Last month, Dr. Andrew Ashikari was named regional director of the Breast Care Center at Northern Westchester and Phelps hospitals, both part of Northwell Health Physician Partners. Ashikari joined the organization in January 2021, and before he was director of the Ashikari Breast Center since 1999. He is also the former chairman of surgery at Hudson Valley Hospital Center and former director of surgery at Dobbs Ferry Pavilion/St. John”™s Riverside Hospital.
In this installment of Suite Talk, Business Journal Senior Enterprise Editor Phil Hall speaks with Ashikari regarding breast cancer care and awareness.
What is the nationwide level of breast cancer today? Is it on the rise or in decline, or has it been unchanged in recent years?
If you look at overall numbers, it”™s definitely on the rise. But there are lot of factors involved, and one is that we have a little bit of an aging population. And even though we hear about breast cancer and younger women, it”™s still a cancer in the postmenopausal older age group ”” and as people live longer, they”™re going to get more breast cancer. Luckily, those tend to be less aggressive cancers.
What about the today”™s level of breast cancer awareness? Are you seeing people taking advantage of the wealth of information that”™s now available for them?
People come in very educated, which is good for the doctors ”” it adds to the length of the conversations because people are coming in with a lot of information. The well-educated patient is definitely a better patient to take care of. And I”™ve had patients definitely teach me a few things ”” not so much about the medical part, but about some of the psychosocial pieces that, to be very honest, doctors are not probably as good at.
What about the treatment of breast cancer during the pandemic over the last two years? How did you handle care during that health crisis?
It was tough. Before I joined Northwell a little less than a year-and-a-half ago, I was in private practice and it was probably the biggest practice in Westchester for breast cancer care. We were at a hold ”” we couldn”™t operate on patients for a good month-and-a-half. It forced us into using other therapies ”” we ended up giving more chemotherapy and hormonal therapy.
We saw no worsening of outcomes ”” patients did fine during this time because these therapies can keep the cancers at bay and give us the time we need until we were able to see the patients. Our biggest problem was that people were not coming in for the screening. What we”™re seeing now is that delayed effect because people missed their screening ”” now, two years down the line, I”™m seeing patients with later-stage disease, which is a problem.
What are the possible breakthrough treatments that you”™re seeing in breast cancer care?
We”™ve been de-escalating surgery for four years now. Basically, we went from mastectomy to lumpectomy, and now in our mastectomies we spare a lot of skin. We can do reconstructions, which are just fabulous by using tissue from the belly without removing muscle. Surgically, those are our major advances.
We also can do things like radiation during surgery, which is just an amazing benefit where patients don”™t have to get a month of radiation afterwards. We can do that for early-stage disease and we”™ve taken less lymph nodes out.
If you look at the major survival advantages for breast cancer, I think most of those have come from the medical oncology side ”” and my medical oncology colleagues are just amazing. I envision a future where surgery may not be needed. In certain cases, we were finding that with certain types of breast cancer we give the patient chemotherapy, and by the time we get to surgery there”™s actually no cancer when we”™re doing the operation.
There are targeted drugs that go specifically at certain types of breast cancer. And also, there”™s the genetic positive breast cancers where we have a whole new group of agents called PARP inhibitors ”” I wouldn”™t even give them chemotherapy at this point, because they”™re not killing all our cells in the body and making us sick. Most of these agents are targeted, so a lot of them cause very little side effects and patients can tolerate these treatments and are getting incredible survival advantages.
