One thing Joshua A. Feinberg, MD, breast surgeon at Maimonides Breast Center, wants people to know: A diagnosis of breast cancer is not the only reason to see a breast surgeon.
That might be a surprising statement from our newest breast cancer surgeon, but as Dr. Feinberg notes, one of the things that makes Maimonides Breast Center (Brooklyn’s only Breast Center accredited by NAPBC) and Breast Imaging Center of Excellence exceptional is the way our clinicians embrace research and clinical innovation.
“I chose Maimonides because it is the perfect hybrid of an advanced academic medical center with a personal feel,” says, Feinberg. “The opportunity to provide specialized care for our Brooklyn patients while training the next generation of physicians excites me.”
During his general surgery residency at Maimonides Medical Center, he completed a research fellowship in evidence-based medicine and patient safety at Oxford University. He then went on to a Society of Surgical Oncology (SSO) breast surgical oncology fellowship at NYU Langone before returning to Maimonides. His work has been published in several peer-reviewed journals, including The Lancet and Annals of Surgery.
In addition to those who are newly diagnosed, Feinberg sees those at an increased risk for developing breast cancer in the future. Through shared decision making, the patient and I can “shape a long-term surveillance plan customized specifically for the patient,” he says.
He also sees individuals who have had recent biopsies that showed high-risk lesions. Historically, those were surgical cases but we now have long term data to support surveillance imaging as opposed to surgery for many of these lesions, as they do not all carry the same risk of breast cancer.
Empowering patients with clinical trial opportunities
Maimonides provides access to clinical trials. “Patients often think that clinical trials are an option only for people with cancer that does not respond to standard treatments. But that’s not the case,” Feinberg says.
Ongoing trials at Maimonides include using molecular testing on tumors to tailor treatment and spare patients from toxic chemotherapy regimens used in past, Feinberg notes.
State-of-the-art breast surgery
Feinberg integrates research findings into treatment. For example, surgeons often perform a sentinel lymph node biopsy or axillary lymph node dissection when removing breast cancer that has spread to the lymph nodes. That can lead to lymphedema, causing the patient’s arm to swell or become painful and increasing risk of infection.
Maimonides takes a more targeted approach, removing only the lymph nodes that contain cancer. There’s strong evidence this is just as effective as a complete axillary dissection, Feinberg explains.
Developments in genomics
The Maimonides Breast team stays current with innovations in genomics, where cancer tissue is tested to determine likely prognoses and predict how tumors may respond to treatment.
“Genomics have led to treatment de-escalation in all spaces of breast cancer management, thus sparing patients unnecessary toxicity,” Feinberg says.
Maimonides is part of a registry trial that conducts tests on tumor biopsy specimens in patients with an early form of breast cancer known as ductal carcinoma in situ (DCIS). Results can determine which patients won’t need radiation and which may benefit most from it. The results can guide subsequent treatment decisions, including the type of surgical procedure best suited for the patient, he notes.
Looking ahead
From spearheading tailored treatments to conducting research—and connecting patients directly to cutting-edge clinical trials—Feinberg is involved in all aspects of breast cancer treatment at Maimonides.
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