Saturday, March 24, 2018


The Road Ahead: Diagnosis and Treatment of Breast Cancer

Cancer. Just hearing the word can bring you down. For many women, a breast cancer diagnosis is a reality they have to face. The thought of receiving a diagnosis can cause much distress and anxiety in women on top of all the stresses they experience every day. Fortunately, there have been great strides in breast cancer research, treatment and diagnosis. Breast cancer is no longer a death sentence, and more women are living healthy and happy lives after their diagnosis. With death rates down 34% since 1990, breast cancer is no longer a death sentence, and more women are living healthy and happy lives after their diagnosis.

The road to recovery begins with diagnosis. So, how do we do so with confidence and accuracy? Physicians employ a variety of breast imaging services including mammography, ultrasound and MRI to detect breast cancer, depending on various patient factors. However, breast cancer screening guidelines have become somewhat confusing in recent years, with multiple organizations offering different recommendations. The most common advice from radiologists and breast surgeons is for an annual mammogram starting at the age of 40. For women with denser breast tissue, tomosynthesis (3D) mammography may be beneficial and/or consideration of screening breast ultrasound. Those women whose lifetime risk of breast cancer exceeds 20% would also be screened with annual MRI. Still, I find it helpful for women to have a general sense of what is normal for them. For instance, if a new breast lump is identified by a patient that does not go away within one menstrual cycle, it is worth exploring with at least an ultrasound.  In a postmenopausal woman, a new lump warrants diagnostic breast imaging including ultrasound.

Once breast cancer is detected, the next step to recovery is treatment. There are three main forms available: medications, radiation therapy and surgery. Which one or ones are right for you is dependent on the type and severity of the cancer. Medications used for breast cancer include chemotherapy agents, hormone blocking drugs like tamoxifen or aromatase inhibitors, and immunotherapy. The biology and behavior of the cancer tend to influence which drugs, if any, would work best for a particular cancer. With radiation therapy, doctors take into account a patient’s age, surgery performed, and pathology characteristics to assess whether radiation is indicated, and if so, what course might be best suited for the patient. Breast surgery procedures range from lumpectomy, which conserves breast tissue, to mastectomy, which removes the majority but not all of the breast tissue. In determining which surgery is best for an individual, several factors are taken into consideration, including the size and location of the cancer, personal and family history, and the patient’s personal preferences. More and more women are benefiting from the use of oncoplastic surgery, where oncologic principles of taking out cancer with, ideally, widely clear margins, are combined with plastic surgery closure techniques. Oncoplastic breast conserving procedures and mastectomy reconstruction options have really revolutionized breast surgery, allowing women to boost their self-confidence and feel more like their usual selves. 

Reconstruction is an option for the vast majority of patients undergoing mastectomy and allows women to retain a natural, feminine appearance after surgery. Two main forms of reconstruction are available: reconstruction with implants and reconstruction with tissue. Reconstruction with implants is the most common technique used in breast reconstruction. It often involves the initial placement of a tissue expander to maximize the ability of the skin to heal, while allowing flexibility in the size of the reconstructed breast, followed by later removal and replacement with a formal implant. Some women may prefer to use their own tissue for reconstruction. In this case, tissue is taken from another part of the body, most commonly the abdomen or the back, and transferred to the mastectomy site, creating a natural texture to the reconstructed breast. 
The thought of being diagnosed with breast cancer can be frightening. Fortunately, great strides have been made in breast cancer research, and new technologies help women get back to their normal lives more quickly. 

For more information on breast cancer imaging, treatment and diagnosis, visit 

Webinar: Coordinated Care Initiative: Key Information for O.C. Physicians

The Coordinated Care Initiative:  Key Information for Orange County Physicians occurs several times:

Wednesday, April 27, 2016, 12:00 noon - 1:00 p.m.

Wednesday, May 25, 2016, 12:00 noon - 1:00 p.m.

Wednesday, June 22, 2016, 12:00 noon - 1:00 p.m.

Please register for the date and time that works best for you:

Program Description:  This webinar is designed for physicians and will cover the Coordinated Care Initiative (CCI) and the programs within the initiative including Cal MediConnect, known as OneCare Connect in Orange County.

The CCI is a new program designed to help provide extra support for low-income seniors and people with disabilities in California, including those who are dually eligible for Medicare and Medi-Cal.

