Knowing the symptoms of inflammatory breast cancer—a rare and aggressive form of the disease—can lead to life-saving early detection.

Ohio State's Margaret Gatti-Mays, MD, MPH, shares the signs of inflammatory breast cancer, along with information about care, research and more.

Learn more about breast cancer, including risks, symptoms and treatment: https://cancer.osu.edu/breastcancer

Watch The James Cancer-Free World Podcast on YouTube: go.osu.edu/CancerFreeWorldPodcastWatch

“We are constantly evolving,” said Roman Skoracki, MD, medical director of the Stefanie Spielman Comprehensive Breast Center. "There are so many exciting things go on." In this episode, Skoracki fills us in on some of these advances, including enhanced breast cancer screening technology; a program to reach out to women in underserved urban and rural areas to provide screening mammograms; a High-Risk Breast Cancer Program; innovative clinical trials, a new, Inflammatory Breast Cancer Program; and a comprehensive Survivorship Program to help improve the quality of life of Spielman patients. “We identified the hurdles some women have to overcome in order to be screened,” Skoracki said. “They can be socio-economic, language barriers, transportation issues … we want to reach out to these communities.” Under Skoracki’s leadership, the Spielman will continue to evolve. “We have an emotional attachment with our patients and we want to continue to push the envelope and give our patients the very best,” he said.

Richard Wu, MD, PhD, is a medical oncologist who specializes in skin cancer and melanomas and the early development of new drugs. One of the new cancer

treatments Wu is helping to develop is TIL – which stands for tumor infiltrating therapy. T cells in the immune system are programmed to locate and destroy cancer cells. “We take and isolate T cells from each patient’s unique tumor and expand them to billions of T cells in the lab and then reinfuse them back into the patient,” Wu explained. Prior to reinfusing the T cell, patients “have received chemotherapy to deplete their immune system to make space for these new T cells. This is a very personalized form of immunotherapy.” The TIL procedure is currently being performed in clinical trials at the James and other leading cancer hospitals. Wu said that the Food and Drug Administration will soon approve a new drug that will make the procedure more effective. The process in the lab “will make the cells stronger and smarter and better able to differentiate between cancer cells and healthy cells … the amount of cells we put back into the patient is critical, we need billions,” Wu said. Currently, TIL is being used to treat patients with a very limited number of cancers, including metastatic melanomas. However, Wu is optimistic that the procedure will eventually be used to treat several other types of cancer. Initial clinical trials are testing the TIL approach for patients with head and neck cancer and triple-negative breast cancer. The early studies have indicated there’s a potential efficacy, there are some really exciting signs,” Wu said.

The next chapter in the career of Peter Shields, MD, has begun. “Now I get to do what I started out doing … seeing patients and doing research,” he said. Shields recently stepped down as deputy director of The Ohio State University Comprehensive Cancer Center, a position he has held for more than a decade. Under his leadership, the Center continued to grow at a rapid rate and has become established as one of the leading cancer-research institutions in the world. But Shields, a lung-cancer specialist, is definitely not retiring. He will continue to see patients and do research. And, he is also in the midst of becoming licensed as a paramedic. “I had this passion as an undergraduate and in medical school for being an (emergency medical technician) and riding in ambulances, going to places where people really need help.” As deputy director of the Comprehensive Cancer Center, Shields recruited new physicians and scientists, helped pull together teams that collaborated to do research and apply for grants, and he helped created the Pelotonia Institute for Immuno-Oncology and the Center for Tobacco Research. “My job was to be a catalyst,” he explained. “It’s not me doing the research, but it’s understanding that this is the direction we need to go and fostering collaborations and providing our great people with the tools they need.”

CAR T cell therapy is revolutionizing the treatment of many leukemia and lymphoma patients. “For our relapsed leukemia and lymphoma patients we found some really impressive responses with these clinical trials,” said Samantha Jaglowski, MD, associate director for clinical operations and quality of the Blood and Marrow Transplant and Cellular Therapy Program. In this episode, Part 1 or a two-part series on the James Cellular Therapy Program, Jaglowski explains the basics of CAR T cell therapy. The white blood cells are removed from a patient and “re-engineered to become super charged fighters,” she said. “They are trained to recognize and respond [to cancer cells] and if these cancer cells pop up again these cells are already primed to recognize and fight it.” Now that CAR T cell therapy has been approved by the Food and Drug Administration to treat certain types of leukemia and lymphoma, Jaglowski and her James colleagues are exploring new ways to utilize this treatment option for other types of cancer. “We involved in studies to use cellular therapies for melanomas, cervical cancer, lung cancer … and we expect FDA approval; for treating melanoma [with CAR T cell therapy] in 2024.” She also discusses how the James is now re-engineering cells “in house,” which speeds up the treatment process; and new clinical trials to utilize donor cells in CAR T cell treatment. “The advantage is these cells have never been exposed to cancer and can be off-the-shelf and ready immediately.” The James will also begin treating some patients with CAR T cell on an outpatient basis. While the growth of CAR T cell therapy is a game changer, “we can never be satisfied,” Dr. Jaglowski said.

