Photo by Michael Chiabudo
Silver Lining
Melvin Silverstein brings his devotion to patient care and research to the new Harold E. and Henrietta C. Lee Breast Center.
by Jon Nalick
For Melvin J. Silverstein, M.D., the future of breast cancer treatment is less breast cancer treatment-and that's good news.
An internationally respected surgeon and specialist in research and the clinical treatment of breast cancer, Silverstein foresees therapies that are less invasive, less costly and less daunting for patients, and at the same time more effective.
"There have been dramatic changes in breast cancer research and treatment over the past 10 years and that will certainly continue. In the future, we'll see more reliance on minimally invasive surgical procedures and more use of drugs to prevent breast cancer. There will also be more emphasis on genetic counseling," says Silverstein.
Silverstein, who founded the acclaimed Van Nuys Breast Center in 1979 and served as its medical director and senior surgical oncologist, recently joined USC/Norris as medical director of the Harold E. and Henrietta C. Lee Breast Center, co-leader of its breast cancer research program, and professor of surgery. The 5,500 square foot Breast Center, which will be completed in the spring, is located on the first floor of the USC/Norris Hospital.
Silverstein joins Christy Russell, M.D., chief of medicine for the Norris and a USC associate professor of medicine, Kristin Skinner, M.D., assistant professor of surgery, and Howard Silberman, M.D., professor of surgery.
A past president of the American Society of Breast Disease, Silverstein has authored more than 180 scientific papers, book chapters and abstracts as well as a definitive text on breast cancer, "Ductal Carcinoma In Situ of the Breast."
Silverstein says he decided to devote his career to improving treatments for breast cancer when he met a distraught breast cancer patient more than 30 years ago.
He had performed a technically flawless radical mastectomy on a French woman in her 40s and considered the operation a success, but discovered that the patient had been poorly prepared for the loss of her breast and was inconsolable.
"This was in the context of the 1960s before patients played a significant role in their own care and made informed decisions. A patient with a lump would enter the hospital and be put to sleep using general anesthesia for a breast biopsy. Immediate pathologic examination would be performed and definitive treatment would be carried out immediately if cancer was found. The patient didn't know if she was going to wake up with a band-aid over a biopsy or a bulky dressing over a radical mastectomy," says Silverstein.
"I was proud of my work, but for the French woman, and I soon learned for virtually all patients, when we took off the dressing, it was a terrible shock. Doctors at the time didn't appreciate what an awful experience mastectomy was and did a poor job counseling patients preoperatively. What I learned was that I really needed to be less of a surgeon and more of a human being," he says.
Silverstein says the incident made him start to think of the cancerous breast as more than just diseased tissue, but also as a sexual organ related to a woman's self-image and feelings of motherhood and femininity.
"That's when I realized that we needed to integrate the social and psychological implications of cancer with the medical aspects of treatment," he says.
In 1973, as an assistant professor of surgery at UCLA, Silverstein began one of the first integrated breast cancer programs in the U.S. Six years later he founded the Van Nuys Breast Center.
He says that returning to an academic medical setting gives him a unique opportunity to push the limits of research and treatment.
"USC is a fantastic place to develop an integrated multidisciplinary breast center because it already has in place the crucial elements needed, including outstanding basic science, epidemiology, medical genetics, radiation therapy, medical oncology and surgery," he says. "It's a great challenge to help create a truly state-of-the-art breast center at a facility like the USC/Norris, which I believe is one of the outstanding science centers in the world."
Silverstein says that USC will play a continuing role as a pioneer in advanced research, helping pave the way for more effective breast cancer treatments that cause less physical and psychological damage.
"For the future I see almost all breast cancer treatment being performed on an outpatient basis, except in cases of major reconstructive surgery. In fact, much of breast cancer treatment today is already performed on an outpatient basis.
"When I started in the 1960s, the average breast cancer treatment required five to six days in the hospital. Now it's common for patients, even with a mastectomy, to spend only one day in the hospital. State-of-the-art minimally-invasive biopsies, lumpectomies and sentinel lymph node biopsies are now all done on an outpatient basis," explains Silverstein.
He also foresees profound changes in the ability to make more accurate and earlier diagnoses of breast cancer as new tools enable physicians to detect tumors far smaller than those found today.
"We want to continue the development of new diagnostic technologies because the 10-year cure rates for non-palpable tumors are as high as 95 percent. For tumors you can feel with your fingers, those rates drop to about 60 to 75 percent," he says.
"We want to meet the cancer as early as we can in its natural history. When it's still a little kid, you can do something about it, but when it's an adult, it's much more difficult," he says.
Silverstein emphasizes that winning the fight against cancer requires close teamwork among physicians, researchers and patients.
"Our goal is to get the basic research into the hands of the clinician as quickly as possible while being on the leading edge of progress. Here at USC we have hundreds of scientists who are making progress against breast cancer one small step at a time-that's the way progress is made in cancer research."
For more information about the research and treatment available at the USC/Norris Harold E. and Henrietta C. Lee Breast Center, call 1-800-USC-CARE (1-800-872-2273).