Webinar topics include:  

1.  Overview:  How the CCI is changing health care for dual eligible patients;

2. Continuity of Care:  How to keep seeing your patients if they join OneCare Connect;

3. Care Coordination:  How OneCare Connect can help support physicians in coordinating care for patients, including in-home and community based services;

4. Billing Processes: How billing works under the CCI for patients who join OneCare Connect and for those who remain in  fee-for-service Medicare and join the CCI for Medi-Cal services.

Speakers:  Rita Cruz Gallegos & Joe Garbanzos, Provider Outreach Specialists, Harbage Consulting; and Laura Grigoruk, Director of Direct Networks - CalOptima.


CURES On-Demand Webinar

July 1, 2016 is the deadline for mandatory CURES registration for all physicians with an active medical license and a Drug Enforcement Agency certificate. In order to help prepare physicians, CMA hosted a webinar on the CURES 2.0 registration process, which was presented by the Department of Justice. The webinar is now available on-demand in the CMA Resource Library and is free for both members and non-members. Please click here to view the CURES 2.0 webinar

St. Joseph Hoag Health Names Tarek A. Salaway as Chief Operating Officer of Mission Hospital




Media Contact: Nisha Morri

Office: 714-414-3232


 St. Joseph Hoag Health Names Tarek A. Salaway as Chief Operating Officer of Mission Hospital

MISSION VIEJO, CA, March 8, 2016 Mission Hospital, part of the St. Joseph Hoag Health network of care, today announced that Tarek A. Salaway, MHA, MPH, MA, has been named Chief Operating Officer of Mission Hospital, one of seven not-for-profit hospitals operated by the health system.


In his new position, Salaway will be responsible for maximizing the operational performance of Mission Hospital’s campuses in Mission Viejo and Laguna Beach as well as its off-site locations, including inpatient and outpatient centers and associated services. He will play a key role in developing the hospital’s strategic direction and optimizing the market presence of the hospital in the Orange County region. Salaway will oversee a wide range of clinical and ancillary programs that are core to Mission Hospital, and he will also be responsible for identifying and developing opportunities for growth.


The chief operating officer plays an extremely important executive role in the success of Mission Hospital. Having a proven leader like Tarek Salaway in that role fortifies our more than 40-year-old ministry and strengthens our ability to provide our communities with access to advanced, integrated care in the years to come,” said Richard Afable, MD, interim CEO of Mission Hospital and President and CEO of St. Joseph Hoag Health, the Southern California region of St. Joseph Health. St. Joseph Hoag Health, of which Mission Hospital is a vital part, is committed to transforming the delivery of care through innovations that foster ever higher quality, access, and efficiency,Dr. Afable continued. Mr. Salaway provides Mission Hospital with senior-level experience and talent to implement its goals in all aspects of our operations.


I am truly honored for the opportunity to join the Mission Hospital leadership team, said Salaway. Mission Hospital, like many hospitals in Southern California, operates in a changing and intensely competitive market. I look forward to developing our clinical programs and mobilizing our stakeholders to be best positioned to respond to the market and deliver high quality results for patients and their families.

Salaway comes to Mission Hospital after serving as the chief operating officer at Keck Medical Center of the University of Southern California (USC), which includes Keck Hospital of USC and USC Norris Cancer Hospital. His experience in the health care clinical operations and business management spans more than 20 years and includes progressively responsible leadership positions at Stanford Hospital and Clinics and Providence Health & Services.


Salaway completed his Master of Healthcare Administration (MHA) degree at the University of Washington. He earned his Master of Public Health (MPH) degree, with an emphasis in epidemiology  and health services, and his Master of Arts in international relations, at the University of Washington. He received a Bachelor of Arts degree in political science and French literature from the University of California, San Diego. Salaway, a native of Southern California, resides in Aliso Viejo.


About Mission Hospital


As a part of the St. Joseph Hoag Health network of care, Mission Hospital was founded in Mission Viejo in 1971 and has since grown to a two-campus facility with 552 beds and approximately 2,500 employees. Mission Hospital, a ministry of St. Joseph Health, has been serving the greater needs of the community for more than 40 years, improving the quality of life in the communities it serves in the tradition of the Sisters of St. Joseph of Orange. Mission Hospital in Mission Viejo is an acute care, full- service facility providing advanced health care services and diagnostic care to south Orange County and is the only designated trauma center in South Orange County. Mission Hospital Laguna Beach (MHLB) provides South Orange County coastal communities with 24-hour emergency and intensive care as well as medical-surgical/telemetry services. Mission Hospital offers specialty care in cardiovascular, neuroscience and spine, orthopedics, women’s services, urology, behavioral health, head and neck and other key specialties. CHOC Children’s at Mission Hospital is a 48-bed facility that is the area’s only dedicated pediatric hospital for more than two decades. Fully accredited by The Joint Commission and designated as a Magnet hospital by the American Nurses Credentialing Center for nursing excellence, Mission Hospital has received numerous awards and recognition for its high quality of care. For more information, visit

Health Advisory-Zika Virus In Latin America

Click Here to view the CDC advisory which reviews the epidemiology, recognition and management of Zika virus infection.

