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Dr. Elissa Santoro has been recognized for her outstanding contribution in her role as an Oncologist specializing in surgical breast procedures and treating breast cancers at Montclair Breast Center in Montclair, New Jersey.
    With an impressive 50 years of medical experience as an Oncologist, she is a very loyal to her patients and proven in her commitment to her current role. She was in fact the first medical professional in New Jersey to specialize in Oncology and breast health, with 48 years of those years at Saint Barnabas Medical Center located in Livingston, New Jersey, and was the first woman surgeon at St Vincent's Hospital - thus she has certainly been a vehicle of change in the medical arena.
   As a result of her unparalleled commitment to the medical profession in 2018 Dr. Santoro was awarded "New Jersey Top Doc", a “Patient Preferred Physician” as well as being the first individual to achieve "Outstanding Woman" in the field of medicine now named the Christine Todd Whitman Award.
   Dr. Santoro has also partnered with New Jersey State Legislators assisting in the development of the Women's Health Department to increase fund allocation to Breast Cancer Research. Furthermore, since embarking on her career in the field of medicine Dr. Santoro has been committed to offering the best level of care possible for her patients.

  As part of the Breast Cancer Awareness features, Preferred Health Magazine asked the esteemed oncologist about her career and for her advice to women diagnosed with BRCA gene and Breast Cancer. 

PHM:  You have an impressive 50 years of medical experience as an Oncologist, with a specialty in Breast Oncology, which she held for forty-seven years.  What can you say about the differences in breast health 50 years ago vs. today?

Dr. Elissa Santoro: Breast cancer is recognized as the leading major cause in the Western world for women and a very small percentage in men. For years solo practitioners directed the diagnosis and treatment. Outcomes were poor for many reasons. Change came when it became obvious that multiple physicians of other specialties were needed to have input in each breast cancer patient’s best care. Other multiple disciplines were part of the team to afford the best outcomes to afford whole patient care. Clinical trials including screening mammograms changed surgical care from radical mastectomy to modified radical mastectomy to conservative breast-preserving procedures with radiotherapy and adjuvant systemic treatment. With early detected cancer sentinel node biopsy began to replace complete axillary node dissection. 
   Reconstruction became possible to help make the woman feel “whole” again. It is estimated that for women between 40-75 years of age doing annual screening mammograms, the mortality would be dramatically reduced by 2/3. 

Technology in women with dense breasts that could obscure a cancer is now aided by ultrasound and MRI. Gene testing has identified those women who have from 55% to 85% lifetime risk can have the option of prophylactic mastectomies with reconstruction. A cohort would benefit from prophylactic oophorectomy, thus preventing ovarian cancer. Young women can have their eggs frozen to preserve fertility if they so choose. Oncotype testing can help select patients who do not need chemotherapy Instead they can have anti-estrogen therapy. Tumors are tested for estrogen and progesterone positivity or negativity. Her 2 neu tested on the tumor if positive can be treated with a monoclonal antibody. Neoadjuvant therapy can reduce large tumors to either a complete response or partial response affording a more conservative surgery. Clinical trials using neoadjuvant treatment including radiotherapy are showing improved survival. Clinical trials are critical in advancing our ability to reduce mortality. Ideally, patients should be encouraged to enter clinical trials. 

PHM: According to the American Cancer Society, 1 in 8 women in the United States will be diagnosed with breast cancer in their lifetime. In 2023, an estimated 297,790 women and 2,800 men will be diagnosed with invasive breast cancer. Do you find these rates alarming? And what do you believe is the cause? 
The invasive breast cancer increase is alarming and there are multiple apparent factors. Elevation of risk is associated with obesity in younger postmenopausal women. Women over 75 who are already at higher risk have more than a 40% increase. Insulin resistance is on the rise and associated with obesity. Especially since COVID-19, there is a marked decrease in physical activity. More women are working from home. Known risk factors include early menses under 12, menopause 55 and older, no children, first birth over 30, not breastfeeding, smoking, more than one glass of alcohol daily, low vitamin D, breast biopsies showing proliferative disease, atypical ductal hyperplasia, Mother with breast cancer, two first degree relatives with breast cancer, dense breasts on mammograms, drug abuse. Processed foods and hormone-fed meat, chicken and milk, and dairy from hormone-fed animals. Environmental exposure to toxins. High-stress levels lower the immune system. Sleep deprivation with lack of restorative sleep.

PHM:  In the last decade or so, there have been women who have chosen to have early genetic testing done for BRCA 1 and 2 Genes that would predispose them to breast cancer. These women are often choosing a Bilateral Mastectomy as a means of saving their lives. As a breast oncology consultant, is this something you find your patients have come to you for in recent times? What can you tell us about Mastectomy and its life-saving capabilities? 
Patients with hereditary breast and ovarian cancer (HBOC) especially with BRCA1 and BRCA2 mutation, are known to have early-age breast cancer and excess risk lifetime for bilaterality, and a significant gain of life expectancy, are choosing prophylactic mastectomy. This knowledge of lifetime benefits is now more widely known. 

PHM: As for post-mastectomy, surgical options are available for women to either go flat, fat graft or choose implants. What advice can you give regarding these options? 
The breast can be considered a psychosocial organ. Each patient has her own risk perception. Individual cultures play an important role. The decision-making process requires extensive discussions. Now with skin and nipple areolar-sparing surgery, DIEP (autologous) reconstruction, and more recent pre-pectoral implants (not under the muscle and more natural) more women are not choosing to go flat. However, there are those who prefer no reconstruction, usually based on anxiety about any kind of reconstruction. Addressing each patient’s fears and anxieties with compassion and understanding usually leads to affirming her decision. 

PHM: What step-by-step advice can you give to women who have been recently diagnosed with either the BRCA Gene or Breast Cancer?
: One should be treated by a team of surgical and medical oncologists
and if indicated radiation oncologists. This team must present your case to a Tumor Board where all disciplines including the psychosocial, genetic counselor, and clinical trials are available. Each patient’s case is unique and must be individualized. I cannot stress enough participating in clinical trials to advance our better treatment for each patient. 

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