“It’s exciting to be part of a medical field that’s making a difference,” says Angela Keleher, M.D. She’s director and lead breast surgeon for the Breast Care Center at the Dyson Center for Cancer Care at Vassar Brothers Medical Center in Poughkeepsie.
“We’re catching the disease earlier, in many cases,” she notes. “We have better screening tools and less-invasive surgery for breast cancer. The treatments are evolving, and we’re seeing better outcomes.”
Born and raised in Illinois, Keleher — who’s board certified — earned her medical degree at the University of Illinois at Chicago. “I was always interested in science, and I really love surgery,” she says. She went on to complete her general surgery residency in Pittsburgh, her internship in Chicago, and her clinical breast fellowship at the M.D. Anderson Cancer Center in Houston.
Keleher first began working with cancer patients while going through surgical rotation as a med student. “I thought, ‘Here’s a real challenge; it’s mentally challenging, physically challenging, emotionally challenging. You can really help people here.’ There’s also a lot of breast cancer in my own family; my sister has had it twice.”
Prior to joining the Dyson Center, Keleher was chief of surgical breast oncology at Western Pennsylvania Hospital and an assistant professor at Temple University School of Medicine.
She says the world of breast cancer treatment is constantly evolving. “For example, stage four breast cancer is not automatically regarded as a death sentence anymore. It’s more like a chronic disease, in many cases. Like with diabetes, you check blood levels, you change and adjust the medicine when needed, you monitor the patient — that’s the direction treatment is going in.”
Advancements in treatment each year mean that recurrences of breast cancer can be more successfully treated, but only if former patients remain vigilant in the years after. “We’re seeing people coming in with a cancer recurrence after 10, 12, 17 years, and we go to work treating it. Just because you have a recurrence doesn’t mean it’s a death sentence,” Keleher says, stressing that each case is unique; some patients do have better outcomes than others.
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Photograph by Michael Polito
Another positive advance: Breast-cancer surgery no longer leaves women as physically disfigured as in the past, Keleher says. “In many cases we can do a lumpectomy, which leaves much of the breast intact. And if we need to do a mastectomy and remove the breast, we usually can do immediate reconstruction by a plastic surgeon — it’s done during the same surgery. We see beautiful cosmetic results.”
Keleher says the mastectomy rate has actually been going up again, after a trend for many years of performing less-invasive lumpectomies. “More women are choosing mastectomy because of the wonderful reconstruction options,” she says, adding that New York State law now requires hospitals and doctors to discuss all available options and insurance coverage for breast reconstruction before patients have a mastectomy, lymph node dissection, or lumpectomy. (A 1998 federal law already mandated that insurance companies cover reconstructive breast surgery.) As important a factor in that choice, though, is that women nowadays thoroughly research treatment options and often choose a mastectomy for the peace of mind it brings, she says.
“In my experience, what’s most challenging about this field isn’t the surgery or dealing with the disease process itself,” Keleher says. “It’s about understanding the patient. As a physician, it’s my job to tell you what the options are for cancer treatment. But it’s also my job to listen to your needs as a patient.”
She adds: “It’s not just about the cancer. It’s about the patient, her family, her relationships, her sexuality, her job, her self-image, everything. I think that’s the wave of the future in medicine: more awareness of a patient’s total needs.
“We, the surgeons, are just part of the equation. We’re often the first people to see a patient during her medical journey. I call it ground zero; we sort of take care of them from the ground up. And nowadays, more physicians understand that it’s important to help orchestrate their other care, besides just getting a patient to the medical oncologist and the radiation oncologist and the genetic counselor.”
Keleher says the total-care approach can range from exploring palliative needs — making sure the patient is comfortable and pain-free — to arranging for a family counselor, a support group, “or maybe making sure their kids get some books or brochures to read so they understand what’s going on.”
To make her hectic day a bit easier — Keleher handles administrative duties at the breast center and maintains a full clinical/surgical practice — she skips the headache of commuting. She and her husband live just a few steps away from the hospital in Poughkeepsie. During their free time, the couple enjoys exploring the region; they’ve resided in the Valley for more than three years.
“Sometimes we’ll take the train to New York City, explore a different neighborhood each time, and maybe try a new restaurant. Or we might go to Mohonk [Mountain House] for the weekend. I’ve even taken the train up to Lake Placid. The Hudson Valley is very beautiful, and our community has been very warm and embracing to us,” Keleher says.
Her medical advice to women: “Mammograms do save lives. Do breast self-exams because you know better than anyone what’s normal for your own body. And if you do find anything abnormal, don’t be afraid to have it checked out right away. I think women should be empowered about their health — it helps patients have a faster recovery, and it helps us help you in treating the disease, so you can get back to living a full life.”