To view the Health Advisory from the California Department of Public Health, please Click Here

In response to the CDC Health Alert regarding the Zika Virus in Latin America, CDPH recommends special travel precautions for pregnant women and women trying to get pregnant.  Call the Orange County Health Care Agency’s Epidemiology and Assessment Program at 714-834-8180 with any questions or to report a suspect case of Zika.

Dr. Nikan Khatibi appointed to CHPEF Board of Trustees

Governor Jerry Brown appointed Dr. Nikan Khatibi to the Board of Trustees for the California Health Professions Education Foundation (CHPEF). Established in 1987, the CHPEF is the state's only non-profit foundation statutorily created to improves access to healthcare in underserved areas of California. The Board has awarded more than $124,000,000 in scholarships and loan repayments to California health professionals who are dedicated to providing direct patient care in those key areas. By doing so, the Board has provided California patients with a culturally and linguistically competent health workforce dedicated to delivering direct patient care in California's underserved communities. Dr. Khatibi is a physician anesthesiologist, pain medicine and addiction specialist. He currently resides in Orange County, California.

Mission Dhulikhel, Nepal

Mission Dhulikhel, Nepal

November 11-22, 2015
This past November, under the umbrella of Arpan Global Charities CHOC and SJO doctors traveled to Nepal to exchange information and share their skills and time at the Kathmandu University Hospital in Dhulikhel, Nepal, an independent, non-profit  teaching hospital. Opened in 1996, the hospital, besides health services, also provides medical, dental and nursing schools, in collaboration with Kathmandu University.

The devastation from the 7.8 earthquake that killed 9,000 people and destroyed the area’s infrastructure in April 2015 was quite visible. The current fuel crisis was also evident causing the hospital to cook meals for patients and staff outdoors with wood.

Before the trip, some of the Dhulikhel surgeons requested needed supplies. SJO Interim Chief Medical Officer and orthopedic surgeon Paul Beck, MD, who made the trip along with his wife, internist Huong Thi  Duong, MD, cited arthroscopy shavers used to trim tissue in the knee as an example. “In the US we use these blades once but in Nepal they were reused and sterilized dozens of times and were quite dull.”  He has contacted a supplier in the US who will be donating new blades, although after the trip.

SJO NICU Medical Director and the founder of  Arpan Global Charities,  Sudeep Kurkreja, MD, and his wife, Song Kukreja, helped organize and participated in the trip. This Mission Dhulikel , Nepal was the 18th volunteer medical mission organized by Arpan Global Charities and was tremendously successful.  During this mission focus was more on teaching and education than service, although our team members examined and treated more than 300 patients and performed 65 surgical and dental procedures.  Every single day each team members gave 2-3 didactic lectures to their respective counterparts from Nepal as well as hands on demonstration of latest surgical procedures and skills. 

He continues, There is great need for exchange of knowledge and skills between the physicians and surgeons from US and Nepal.”  Dr. Ram Shrestha, the Vice Chancellor at Katmandu University Hospital in Dhulikhel, was very supportive of having an ongoing academic affiliation between Dhulikhel Hospital and SJH/CHOC.  We discussed at great length about developing exchange program between Kathmandu University Hospital in Dhulikhel and SJH/CHOC especially in the area of neonatology and pediatric surgery. SJH President and CEO Steve Moreau, who was part of this mission with his wife Anne, will be working with CHOC to facilitate this exchange.   

Also on the Nepal mission trip were anesthesiologist Jeffrey Sycamore, MD; dentist Vazrick Navasartian; pediatric infectious disease subspecialist Jasjit Singh, MD and her husband pediatric ENT Gurpreet Ahuja, MD; ophthalmologist David Yomtoob MD, and his wife Allison; pediatric nephrologist Dorit Ben-Ezer, MD and her daughter Maya; Hillary Nguyen, a SJO volunteer and Cal State Fullerton student; CHOC neonatal nurse Cindy Hecklau. All the volunteers paid for their own flight, meals, and accommodations at a lodge about a kilometer from the hospital.

This mission was not possible without contribution by each and every one of the volunteers and  our host team members at the Kathmandu University Hospital, Dhulikhel.