The team approach has helped Joel Mayerson, MD, build one of the nation’s largest and best sarcoma cancer programs. Treating sarcoma patients “is a team sport,” said the director of the James Sarcoma Program. “And we use tri-modality care – medical oncologists for chemotherapy, radiation oncologists for soft-tissue sarcomas … and surgeons.” Mayerson has been at the James since 2001 and, under his leadership, the sarcoma team has grown significantly. The tri-modality model of patient care is the starting point for the sarcoma program. “We’re very excited about our [growing] orthopedics plastic surgery program,” Mayerson said, adding plastic surgery is vital in patients in which large, cancerous masses are removed. “Plastic surgeons take muscles from other places [in the patient’s body] and fill these spaces and can even return function by reconnecting the nerves,” he said. Mayerson and the James are also pioneers in targeted muscle reinnervation. This microsurgery technique reconnects nerves severed during an amputation so that “now they have something to fire into rather than into empty space,” Mayerson said. “This helps reduce pain and after surgery and also reduces phantom-limb pain.” Another advanced technique for patients requiring an amputation is inserting a metal stem into the “residual limb … so the patient can snap their artificial limb on and off instead of putting it into a socket,” Mayerson said. “Patients say this makes it feel more like their normal leg.” Mayerson has always been passionate about caring for his patients, but, “it became even more personal for me this past January,” he said. His mother was diagnosed with a late-stage soft-tissue sarcoma and passed away a few weeks later. “If it wasn’t already personal enough, now it’s family.”

Pelotonia is an emotional rollercoaster filled with special moments, connections, community and lots of memories. In this new episode, David Cohn, MD, joins Steve as co-host. Dave is the interim chief executive director of the James, has ridden in every Pelotonia, and has a lot of memories. “It’s truly an emotional experience and I’m not hesitant to say I’ve cried at every Pelotonia at some point,” he said. We’ll also hear from five other James physicians who participate in Pelotonia. Tim Pawlik came to Ohio State and the James a few weeks before a Pelotonia ride, and “I was blown away … the number of people riding and the number of people supporting the ride and the number of people along the side of the road.” Eric Singer is brand new at the James, recruited from a cancer hospital in New Jersey. However, the urologist knew about Pelotonia from one of his patients, a New Jersey man who rode ever year in Pelotonia. Joel Mayerson, an orthopedic oncologist, said his favorite memories are riding with patients. “It’s an amazing feeling,” he said. Samantha Jaglowski was treated for a brain tumor and has some related physical issues that prevent her from riding. Instead, over the years, she has been a volunteer and a Challenger, raising money for Pelotonia. Mary Dillhoff has a rather unique way to cover the Pelotonia course: she runs. As much as 72 miles.

“We’re taking a very patient-centered approach, we’re putting the patient at the center of everything we do,” said David Cohn, MD, of The James Outpatient Care that opened July 17. In this episode, Cohn, a gynecologic cancer surgeon and interim chief executive of The James, provides a detailed look at The James Outpatient Care located on west campus in the new Carmenton District. The district also includes the Pelotonia Research Center and Energy Advancement and Innovation Center. The outpatient facility will provide a long list of ambulatory (outpatient) treatments, including: clinical trials, screenings, digital pathology, infusions and cancer surgeries that do not require an overnight stay. “There are three goals: to create innovation, allow space for new programs and all for the expansion of our cancer program,” Cohn said. “The demand for cancer services is beyond what we’ve ever seen before, and we have to expand our footprint to accommodate the growing number of patients who need to be seen.” The facility will focus on cancers that affect bone and soft tissue, blood, kidney, bladder and prostate, which are all cancers in which the treatment options have advanced to the point that outpatient care is now an option. The center will also be the location of the new proton radiation therapy facility created in partnership with Nationwide Children’s Hospital. “This is really exciting, this is the next generation of cancer care,” Cohn said. “I couldn’t be more proud of what will happen on July 17.”

“It’s been a labor of love to get this project off the ground,” says Kristin Bixel, MD, of a new James clinical trial for a minimally invasive surgical technique for cervical cancer that she is leading. Minimally invasive surgery (also called robotic surgery) is being performed on a growing number of different types of cancer. These less invasive surgeries reduce complications and speed up the recovery process for patients. However, the first minimally invasive procedure and clinical trial for cervical cancer resulted in an increased rate of recurrence for patients – and was immediately abandoned. This spurred Bixel to think outside the box and develop a new, different technique in which the cancerous tumor in the cervix wasn’t exposed to the peritoneal cavity. “My mind immediately went to the procedure itself,” Bixel said, adding she could picture the new surgical technique in her mind, as if looking through a scope, and began the long process of creating a clinical trial. The clinical trial began in February 2022 at the James, and several other leading cancer hospitals around the country have joined the trial. “If we can make this procedure safe for our patients that will be huge,” Bixel said. “One hundred percent of our patients want this type of small-incision surgery.”

The James Cancer Hospital is the first medical facility in central Ohio to offer radiofrequency ablation to treat and destroy benign and cancerous thyroid nodules. In this episode, Barbra Miller, MD, describes this high-tech, minimally invasive treatment technique and the advantages for patients. “It can be done in the office and most patients are in and out of the clinic within 30 minutes to an hour after the procedure,” she explained. Here’s how radiofrequency ablation works: The surgeon insets a very small needle into the nodule; radiofrequency waves are used to heat the tip of the needle, and this ablates (destroys) the tissue in the nodule. “We use the moving-shot technique,” Miller said, adding this technique involves moving the end of the needle to different locations with the nodule to destroy it completely. Miller also describes microwave ablation, which is similar but uses microwaves to heat the end of the needle. This technique is in the early stages but could eventually be utilized as much or even more than radiofrequency ablation. “It’s exciting to have this ability to offer our patients, something better and safer and that’s always what we look to accomplish,” Miller said.