Breast Cancer Surgery as a Specialty
During the last decade, there is a growing realization that breast cancer surgery is a distinct area of
specialization. In 1998, Dr. Orr and his associates were able to show a difference in practice patterns in a Massachusetts hospital,
comparing his performance to that of 11 general surgeons in the same institution.
(Publication)
By utilizing a focused approach to breast biopsy and treatment,
Our patients had fewer operations and fewer patients needed a
mastectomy. Larger series have been published recently, showing some of the same results. Importantly, recent data suggest that
patients operated upon by large volume breast surgeons may actually have better survival results (Publication)
Working with SRHS surgical resident, Dr. Jason Johnson and others, Dr. Orr also published articles
related to the "learning curve" for sentinel node biopsy. (SNB) (Publication) SNB has the potential to minimize the complication rate after breast surgery, but must be done properly! Inaccurate SNB may lead to
patients receiving the wrong treatment, or even missing out on treatment that they needed! Dr. Orr’s research in this area has
confirmed similar studies from other groups regarding the importance of expertise in performing this procedure.
Dr. Orr’s Breast Cancer Surgery
Experience
Dr. Orr has operated on more than 1000 women with breast cancer and has seen even more referrals for
abnormal mammograms and breast lumps. He trained with Dr. Walter Lawrence in Richmond, VA and took part in some of the early research
of the National Surgical Breast and Bowel Project (NSABP). After his fellowship, he was the junior partner of Dr.
Alfred Ketcham, former chief of surgery at the National Cancer Institute. Dr. Ketcham was one of the early proponents of breast
conservation surgery and Dr. Orr became an avid disciple. 20 years of surgical practice has shown that most women can preserve their
breasts while being treated for breast cancer!
While in Massachusetts, Dr. Orr studied the feasibility of breast conservation in almost 600
consecutive patients. Breast conservation was possible in almost three-quarters of these women, and almost 85% of those women with
small tumors (<2cm). Importantly, only a few patients in the breast conservation group required mastectomy at a later time, and the
overall 5-year survival was in excess of 80%. A detailed description of Dr.
Orr’s experience may be found on the Outcome Studies page.
Dr. Orr began performing
sentinel node biopsies in 1997, and has extensive experience,
with well over 200 procedures. More recently, he has undergone training with the
Mammosite system – a new technique for
delivering breast irradiation.
Dr. Orr works closely with medical oncologists, radiation oncologists, and the breast health program
at the Gibbs Cancer Center. He participates in research through various clinical trial groups including the NSABP and the
Southwest
Oncology Group (SWOG).
Dr. Orr’s Publications
Some helpful references about breast cancer and breast surgery:
Questions to Ask the Doctor
American Cancer Society
National Cancer Institute
MedicineNet (Surgeon
Experience)
ICSI Guidelines
American College of Radiology (Breast Preservation Guideline)
Mammosite Radiation Device
Susan
G. Komen Foundation
FORCE (Hereditary Breast Cancer)
Sentinel
Node Biopsy
DCIS
DCIS (very technical)
DCIS (Silverstein)
DCIS (Van Nuys Index)
Her 2 Neu
Herceptin
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