Augmentation, Reduction and Reconstruction, Body Contouring and Hand and Wrist Reconstructive Microsurgery
See full Profile
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Terry M. McCurry, Jr., MD
Terry M. McCurry, Jr., MD
Type of Doctor
Plastic Surgeon
Area of Interest
Head and Neck Melanoma, Breast Reconstruction, Body Contouring (Including Patients Who Have Had Weight Loss Surgery) and Breast Surgery (Reconstruction, Reduction, Augmentation and Corrective or Revision of Previous Breast Surgery)
See full Profile
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Jarrod A. Little, MD
Jarrod A. Little, MD
Type of Doctor
Plastic Surgeon
Area of Interest
Aesthetic Plastic and Reconstructive Surgery and Head and Neck Surgery
See full Profile
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Megan Nelson, MD
Megan Nelson, MD
Type of Doctor
Cancer Rehabilitation
Area of Interest
Physical Medicine & Rehabilitation
See full Profile
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Whitney Pitman, Nurse Practitioner
Whitney Pitman, Nurse Practitioner
Type of Doctor
Medical Oncology Nurse Practitioner
Area of Interest
Survivorship and Cancer; Chemotherapy and Breast Cancer; Metastatic Breast Cancer; Breast Cancer in Young Women; Breast Cancer Survivorship
See full Profile
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Kelly Pagidas, MD, FACOG, FRCSC
Kelly Pagidas, MD, FACOG, FRCSC
Type of Doctor
Fertility Center
Area of Interest
Assisted Reproductive Technology (A.R.T), Preimplantation Genetic Testing (PGT), Third Party Reproduction, Fertility Preservation, Recurrent Pregnancy Loss (R.P.L)
See full Profile
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Shahab Ghafghazi, MD
Shahab Ghafghazi, MD
Type of Doctor
Cardio-Oncologist
Area of Interest
Cardiovascular Medicine
See full Profile

UofL Brown Cancer Center lobbyMany of the services provided by the HER Breast Cancer Program will take place at UofL Brown Cancer Center in downtown Louisville. Individual doctors may be seen in other offices depending on their specialty and location, most of which are also downtown only a block or two from UofL Brown Cancer Center. Fertility consultations will take place at the UofL Physicians - Fertility Center, located in the Springs Medical Center in St. Matthews.

Physicians may not see patients at all locations listed below. For details, please call the appointment line for the location you are interested in visiting.

To schedule a new patient appointment at UofL Brown Cancer Center, call 502-562-HOPE (4673) or fill out the online new patient appointment form.

The HER Breast Cancer Program offers a variety of medical services including those focused on curing the cancer itself, and others dealing with the side effects of cancer treatment.

Cancer Treatment and Surgery Options

Medical oncology
Medical oncologists specialize in the treatment of cancers of all stages. These physicians oversee chemotherapy, targeted therapy (such as tamoxifen or aromatase inhibitors), as well as immunotherapy. Learn more about Medical Oncology.

Dedicated breast surgeon
Premenopausal patients with breast cancer benefit from surgical treatment in conjunction with radiation therapy and chemotherapy.  

Mastectomy (removal of the entire breast) and lumpectomy (removal of the cancerous lump) have been proven to have equivalent survival results. Learn more about our surgery options.

Oncoplastic reconstructive surgery
Plastic Surgery at the University of Louisville is available and involved in most breast cancer patients cared for at UofL Brown Cancer Center.  Learn more about Oncoplastic Reconstructive Surgery options.

Radiation oncology
If you have been diagnosed with breast cancer, radiation therapy will likely be required as part of your treatment. UofL Physicians – Radiation Oncology at UofL Brown Cancer Center offers patients the world’s most sophisticated cancer-fighting technology and most proven radiation treatment techniques available. Our radiation oncologists are experts in radiation therapy and offer specialized care for cancer treatment. Each cancer diagnosis requires an individually-designed treatment plan based on the type and stage of the tumor. 

We were the first in the Kentuckiana region to receive a three-year accreditation for the American Society for Therapeutic Radiology and Oncology (ASTRO) and American College of Radiology (ACR). 

Learn more about UofL Physicians - Radiation Oncology.

Other Consultation and Treatment Options

Fertility Preservation
Breast cancer affects approximately 10 percent of women in their childbearing years. Breast cancer treatments may adversely impact a young woman’s fertility. Discussing strategies to preserve fertility prior to the initiation of breast cancer therapy is an integral part of maintaining quality of life after cancer in young women. Learn more about your Fertility Preservation options from the UofL Physicians - Fertility Center.

Our OB/GYN & Women's Health providers can also assist with other gynecological issues you may face before, during or after treatment. Learn more about UofL Physicians - OB/GYN & Women's Health.

