New study suggests that Tamoxifen needs to be taken for 10 years for improved survival.

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A recent study published in Lancet medical journal has shaken up the breast cancer field. Traditionally, in order to prevent recurrences and extend longevity, we have treated early breast cancer patients who have  hormone sensitive tumors with 5 years of the hormone blocker Tamoxifen. However, a recent study shows that 10 years of treatment results in improved rates of living longer without breast cancer.

The study involved 6,846 women with hormone sensitive breast cancer who had completed 5 years of Tamoxifen therapy. They were randomly chosen to either stop taking Tamoxifen or to continue with an additional 5 years, for a total of 10 years of Tamoxifen. The results showed that those women in the 10 year Tamoxifen group had less breast cancer recurrences and less breast cancer deaths. By year 15 breast cancer deaths had improved from 15% to 12.2% by the additional Tamoxifen treatment. The risks of taking more Tamoxifen included increased rates of uterine cancer (3.1% versus 1.6%) and pulmonary embolism [blood clot to the lung]. Overall though the amount of women dying from any causes were significantly smaller in the 10 year Tamoxifen group (639 versus 722).

Since this study has been presented, there has been much discussion about how to apply these results. Here are some thoughts:

Is the benefit of 3% (15% t0 12.2%) worth the additional 5 years of medicine. Our thoughts are that it depends upon how a woman tolerated Tamoxifen. If she barely noticed taking the medicine, then yes it makes sense. If she had side effects then 5 years would be fine.

What do we do with women who have DCIS or those who are taking an aromatase inhibitor? The real answer is that we don’t know.

Most people are leaning towards increasing the length of time for all hormonal medication because we know that hormone sensitive cancers can recur years after a diagnosis. In fact, half of all recurrences occur 8 years from initial treatment. We are also giving Tamoxifen for a few years followed by an aromatase inhibitor for a total of 5-8 years of treatment. This allows women to be exposed to less of the side effects of both drugs.

Should we extend it to 10 years, 15 years, forever…?

One of our patient’s testimonials.

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“Before coming to the Cancer Center at Hudson Valley I spoke to a surgical oncologist at another hospital. All the right words were said but it didn’t make me feel better. I decided to go for a second opinion. When I walked in and met Dr. Pond Kelemen for the first time he looked at my charts, looked at me with such warmth, smiled and took my hand and said you’re going to be ok. From that moment on I truly believed that I would be. That’s patientology.”

- Kimberly Gerosa Ashikari Breast Center patient.

As a lifelong resident of Cortlandt Manor, Kimberly Gerosa had witnessed Hudson Valley Hospital Center evolve from a nice little hospital to the amazing facility it is today. Kim says she had always had a positive impression of the hospital. Her internist and gynecologist are affiliated with it, but now she knows and appreciates the hospital on a much deeper level.

Kim’s journey with breast cancer began after her routine mammogram in December of 2011 indicated a problem. The radiologists at Hudson Valley recommended an ultra- sound, which confirmed Kim needed a biopsy. Everyone in this imaging department was extremely nice, and very compassionate in helping Kim deal with this news – from the technicians to the radiologists. At this point in time, the Cancer Center at Hudson Valley was brand new. Not knowing much about it Kim went at first to another hospital to speak to a surgical oncologist.

Kim was told she had the early stages of breast cancer. All the right words were said but Kim did not feel at ease with this doctor. Her internist recommended she go and speak to the doctors at the Ashikari Breast Center at Hudson Valley Hospital Center. From the moment Kim met Dr. Kelemen she knew this was the right decision for her. She had a lumpectomy in January of this year. Unfortunately she learned soon after, on her birthday actually, that her birthday surprise was that the cancer had moved to her lymph nodes taking  her cancer from stage 1 to stage 2 .Consultations were arranged with Drs. Azim Ajaz, director of oncology services, and Chika Madu, Medical Director for Radiation Oncology, and Dr. R Michael Koch, plastic surgeon specializing in breast reconstruction. They designed a treatment plan that was right for her, which began with a 5-month course of chemotherapy. Kim said that Dr. Aijaz’ compassion and intelligence helped her get through the treatments.

While going through chemotherapy was a tough time in her life, she said the Hudson Valley Hospital Center team did everything they could to make it easier for her.  In June, after finishing her chemotherapy treatment Kim came back to Hudson Valley to have a bi-lateral mastectomy. She was in the hospital for 3 days and everything was done to make her feel as comfortable as possible. The night of her surgery the nurses were wonderful, checking constantly to make sure she had everything she needed. And even though she was not a candidate for the one-step mastectomy, the doctors were able to perform skin and nipple sparing . Nancy, Dr Koch’s Surgical Physician Assistant, has been there for all Kim’s post op questions and concerns.