Anyone interested in upcoming mission trips with Arpan Global Charities can contact Dr. Kukreja at


ASCO 2015 Update: Releasing the Potential of the Immune System

This article is brought to you by: John Link, MD of Breastlink

visit for more information

- The Annual Meeting of the American Society of Clinical Oncology (ASCO) provides an opportunity for thousands of oncologists and health care professionals to receive research updates and exchange ideas surrounding trends in cancer treatments.

More than 30,000 attend each year, making it one of the largest educational and scientific conferences dedicated to advancing cancer care. I recently joined my colleagues for the ASCO 2015 Annual Meeting, where a focus was on breakthroughs in immunotherapy.

What is Immunotherapy?

Immunotherapy refers to treatments that prompt the human body’s immune system to attack cancer cells. Cancer occurs when a genetic mutations occurs that causes a healthy cell to become cancerous. Can the immune system recognize these cancerous cells as harmful or are they too at home within the body?

Recently, we have determined that the immune system often does recognize cancerous cells. The immune system produces white blood cells called lymphocytes that target harmful substances, called antigens, within the body. In response to the development of some cancers, lymphocytes will gather around cancerous cells. However, they do not always infiltrate cancerous cells and cause them to die.

Some cancers produce certain proteins, such as programmed cell death 1 (PD1). These are similar to other naturally-occurring proteins that prevent the immune system from interrupting certain normal biological functions. For instance, these proteins prevent the body from rejecting a fetus during pregnancy. When a cancer cell produces PD1, it sends a message to lymphocytes to back off.

A relatively new class of drugs called PD1-inhibitors prevents cancer cells from disguising themselves as healthy cells. Several ASCO 2015 Annual Meeting presentations on PD1-inhibitors revealed that they were an effective treatment for several cancers.

  • Pembrolizumab – More than one-half of patients with advanced head and neck cancer experienced noticeable decrease in size of tumors following treatment with pembrolizumab.
  • Nivolumab – Tumors ceased growing in approximately one-half of patients with advanced liver cancer treated with nivolumab. Advanced lung cancer patients treated with nivolumab lived an average of three months longer than patients treated with docetaxel, a chemotherapy.

Immunotherapy in Breast Cancer Patients

Ongoing research is also investigating the use of PD1-inhibitors in breast cancer patients. In an early stage trial, 4 of 21 triple-negative breast cancer patients with the PD1 protein responded to a PD1-inhibitor currently under investigation. These results prompted the FDA to assign the drug, MPDL3280A, Breakthrough Therapy Designation, which is reserved for treatments that appear significantly more effective in clinical trials than existing treatments.

In an upcoming phase III trial sponsored by drug maker Hoffman-La Roche, researchers will investigate the use of MPDL3280A in combination with nab-paclitaxel, a type of chemotherapy, in patients with metastatic breast cancer. The phase III trial is currently recruiting patients. Eligible candidates include women with advanced triple-negative breast cancer with no prior chemotherapy or targeted systemic therapy for inoperable disease.

Breastlink will work with researchers as a clinical partner in ongoing MPDL3280A research. This means patients eligible to participate in the study can receive MPDL3280A at Breastlink locations in Orange County. At this time, Breastlink locations are the only sites in Orange County and Los Angeles County where patients can participate in this study. As part of our commitment to advancing innovative breast cancer therapies, Breastlink is excited to play a role in ongoing research and to offer patients an opportunity to participate.

One drug already approved by the FDA for breast cancer patients combines immunotherapy with conventional chemotherapy. Ado-trastuzumab emtansine ( T-DM1) uses an antibody called trastuzumab to target receptors present on cancerous cells in women with HER2-positive breast cancer. Once T-DM1 has bound to HER2 receptors, a chemotherapy agent called DM1 is delivered to the interior of cancerous cells, destroying them from the inside.

There are several benefits to immunotherapy over conventional chemotherapy and other targeted treatments. Researchers are continuing to produce evidence that immunotherapy improves clinical outcomes compared with conventional chemotherapy. Additionally, patients generally experience fewer side effects when treated. Immunotherapy also allows the immune system to develop a lasting memory of the antigen – in this instance, a type of cancer cell. If this specific type of cancer recurs, the immune system will continue to respond.

Developments such as those presented provide hope for a cure. The scientific and medical communities recognize new immunotherapy agents as huge breakthroughs. With these drugs, we can avoid treating more women with chemotherapy while improving their outcomes. At Breastlink, we are excited by these advancements and will eagerly track updates as they occur.

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