Sexual health and wellness expertise
We understand the impact that breast cancer treatment may have on a woman physically and psychologically. A change in body shape can affect how you feel about your sexuality and womanhood. Our sexual health and wellness experts can discuss body image with you, help you deal with these changes, including any pain or change in libido.

Our medical social worker has 30 years of experience, including 20 in oncology.

Cancer Rehabilitation
Cancer Rehabilitation is focused on your function before, during, and after cancer treatments. Learn more about Cancer Rehabilitation.

Cardio-oncology
Cardio-oncology is a subspecialty that assists in the overall care of cancer patients with and without cardiovascular disease.  Learn more about cardio-oncology.

High Risk Genetics Clinic
Not all breast cancers are hereditary, but anytime someone under age 50 has cancer, there is a higher risk of it being hereditary. Learn more about the genetic cancer counseling from the High Risk Genetics Clinic.

M. Krista Loyd Cancer Resource Center
From coffee to counseling, the M. Krista Loyd Resource Center was created to help connect patients and family members with complementary services needed to aid in their healing.

For patients and their loved ones, a cancer diagnosis means having to understand

information about treatment plans, side effects, and complicated medical terms that can often be confusing and frightening. For those just beginning their families and/or careers, a cancer diagnosis challenges the very essence of their being creating questions to an unknown future.

Inside the M. Krista Loyd, you will find services that provide an environment to learn, relax, and heal emotionally. All services are offered free of charge to both the patients and caregivers.

  • Massage therapy is the therapeutic practice of manipulating the muscles too ease tension, reduce pain, and reduce stress. 
  • Personalized art therapy sessions promote the healing process with the power of expression through artistic creations.  
  • Reiki therapy is a simple therapeutic touch technique that improves the flow of energy in a person reducing tension and stress.  
  • Look Good, Feel Better, a program offered in partnership with the American Cancer Society is a special program that teaches women how to cope with skin changes, hair loss using cosmetics and skin products. 
  • Educational classes concerning chemotherapy, radiation and surgery are offered along with one-on-one nutritional counseling. 
  • Behavior oncology offers counseling sessions for patients dealing with stress, depression and anxiety.


Support Groups
The M.Krista Loyd Resource Center has partnered with Gilda’s Club of Louisville offering support groups so that family and friends can join with others to build social and emotional support as a supplement to medical care. 

Kids Inquire, We Inform (KIWI)Mom and child
Many of our young patients still have children at home. A special program, KIWI (Kids Inquire, We Inform) was established to provide information and give children and adolescents the tools to work their way through the parent’s diagnosis. This has been highly successful in building good communication channels for parents and their children during a very stressful time. When “normalcy” is not normal and things aren’t exactly what they seem, this program which includes art therapy serves as a way to express feelings about illness, treatment, and life itself. The primary focus is to open the conversation between family members dealing with cancer.

Survivorship Clinic
When radiation and chemo are over, and a cancer patient no longer needs treatment, a patient and their family still have unique needs to thrive in life, and focus on living normally again. The Survivorship Clinic at James Graham Brown Cancer Center helps patients transition from active treatment into surveillance mode.

UofL Physicians providers see patients from the Cancer Center after treatment is completed, ideally within a couple of months, to provide education and help patients grasp hold of what’s happened, and how they can move forward.

We understand that this is a unique period of time and we focus on educating patients about their diagnosis and potential short and long-term side effects from their treatment. We spend time discussing strategies to restore function and improve quality of life. We help manage physical dysfunctions as well as emotional well-being, sexual dysfunction, sleep disturbance. We also educate our patients on their unique cancer surveillance needs. Survivorship care also focuses on healthy lifestyle choices with exercise, nutrition and tobacco cessation.

The success of the clinic is centered on a Survivorship Care Plan, which serves as a roadmap to transition from active treatment to anticipate needs in post-cancer life. This also helps close any disconnect between oncologists and primary care physicians, by helping guide patient care so the PCP can anticipate unique needs and better treat that patient in the future.

Whitney Pitman, AOCNP, APRN-C, with UofL Physicians – Medical Oncology, leads the clinic. 

Our physicians work both in the treatment of breast cancer patients but also are dedicated to understanding new and innovative treatments which help save lives. One of the missions of the HER program is to better understand why cancer is different in young women and how treatment can be improved to save more lives and provide less side effects for patients.  

We are leading the research of UofL Brown Cancer Center’s breast cancer program to find new and innovative treatments for breast cancer with the goal to reduce the number of breast cancer deaths in the region and worldwide.

The HER program aims to increase specific research to this patient population and gives patients an opportunity to contribute to such research through the donation of blood and tissue.

We can also provide direction on any clinical trials tailored to young women with breast cancer that you may qualify for.