A transformation of breast care services at Columbus Regional Health over the past two years has resulted in new and improved care options for women in the Columbus area.
Improvements coincide with the Sept. 3, 2020, arrival of Dr. Carlos A. Vieira, a fellowship-trained breast surgeon, to lead the Columbus-based hospital system’s breast care multidisciplinary team.
The CRH breast care program includes screening mammograms, breast surgery, radiation and medical oncology services and cosmetic/reconstructive surgery services with a focus on breast conservation. The services are all available on the Columbus Regional Hospital campus.
Incidence statistics demonstrate the importance of breast services, as one in every eight women born in the United States (about 12 percent) will develop breast cancer at some point in their lives, Vieira said.
When he joined Columbus Regional Health, Vieira became the first breast cancer specialist to perform surgeries on local patients. Until then, breast cancer surgeries were performed by CHR general surgeons.
Before Vieira’s arrival, an estimated 70% of Columbus area breast cancer patients sought out breast surgery specialists affiliated with large Indianapolis health care systems, roughly an hour away, he said.
That trend has reversed in the past two years, with 70% of Columbus area women now receiving their breast care treatment within a 15- to 20-minute drive of their homes or businesses at Columbus Regional Health, Vieira said.
“It took a lot of work,” Vieira, 50, said of reversing the patient-care trend, citing tremendous support within the Columbus community.
“We’re a cutting-edge program that can offer anything being offered at any other big hospital system in Indianapolis,” Vieira said.
Innovations that have been introduced by Vieira at Columbus Regional Health include:
- Use of a numbing solution when removing the breast, which reduces post-operative pain.
- Use of a special, long scalpel blade that can remove hard-to-reach tumors and allows for a better cosmetic outcome with less-visible scarring.
- Performing mastectomies without putting a patient under general anesthesia. Instead, nerves that go to a woman’s chest area are blocked. Afterward, the patient is sedated — like someone undergoing a colonoscopy — without pain and patient awareness.
This alternative mastectomy approach is a benefit to patients who are extremely sick and is a safer procedure for healthier patients, Vieira said. This approach can also be used for minor breast surgeries on patients who easily develop nausea or have difficulty waking up after surgery, he said.
While three-dimensional digital mammography has been available locally for several years, an even newer screening technology was brought in after Vieira arrived — breast magnetic resonance imaging (MRI) equipment.
The MRI diagnostic test has a much higher sensitivity, able to better detect lesions on the breast that might be missed during a routine mammogram, Vieira said.
It is used for high-risk patients — those with a 20% or higher risk to develop breast cancer, and in select cases for patients classified as having dense breasts, which make it more difficult to spot small legions.
Special training
Vieira holds a distinction that none of his peers in southeastern Indiana have as the only fellowship-trained breast surgeon in the region.
After practicing general surgery and breast surgery in Shelbyville for 15 years, Vieira completed his one-year fellowship training at the McGaw Medical Center of Northwestern University in Chicago on July 31, 2020.
He is a fellow of the American College of Surgeons, a scientific and educational association of surgeons founded in 1913 to improve the quality of care for the surgical patient by setting high standards for surgical education and practice. Completion of the program means that the surgeon’s education and training, professional qualifications, surgical competence and ethical conduct have passed a rigorous evaluation.
The doctor feels that his fellowship experience gives him — and his patients — an advantage.
“You have seen thousands of patients with breast cancer,” Vieira said. “You’re dedicated 100% to that course. You are attuned to all of the advances and techniques.”
Treatment options
Five different treatment options are considered for breast cancer patients: Surgery, chemotherapy, hormonal therapy, biological therapy and radiation therapy — all available through Columbus Regional Health.
“Every single breast cancer is different. Some people will require only surgery. Some will require the gamut,” Vieira said.
Surgery is the definitive treatment for breast cancer, done 99.9 percent of the time, he said. The only patients who are excluded from surgery are those who are ruled out as a candidate for medical reasons.
While an important part, surgery is far from the only piece of the treatment puzzle.
Vieira works closely with CRH certified mammography and ultrasound technologists, nurse navigators, board-certified radiologists, and medical and radiation oncologists to provide local comprehensive breast care services.
Most breast cancer cases require a combination of surgery, radiation and hormonal therapy to be successful, Vieira said.
A lumpectomy, in which the surgeon removes cancer and other abnormal tissue and a small amount of healthy tissue around it, makes up 80% of Vieira’s breast cancer cases and requires radiation therapy, which reduces the chance of cancer returning.
A mastectomy, a surgical operation to remove one or both breasts, does not require radiation, he said.
Second-generation doctor
Vieira did not have to look far for inspiration when considering a career in medicine. His father, Brazilian-born Jose Vieira, has served as a medical doctor in his home country for nearly 50 years — and still practices to this day.
The senior Vieira, a kidney specialist, grew his private practice by treating patients as family, and the younger Vieira strives to do the same.
For example, Carlos Vieira in August attended the 60th wedding anniversary of one of his patients. From his youth, Vieira has memories of accompanying his father on weekend social visits to the homes of his Brazilian patients to share a meal.
“That’s from my upbringing, seeing how my dad took care of his patients,” Vieira said.
Born in New Orleans, where his father was training to become a medical doctor, Vieira grew up starting at age 1 in Brazil, where he attended medical school from 1990 to 1997.
“I liked to study – read, learn how to make diagnoses. I began to think, how can I impact people in a very fundamental way that will bring me purpose?” said Vieira, explaining his decision to pursue a career as a surgeon.
Besides the surgical act, Vieira learned how to interact with patients, demonstrating empathy in their care leading up to and after surgery. It helped that he became multilingual, influenced by his mother, Sonia Vieira, a retired teacher who gave private lessons in English, the second most prevalent language in Brazil after Portuguese. He also speaks Spanish, which he uses almost daily while conversing with patients within the diverse Bartholomew County population.
While serving as a general surgeon, Vieira realized that helping breast cancer patients brought him particular satisfaction.
“Being able to cure breast cancer is very rewarding – emotionally to the patient and also to the provider,” he said.
This fall, Vieira got involved in two grassroots programs organized by Columbus North High School students for their senior projects.
“Serving for a Cure” was presented Sept. 15 during a Columbus North-Jennings County High School volleyball game. Volleyball player Logan Branstetter’s project was two-fold — to raise money for a breast cancer patient while also finding out how many local women are regularly getting mammograms.
A project by Rylie Boezeman will provide free breast exams from 8 a.m. until noon Oct. 29 at the CRH Breast Surgery department in the medical building at 2326 18th St., Suite 230 in Columbus, sponsored by Columbus Regional Health.
“I am excited to be here,” Vieira said. “The community has been very supportive. With a lot of joy and hard work, we have been able to make the breast services at Columbus Regional Hospital better every day.”
