Dr. Peter Pressman on Breast Cancer Treatment

Peter Pressman, M.D., is a surgical oncologist who specializes in the treatment of breast cancer. He also directs a genetics program in breast cancer at Weill Cornell Medical Center. A graduate of Columbia College and the Columbia University College of Physicians and Surgeons, he trained at Presbyterian Hospital and the Columbia Division of Bellevue Hospital in New York City. Pressman has been in private practice in New York for over thirty-five years and is clinical professor of surgery at the Weill Medical College of Cornell University. He was attending surgeon at Beth Israel Medical Center and Lenox Hill Hospital. Here, he shares some wisdom about finding the best medical treatment you can for breast cancer.

You say that the first few weeks after a diagnosis are most difficult and most important. Why is that?

A woman gets up in the morning and discovers a lump, or she has an annual exam, and the doctor finds something, and in one short period of hours, she finds that her life may be changing. She is certainly concerned that what she's found may be a cancer and that she is going to die. Everything seems very overwhelming.

Then it becomes a matter of acquiring a lot of information. She has to deal not only with where do you get the information, but who is going to help her take care of this. Who is going to be the right doctor? Where do I find the right doctor? How are you going to know who it is you should go to?

Women are asked to become instant experts. It's hard, but it is amazing how knowledgeable we are able to become. It's very hard to sit down at the computer and get all of this information which is out there, because you have no way of knowing how accurate it is. You really have to depend a lot on the personal advice of people you can trust.

Are there very different survival rates between people who can't have the most cutting edge care and those who do?

We do say to women, "If necessary, leave your community for a week or two and find out what other options may be available to you. You can get your treatment and then go back and live your life." If you don't live near a big city, it's a big problem. We know that when women are treated in cancer centers or in cities where they have comprehensive cancer information, like any university-associated hospitals, that the survival [rate] is better. And the reason is not that an isolated surgeon somewhere can't do as well, or that a chemotherapist can't deliver that therapy. It's having all the specialists together, in a place where everyone's case gets discussed all the time.

What are some of the advances that might not be available from non-specialized surgeons?

Onco plastic surgery. When we take out a lump and the surrounding tissue, we move tissue around within the breast so we can improve its appearance and retain a normal or near-normal appearance. When that can't be done, and you have to remove a fair amount of the tissue, then obviously a mastectomy must be considered. If a woman has a large breast, you may do a very generous lumpectomy on one side and then you may reduce other side to match it. That's the onco plastic approach: to consider the cosmetics while you are planning your procedure for therapy. The lumpectomy has evolved over the years to be able to treat larger tumors with better results. We can now treat larger tumors than we used to with lumpectomies because of onco plastic approaches. And these are refinements that you would find in cancer centers and offered by doctors who are specialized in doing breast cancer surgeries. It doesn't have to be a cancer center, but it has to be a doctor who is known for concentrating his practice on treating breast cancer.

SIGNATURE QUESTIONS

What is the belief you personally go to during times of change?

I have such a positive approach to life. I look to the wonderful relationships I have in my family, in my life, and with my patients, who are also an extended family. And that's really brought me though any adversities along the way.

The best thing about change is...

Whenever you're facing adversity, you need to try to establish goals, recognizing that you want to retain the best of your life, and make the changes necessary to accomplish this. And when those may be considerable, try to turn them into the best possible advantage.

What is the best change you have ever made?

I made an early change as a very young person. I started my life as a musician, and I was very successful, but I wanted more. What I missed most when I was performing as a concert artist was the personal relationships, because you're very isolated when you're a solo artist.

When I became a surgeon, I sought out a part of surgery where my relationship to patients was almost more important than surgery itself. And when you deal with life as a breast surgeon, you're dealing so much with talking to people, and their lives, and making life-changing decisions for them. It's as important as your skill in the operating room, so I really accomplished what I set out to do, which was to relate to people very personally.

For more information on Dr. Peter Pressman, visit www.nyp.org.

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