Make Health Your Habit

By Dr. Nevin Wadehra, hematologist/oncologist with Wellstar and Northwest Georgia Oncology Centers

The world of breast cancer can be confusing, especially because of all the abbreviations and acronyms. Knowing these terms can help us better understand breast cancer.

What does BRCA or HER2 mean when it comes to breast cancer?

To doctors, they’re important pieces of information that can guide their treatment strategies. To patients, they can mean the difference between one treatment plan and another—or even between risk and prevention.

Understanding BRCA

The Definition: BRCA is short for “Breast Cancer Gene.” It includes two separate genes: BRCA1 and BRCA2. These genes have been found to impact a person’s chance of developing certain cancers.

The Explanation: In the past few decades, breast cancer research has advanced from general diagnosis to highly personalized treatment. For example, BRCA1 and BRCA2 are associated with increased risk for several cancers including breast and ovarian cancer in women and prostate cancer in men. This is traditionally referred to as hereditary breast and ovarian cancer (HBOC) syndrome. However, there are other increased risks with BRCA, including prostate and pancreatic cancer.

Patients without cancer but who have a family history of these cancers should discuss BRCA testing with their physician and consider evaluation by a genetic counselor. For patients with cancer who are known to have the BRCA gene, this could affect their treatment choices with more targeted therapy.

Understanding HER2

The Definition: HER2 stands for Human Epidermal Growth Factor Receptor 2. It is a protein found on the surface of breast cancer cells and plays a role in how the cells grow and divide.

The Explanation: Approximately 20% of female patients with breast cancer have tumors with high levels of HER2. Because HER2 is involved in the growth of cancer cells, this type of breast cancer can be aggressive. It's important that anyone diagnosed with breast cancer has their tumor tested for the presence of HER2.

In the past, HER2-positive tumors were associated with an increased risk of both recurrence and death from breast cancer. However, with the use of chemotherapy and targeted treatment against HER2, the prognosis of HER2-positive breast cancer has improved substantially.

Treatment options may include surgery, HER2-directed therapy with chemotherapy, endocrine therapy and radiation therapy. The best combination of treatments and the order in which to receive them can vary depending on the situation. Most patients with HER2-positive breast cancer will receive one or more chemotherapy drugs plus trastuzumab, a HER2 antibody. Many studies have shown that these treatments dramatically improve survival for patients with HER2-positive breast cancer. Trastuzumab and chemotherapy are even recommended for patients with very small, HER2-positive breast cancers. Tumors as small as 0.5 centimeters often warrant such treatment.

Decisions must be individualized based on your unique risk. Talk to your doctor about whether you are a candidate for trastuzumab, especially if you have a small HER2-positive tumor.

How do you determine what treatment is best?

There are many options for the treatment of breast cancer, and deciding which is best can be confusing. Expert guidelines help clarify what treatments are most appropriate for large groups of patients.

However, individual factors—including your personal values and preferences, as well as your cancer stage and characteristics—are also important to consider. Talk to your care team about your treatment options and what is best suited to your individual needs.

Learn more about breast cancer care at wellstar.org/breastcancer.

What started as a research study has grown into a systemwide commitment at Wellstar to improve access to mental and emotional healthcare. By embedding licensed mental health practitioners in the primary care settings, Wellstar is making it easier for patients to receive behavioral health services alongside their routine medical care. 

Today, licensed clinical social workers (LCSW) work alongside primary care providers and pediatricians in more than a dozen Wellstar practices. And there are plans to grow that number.

“With social workers just steps away from an exam room, primary care physicians can make ‘warm handoffs’ for immediate behavioral health support,” said Dr. Jeffrey Tharp, chief medicine division officer for Wellstar.

“It helps lower barriers to mental health and substance use disorder treatment. And it removes some of the stigma some people associate with mental healthcare.”

Dr. Sophie Arkin, a psychologist in Wellstar’s Suicide Prevention department, said, “This is a great way to reach people who might otherwise fall through the cracks. It gives them a real opportunity to live a different life.”

