About one in eight women will develop breast cancer over the course of her lifetime.
With that statistic in mind, Dr. Holly Pederson set out to make a difference and has worked her entire career to develop unique breast cancer services.
When Pederson was in medical school, her mother had a benign breast biopsy that showed lobular carcinoma in situ (LCIS), a marker for developing cancer. It was this shocking, high-risk classification that sparked Pederson’s passion for breast cancer.
“She never got breast cancer and ultimately passed away from Parkinson’s disease in 2008, but I understood what it was like to have the worry that you might get breast cancer,” Pederson says.
Driven by this experience and empathy toward other high-risk patients who faced a lack of specialized services, Pederson helped to develop the Medical Breast Program at Cleveland Clinic, which deals with non-surgical breast disease. Providers there perform breast diagnostics, manage high-risk patients and provide survivorship care with the Cleveland Clinic Breast Center at multiple locations throughout Cleveland. She also advocated for patients with known genetic mutations or strong family histories, establishing Cleveland Clinic’s Hereditary High-Risk Breast Cancer Clinic in January 2015.
“I was approached by Dr. Joseph Crowe, who ran the breast center here at the Cleveland Clinic in 1997, to develop the Medical Breast Service,” Pederson says. “It was really to improve access for patients who needed evaluation for common complaints, but also to provide personalized risk assessment and a more holistic, comprehensive approach to patients who didn’t necessarily have breast cancer or need of surgical services, adding depth to the Cleveland Clinic Breast Center.”
Traditionally, these services were provided by busy breast surgeons or medical oncologists, often with significant wait times for benign disease or risk assessment. At Cleveland Clinic, the Medical Breast providers work in association with dedicated breast radiologists, with rapid access and same-day diagnostic imaging for symptomatic patients. Patients at risk are provided with personalized risk assessments and computerized modeling, estimating risk and making recommendations about enhanced surveillance and chemopreventive strategies.
Pederson attributes her success to her mentors, including Crowe.
“In 2008, I did a clinical fellowship here at Cleveland Clinic in cancer genetics under the supervision of Dr. Charis Eng. She, together with Dr. Crowe and the new head of surgical oncology, Dr. Stephen Grobmyer, have really been my mentors and supporters in developing this program and supporting my career,” Pederson says. “I’ve been fortunate to have the opportunity to work with people like this.”
Major medical centers such as Mayo Clinic and University of Texas MD Anderson Cancer Center also provide Medical Breast services, but the Hereditary High-Risk Clinic is unique with long-term follow-up providing a platform for translational research.
“About 10-15 percent of breast cancer is truly hereditary, meaning there’s a genetic mutation passed down from generation to generation that markedly increases the risk of getting breast cancer.” - Dr. Holly Pederson
In following large numbers of these patients over time, care can be enriched and streamlined, and research can be conducted, providing clues to the development of cancer in high-risk individuals.
While there are high-risk patients, Pederson says they don’t refer to anyone being low-risk, because 75 percent of the time breast cancer arises, there are no identifiable risk factors.
“At Cleveland Clinic, we still recommend annual screening mammograms starting at the age of 40. And we encourage all women to be healthy – to achieve and maintain their ideal body weight and limit alcohol consumption, two under-recognized risk factors for breast cancer that everybody can be aware of,” Pederson says.
Pederson also offers a non-Accreditation Council for Graduate Medical Education (ACGME) accredited fellowship training program in Medical Breast, the first in the country, aimed at training providers to replicate services at other institutions. She is currently training an Ohio State family practitioner to begin a Medical Breast program at the James Cancer Hospital and Solove Research Institute. Candidates come from specialties such as internal medicine or family practice to subspecialize in the field.
In the Medical Breast practice, Pederson has not only trained other physicians inside and outside the Cleveland Clinic to do this work, but she’s also provided a six-month fellowship to certified nurse practitioners to become Medical Breast specialists.
“It has been really exciting to go through the process of creating a training program for something that didn’t even exist before we started it back in ’97.” - Dr. Holly Pederson
Pederson also shares her knowledge across the country, speaking for Bright Pink, the only national nonprofit organization focused on the prevention and early detection of breast and ovarian cancer in young women, sharing methods to help OBGYN providers learn how to identify high-risk patients.
“We’ve identified about 4 percent of the patients in this country that carry genetic mutations, and the other 96 percent are walking around not knowing it,” Pederson laments. “Every week, we see patients in the breast center that come in with breast cancer at a very early age.”
“A lot of times, if people had taken a careful and complete family history, a genetic mutation may have been identified, preventing the cancer,” Pederson says. “So I speak on behalf of Bright Pink and also Myriad Genetics on raising awareness on hereditary risk. One of the things that I probably care most about is trying to help providers around the country learn more about cancer genetics.”
Corinne Murphy is a contributing writer. Feedback welcome at feedback@cityscenemediagroup.com.
Dr. Holly Pederson
Dr. Holly Pederson is a Staff Physician and Director of Medical Breast Services in the Breast Center. This clinic helps create important access for patients, provide education for primary care physicians to identify at-risk individuals and offers training opportunities for doctors, fellows and residents.
After receiving her B.A. in biochemistry from the University of California-Santa Barbara, where she received the distinction of Phi Beta Kappa, she earned her medical degree from the University of California-San Francisco School of Medicine, where she was recognized in the Alpha Omega Alpha honor society.
She completed her internship and residency at the University of California San Francisco Medical Center in internal medicine and in 2008, completed a clinical fellowship in genomics under Dr. Charis Eng at Cleveland Clinic. She directs the Medical Breast Program and is active in clinical research. Pederson is also an assistant professor at Cleveland Clinic Lerner College of Medicine of Case Western Reserve University.