Kim’s breast cancer journey is not over, but all indicators point to a full recovery and a healthy future for her. She said going to a comprehensive cancer center like the Cheryl R. Lindenbaum Cancer Center made her journey a lot easier, because every doctor and course of treatment Kim needed was available at the Center. And it’s all right here for her in her own backyard.

Gilda’s Club OPEN HOUSE Feb. 7 at HVHC Cancer Center

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Gilda’s Club Westchester, a leader in support for cancer patients and their families, invites men and women who have been newly diagnosed with cancer to a new support group called “Living with Cancer.” An Open House is scheduled for Thursday, Feb. 7 at 6 p.m. at the Cheryl R. Lindenbaum Cancer Center at 1978 Crompond Road, Cortlandt Manor.  The group will meet every first and third Thursday of the month from 6-7:30 p.m. at HVHC’s Cancer Center. For more information,  programs, call  Miranda Dold at 914-644-8844.

More Choices for Breast Cancer Treatment at HVHC Thanks to IORT Grant

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Women treated for breast cancer at Hudson Valley Hospital Center will have more choices thanks to a $150,000 grant the Hospital is to receive from New York State with the help of Senator Greg Ball. The money will help to pay for equipment that will allow the Ashikari Breast Center at Hudson Valley Hospital Center to perform intra-operative radiation on women undergoing breast cancer surgery. The procedure will be available to patients starting the second week in November.

“The Ashikari Breast Center at Hudson Valley Hospital Center offers women the best cancer care close to home,’’ said breast cancer surgeon Dr. Andrew Ashikari today at a press conference at the Hospital. “Now women who could benefit from intra-operative radiation don’t have to travel elsewhere to get it. This is a great addition to the Hospital and a victory for women with breast cancer.’’ “Not everyone is a candidate for IORT, but in many women undergoing a lumpectomy it provides a less stressful option to traditional whole breast radiation treatments,” said Dr. Pond Kelemen .

Sen. Greg Ball said he was happy to advocate for his community in Albany.“The stresses associated with battling breast cancer are overwhelming and providing world class services locally, without the additional stress of travel and hardship of leaving the familiarity of their community is exactly why I couldn’t be happier to deliver this $150,000 grant to the Hudson Valley Hospital Center. I am proud to assist in making the Cheryl R. Lindenbaum Cancer Center the destination of choice for cancer patients in the Hudson Valley,” said Senator Greg Ball. “It is a great honor to be able to deliver this money for the hard working doctors, nurses, staff and the entire Hudson Valley Hospital Center community, especially as we embrace the struggles of our

Intra-operative radiation (IORT) allows selected breast cancer patients undergoing breast preservation surgery to receive one dose of radiation while asleep during surgery, compared with 6-1/2 weeks of radiation after surgery. In higher risk patients, it is used to boost the surgical cavity with radiation to reduce the post-op radiation to only 5 weeks. Women who undergo IORT only and develop a recurrence can then undergo a repeat lumpectomy and whole breast radiation, while those who get standard radiation and develop a recurrence are recommended to have a mastectomy. The Ashikari Breast Center has participated in the largest international trial of IORT and will be active in the American trial, which will begin soon.

Welcome to Our New Website

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All of us at The Ashikari Breast Center would like to welcome you to our new and improved website. We have not only changed the look and feel of the site, but have added new exciting features for our patients. We have updated the breast health information pages and link you to the best healthcare sites for further resources. We provide you with local caregivers who supplement our services in traditional and non-traditional techniques. In addition to this regularly updated blog, Dr. Kelemen has a twitter feed that you can join or review at the website. Keep checking this blog site at this website or on our Facebook page for discussions of new topics and controversies in women’s health issues. We hope these changes improve our services and welcome our viewers to contact us with comments or ideas for improvement.


We now have two Ashikari Breast Centers, located in lower and upper Westchester county. Our original center is still located within The Dobbs Ferry Pavilion of St John’s Riverside Hospital at Dobbs Ferry. Our new center is in Cortlandt Manor at The Cancer Center of The Hudson Valley Hospital Center. All of our physicians are working at both sites, Monday through Friday. Both breast centers have up-to-date digital mammography, modern ultrasound, and breast MRI services as well as intra-operative radiation capability. Our outstanding plastic surgeons and medical oncologists have offices in the Hudson Valley Hospital’s Cancer Center with us. Our Dobbs Ferry office is nationally accredited by NAPBC and our northern office will be accredited within the year.