The little things

Left: Henry playing; Right: Ginger and Dr. Escallon

Crouched in the playground sandbox, Ginger rolls a plastic yellow and black steamroller through the sand, clearing a road for her son Henry’s miniature front-loader to travel along.

“What’s next, Mom?” Henry asks when his truck reaches the end of the road.

Ginger smooths a new path through the sand. “Try this one,” she says. “See how fast you can go.” 

It’s a simple, everyday moment between mother and son — and one that Ginger has more reason than most to treasure.

Nearly four years ago, Ginger was diagnosed with aggressive, stage 3 breast cancer that had spread to the lymph nodes. She was 34 years old, newly married — and 28 weeks pregnant with Henry.

Miracle baby

“My husband Andrew and I were in shock,” Ginger recalls. “We didn’t know what the future held for us or our baby.”

Though young and “probably the healthiest I’ve ever been,” Ginger had been alarmed when she’d noticed a lump in her left breast months earlier, but her fears had been dismissed by a physician. Since the lump didn’t go away, Ginger mentioned her concerns when she went for a flu shot. Her family doctor ordered an ultrasound, and the results were troubling. 

Ginger was quickly referred to Dr. Jaime Escallon, an accomplished surgeon who had joined the Marvelle Koffler Breast Centre at Mount Sinai in 2002. Dr. Escallon gently warned her, even before the biopsy results the next day confirmed his suspicions, that he believed the lump was most likely malignant.

Three days later, dazed by the news, Ginger went to a previously scheduled appointment with her obstetrician, Dr. Peter Hawrylyshyn, who quickly referred her to Dr. Cynthia Maxwell, a colleague in maternal-fetal medicine and medical lead of Mount Sinai’s Special Pregnancy Program, who he knew had experience caring for expectant mothers with cancer.

Within days of her diagnosis, Ginger had a team of caregivers with rare expertise in treating pregnant women with breast cancer, including Dr. Srikala Sridhar, an oncologist at Princess Margaret Hospital, all of whom were dedicated to preserving her health and that of her unborn
baby. Because of the aggressiveness of her tumour and the stage of her pregnancy, Ginger’s care team agreed to administer chemotherapy first, followed by surgery and radiation after Henry was born.

“We felt that giving chemotherapy up front would have the most significant impact on Ginger’s
health in the long-term,” explains Dr. Escallon. “We also know it’s safe to give chemotherapy
in pregnancy after the second trimester. The benefits outweighed the potential risks.”

“Making certain a woman receives appropriate medical care and protecting her baby might
seem like conflicting goals,” adds Dr. Maxwell. “But we have learned from clinical experience
and research that we can do both. It benefits the mother to have her treatment promptly, and it
benefits the baby to continue growing inside the womb as long as possible to avoid prematurity.”

Ginger completed two rounds of chemotherapy before Henry was born. Her pregnancy was
monitored closely, with weekly ultrasounds and tests to ensure Henry was healthy and developing on schedule. On January 18, in between Ginger’s second and third rounds of chemotherapy, Henry was born. Other than a little bit of jaundice, he was given a clean bill of health.

“He was our miracle baby,” she says.

Rare expertise, broad impact

Being diagnosed with breast cancer during pregnancy is exceptionally rare; Ginger is one of only approximately a dozen patients each year who are treated by Mount Sinai’s Pregnancy Associated Breast Cancer (PABC) program, which has grown out of the intersection of the Hospital’s dual expertise in women’s and infants’ health and its world-leading breast cancer programs housed within the Marvelle Koffler Breast Centre. The program, in conjunction with the Special Pregnancy Program, assembles a multidisciplinary team of experts to address the complex clinical and emotional needs of these women at all stages of their care, from diagnosis to recovery, from pregnancy through early motherhood.

The program’s reach is not confined to Mount Sinai patients. Doctors throughout the province who are caring for pregnant women with breast cancer often consult with Mount Sinai’s team on how best to care for mother and baby.

“The guidelines we’ve developed to date are followed in many other places throughout Ontario,” says Dr. Escallon. “So the impact of our expertise — even though we don’t see every patient physically at Mount Sinai — is still felt.”

In collaboration with Dr. Maxwell, Dr. Christine Elser, a medical oncologist and head of the PABC program, plans to further broaden the impact of our rare expertise by developing national standards for the clinical management of pregnant women with breast cancer.