Primary care clinicians connect adults to behavioral health specialists

Nearly 10 years ago, Wellstar was one of several health systems nationally that participated in a study of the effects of placing behavioral health clinicians in primary care.

The need is significant. Mental illness and substance use disorders are prevalent throughout the U.S. According to the 2024 State of Mental Health in America report, 22.5% of adults in Georgia had a mental illness in the past year. The report also said that 17% had a substance use disorder.

Primary care physicians at Wellstar routinely screen patients for depression, suicidal thoughts and alcohol or drug use. In other cases, they learn from conversations that patients may have:

• Anxiety or panic disorders
• Sleep disturbances
• Stress related to work, family life or finances
• Grief or unresolved trauma

Introducing the behavioral health clinician

When behavioral concerns emerge, the primary care team introduces the on-site clinical social worker. This specialist conducts an in-depth assessment to determine the next best steps for the patient. This is typically a short-term series of sessions that may lead to referrals to psychiatrists, psychologists or Wellstar’s suicide prevention team.

“One of the biggest strengths of this model is credibility,” Dr. Tharp said. “If a physician or nurse practitioner you trust says, ‘We have a counselor here I’d like you to meet,’ the patient is more likely to follow through.”

This model has proven especially effective for patients who are less likely to seek mental health support, such as men, seniors and caregivers.

Where primary and behavioral health cross paths

People with chronic conditions like diabetes, digestive disorders and kidney disease sometimes have or develop mental health conditions like depression and anxiety. As a result, patients may find it harder to:

• Get the follow-up testing and care they need
• Follow nutrition and exercise instructions
• Take medications according to their doctor’s instructions

Not treating behavioral health issues can contribute to patients’ worsening physical health and higher medical costs.

Conversely, many patients may go to their primary care physician because they’re having trouble breathing, their heart is pounding or they have frequent headaches. Or they’re sweating or feel faint, dizzy or nauseated.

Those can be signs of a medical problem. They can also be symptoms of an emotional or mental health issue. In that case, a behavioral health clinician is around the office corner.

“We know that stress and anxiety show up in lots of different ways in the body. Understanding that allows people to adopt a new philosophy about how to take care of themselves,” Dr. Arkin said.

Pediatricians screen and refer children for behavioral health

Childhood and adolescence are critical periods in development. Mental health issues can affect a child’s ability to learn, grow and develop healthy relationships both now and as an adult.

Pediatricians routinely screen children for behavioral health concerns. They ask questions about social, emotional and behavioral development. Screenings for autism risk begin in early childhood and depression screenings begin at age 12.

At Wellstar KenMar Pediatrics in Marietta and Kennesaw, pediatricians turn to their in-house behavioral health partner, Dr. Kayla Fitch. Common reasons to refer include:

• Behavior challenges
• Feeding disorders, such as extreme picky eating
• Mental health issues among children with chronic or acute illnesses
• Requests for attention deficit hyperactivity disorder (ADHD) evaluations
• Severe social or separation anxiety

While under her care, Dr. Fitch screens patients for anxiety and suicide risk.

“One of the things I’m the most passionate about is early anxiety treatment for kids. We can help kids when they’re 4, 5, 6 years old,” Dr. Fitch said. “I teach parents basic concepts around how to expose their children to anxiety-producing situations to decrease their anxiety.”

She helps children learn “coping strategies, like deep breathing and muscle relaxation. These are things kids can benefit from if we teach them creatively.”

Growing commitment to integrated care

Wellstar’s primary care model continues to evolve to meet the behavioral health needs of patients throughout their life. Time will bring even more collaboration and improved outcomes.

“It serves everyone—patients, families and doctors—to create these seamless connections between primary and behavioral health practitioners,” Dr. Tharp said. “We see the benefits every single day in our patients’ health and their outlooks.”

Learn more about behavioral health at Wellstar.