The evolution of breast cancer care: a sit-down with Dr. William Warlick

All of Novant Health Cancer Care is indebted to Dr. Girard for her tireless efforts to improve and extend the lives of women facing breast cancer. We wish her the best in her retirement!

In honor of breast cancer awareness month, we took a moment to talk with radiation oncologist William Warlick, MD, about the evolution of breast cancer care, as well as his impressions of his newly retired colleague and dedicated breast cancer physician, Donna Girard, MD.

What is the most pivotal development in breast cancer care that you’ve witnessed in your career?
Over the last 15 years, there have been many advances in breast cancer care. I do not think there has been any single, one paradigm shift as we saw in the late ’80s with the adoption of breast-conserving therapies. I believe one of the biggest advances has been the recognition of specific subtypes of breast cancer and the development of targeted agents, such as Heceptin for her-2-neu amplified tumors. This has dramatically improved the outcomes for this group of women that generally did not do as well. Also, I think the adoption of more limited axillary assessment, such as sentinel lymph node biopsies, has saved a significant number of women from the side effects of more aggressive surgery. This is another example of a continuing trend for tailoring treatment based upon the patient’s particular type and stage of disease.

How have women’s opinions and attitudes toward breast cancer changed since you’ve been practicing medicine?
Women have become more involved and proactive in their care. It is a team approach with different disciplines (surgery, chemotherapy and radiation) all helping devise a treatment plan for a particular patient, and I think the patient has also become an integral player in that regard. This specialization allows women to have more information and participate in their care and treatment decisions. I feel the strong advocacy groups and long-term survivors have also helped raise awareness for breast cancer treatments and strengthened women in knowing that they can beat breast cancer.

Explain the difference between the breast cancer diagnosis and treatment process between when you first began your career to now.
We are faster in making a diagnosis and have shortened the overall time from diagnosis to treatment. Now, if there’s an abnormal mammogram, we try to perform a biopsy that day or the day following. We get the information that we need to make treatment decisions much faster. Also, we have clinics with different specialists that meet to review cases together; there’s better collaboration between different disciplines.

What excites you about the future of breast cancer care?
There has been a continued push to understand the biology of different types of breast cancer, which is translating into better overall outcomes. There is recognition that certain cancers don’t have to be treated as aggressively as others. We can do less, yet still have excellent outcomes. An important focus is on quality of life, ensuring patients become long-term survivors with fewer longterm side effects.

What is the most rewarding thing about your job?
Seeing a patient who previously may not have survived breast cancer, and knowing that with modern treatments, we can substantially improve her ability to beat breast cancer so she can continue to have a full and productive life.

What will you miss most about working with Dr. Girard?
I will miss her clinical expertise and her overall compassion for her patients. I know her patients will certainly miss her, as she developed a strong bond with a number of them and has continued to follow some patients 20 years after their care.

How has Dr. Girard contributed to the remarkable patient care received at Novant Health?
Dr. Girard has been instrumental to our program at Novant Health Cancer Care, especially in the founding of multidisciplinary clinics. She has been a strong advocate for women and the multidisciplinary approach. Her passion for taking care of women with this disease has spread to all physicians caring for these patients.