“In addition to delivering optimal clinical care, we plan to collaborate with our obstetrical team to collect and study data and tissue from patient participants to gain a better understanding of this rare cancer and help us to develop future treatment strategies for women with PABC,” says Dr. Elser.

The Pregnancy Associated Breast Cancer program is one of many initiatives through which the
Koffler Centre, the first comprehensive breast centre in Canada, continues to re-envision breast cancer care. Established through the collaborative efforts of Dr. Pamela Goodwin, the Centre’s Director, and Marvelle Koffler, a breast cancersurvivor, donor and activist, the Koffler Centre is home to a bustling practice, with 34,000 patient visits and approximately 400 to 500
new breast cancer patients annually. The Centre, which celebrates its 20th anniversary this year,
maintains a core focus on delivering authentically patient-centred care customized to each patient’s individual needs. And the Centre’s world-renowned research has echoed this emphasis, focusing primarily on the relationship between a woman and her tumour, and how manipulating patient-related factors such as vitamin D and insulin levels can affect a woman’s outcome.

“We’re not a factory,” says Dr. Goodwin. “When patients arrive, our staff greets them by name. That doesn’t happen very many other places.”

Support given at the right moment

“Patients often arrive feeling confused and anxious,” says Dr. Escallon. “What they find here is a multidisciplinary team ready to help them in every aspect of their care.”

That support runs the gamut from efficient, reliable diagnoses by Mount Sinai’s expert pathologists, to genetic counselling, to comprehensive treatment plans tailored to each patient’s needs, to extensive educational, emotional and psychosocial support.

The team collaborates to ensure that care is “given at the right moment,” says Dr. Escallon, when it will have the greatest impact for the patient.

There are many examples: The nurse who cares for a patient in the clinic accompanies her into surgery and cares for her as she recovers, offering a reassuring and familiar face at every stage of her journey. A genetic counsellor screens patients for genetic risk factors as they are assessed for surgery, enabling expedited results that allow physicians to tailor treatment for patients who are genetically predisposed to breast and other cancers. The Scotiabank Transition to Health program, led by nurse coordinator Velita Contiga, RN, navigates patients at key transition points in their care from diagnosis to surgery and chemotherapy, relieving unnecessary confusion and anxiety. The Taking Charge program builds on this model, easing patients’ transitions from active treatment to normal day-to-day activities and helping patients make healthy lifestyle choices as they cope with the emotional, psychological and physical after-effects of cancer treatment. The Centre’s nationally renowned patient education
and outreach program, led by Linda Muraca, RN, has helped develop educational strategies for health care teams designed specifically to improve the breast cancer screening experience for physically disabled patients, among many others. And Dr. Escallon works collaboratively with
Mount Sinai’s plastic surgeons to offer immediate breast reconstruction — completed as part of the same operation that removes the tumour — for patients who require a mastectomy, when possible.

“Breast cancer changes,” says Dr. Goodwin. “When we opened the Centre in 1995, we were in an era when many of our patients died, but we’re in an era now when most of our patients survive. The needs have changed. There’s a greater focus on dealing with the breast cancer and moving on with your life.”

Life after breast cancer

While juggling the joys and challenges of first-time motherhood, Ginger completed four more rounds of chemotherapy before Dr. Escallon operated in May 2012, removing what remained of the tumour from her breast. Over the following summer she completed 30 rounds of radiation.

“I’m so grateful for the care I received at Mount Sinai,” Ginger says. “There are so many shining stars in my head. Dr. Escallon has been so understanding, and the staff in his office and the nurses that work with him are incredibly approachable, friendly and professional. Everyone
remembers my son’s name and asks how we’re doing. It’s amazing.”

In the three years since she completed her treatment, Ginger’s care team has continued to monitor her closely, conducting an MRI every summer and a mammogram every winter. She and Henry remain healthy and happy.

“You end up having a lot of conversations with other survivors in waiting rooms, and I remember someone saying to me, you don’t realize now but this is going to be kind of a gift in the end,” Ginger recalls. “And I thought, that’s crazy. While it isn’t that simple, and it has been the biggest challenge in my life, it has also allowed me to slow down and look at life in a different way. I value my family and friends so much more. As a family, we don’t have goals like, we want to go here or do this. Little things become a big deal for us. We just want to be together as much as we can. That’s the most important thing for us.”


-Sara Daniels
Photos: John Packman

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Mount Sinai Hospital Foundation

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