Hollis Cancer Center Doctor Trained in Breast Cancer Genetics
by TERESA SCHIFFER
Central Florida is a leading region for medical progress. When it comes to advancements in breast cancer research, the patients reap the benefits of the widespread skill and talent.
The Hollis Cancer Center of Lakeland Regional Health holds a rare advantage to helping patients determine their risk of breast cancer. The key? On staff is the only breast cancer surgeon in the area trained in breast cancer genetics.
Dr. Vanessa Prowler is a highly-trained breast surgeon whose credentials include a special certification in genetic testing to determine the risk of a patient developing breast cancer. She is recognized as a Genetics provider by Cigna, the National Accreditation Program for Breast Centers and most genetics companies. What this means for her patients is that she can help them determine their risk of developing breast cancer, and what interventional techniques will be most effective for prevention or management of the disease.
Prowler was raised in Southern California and came to Florida with her family after her mother finished going to school for speech pathology. She attended medical school at Florida State University College of Medicine in Tallahassee, then University of South Florida in Tampa for general surgery. She did her Breast Surgical Fellowship at Mount Sinai Beth Israel.
In 2010, when Prowler graduated, there was not a big genetic component to medical education because there was not yet enough research and information available. Prior to 2013, Myriad Genetics was the only company performing genetic testing, and that was specifically for mutations on BRCA1 and BRCA2, two genes that, when mutated, can increase the risk of breast and ovarian cancers. At that time, there were only three known mutations. Now, doctors recognize more than 1,000 mutations in those two genes, plus additional genes that can put a patient at an elevated risk for developing breast cancer.
Last year, Prowler learned from a surgeon friend that City of Hope offers a Clinical Cancer Genomics Education Program for healthcare professionals looking to expand their knowledge and treatment options regarding various cancers. The City of Hope Division of Clinical Cancer Genetics is an organization that was established in 1996 with the goal of being a national leader in the realm of cancer genetics, research, screening, education, and prevention.
Prowler applied and was accepted into the City of Hope program, and after a few months of weekly Zoom lectures and several hours of off-site training, she went to the organization’s facility in California for a weeklong intensive training session.
“It really opened my eyes to how much we’ve learned, even since I completed my breast fellowship,” she recalls.
Having a genetic risk assessment performed can be a powerful tool in treating or preventing breast cancer. “Overall, throughout the world, only about 5% to 10% of breast cancers are caused by these germline mutations that are passed down in every generation, but knowing that you have one is key because then you can take preventative measures,” Prowler says.
When patients are told what their risk of developing breast cancer is, they have more control over their healthcare practices and outcomes. They may have the option of pursuing prophylactic surgery, as Angelina Jolie did when she had her breasts and ovaries removed in 2013 after learning that she carried a BRCA1 mutation that elevated her risk of developing cancer to 80 percent. If surgery seems like too drastic a measure, patients may choose to have more frequent diagnostic imaging performed instead, in order to quickly spot the development of any potential tumors.
So who should have a genetic risk assessment conducted? According to Prowler, anyone is a candidate for it, but not all insurances want to pay for it.
“Certainly, if you have a family history of breast cancer and are curious about your risk, you can go to someone who specializes in genetics, like I do, or any genetic counselor, or any breast surgeon that has completed an SSO (Society of Surgical Oncology) fellowship and has training in genetics to see if you’re a candidate for it. Of course, you can always go the self-pay route, and there are some companies that have better prices, depending on the insurance that you have, or depending on your family history.”
The procedure of having a genetic test performed is very simple for the patient, involving a collection of saliva or blood which is then analyzed by a lab. When the physician receives the lab results, a conversation with the patient can then be initiated regarding what their risk is, and what preventative steps should be taken.
Ultimately, we are each responsible for taking the best care of our health and bodies that we can. Regardless of our perceived risk of developing breast, ovarian, or any other type of cancer, it is vital that we have the regular, recommended screenings performed in order to ensure the best possible health outcomes for ourselves, no matter what our family history is. Most breast cancers are easily curable – provided that they are caught early enough. Prowler reminds us, “Every woman should begin having mammograms at the age of 40 and then have them every year, and we don’t recommend that women stop getting mammograms until they have less than five years of life to live.”