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Breast Matters - Meet David Euhus - New Chief of Breast Surgery

Breast Matters - Fall 2014
Issue No. 5

Meet David Euhus - New Chief of Breast Surgery

Date: December 15, 2014


David Euhus

David Euhus isn’t one to slow down. After building up a solid reputation at the University of Texas Southwestern Medical Center in Dallas over 17 years and raising his children who are now grown and on their own, he easily could have coasted through the rest of his career before slipping into retirement. But that’s not his style.

“I had done everything there I wanted to do. I was ready for an adventure. We [Euhus and his wife] could go anywhere and do anything we wanted,” says Euhus, who also has lived in England, Hawaii, and California. Euhus and his wife decided to move to Baltimore in 2013 after he was offered the position of chief of breast surgery in the Division of Surgical Oncology at Johns Hopkins.

An enduring fascination with this complex organ

Euhus may have outgrown his last position, but he hasn’t lost his fascination with the breast, which he describes as the second most interesting organ in the body, after the brain.

“The breasts are the only organs that doesn’t exist when you’re born; it’s a collection of stem cells, says Euhus. “They sit there for 10, 11, 12 years, get exposed to whatever you are exposed to, before a massive cell division period occurs, where they make millions of copies of themselves. They’re still susceptible to environmental factors until a full-term pregnancy, where they get to the point of making milk. When the milk dries up, there’s a massive remodeling all over again—stem cells go down, cells get less susceptible to the effects of carcinogens, then they remodel again during menopause. All these changes play into benign and malignant breast disease.”

In addition to the ever-evolving nature of the breast itself, explains Euhus, its health is affected by external factors: weight gain, weight loss, insulin levels, fluctuating hormone levels. “It’s a responsive organ. Outside factors impinge and influence it,” he says.

Accordingly, Euhus’ research has examined the factors influencing the risk of developing breast cancer. He’s a leader in using fine-needle aspiration to evaluate DNA for acquired changes that lead to a higher risk of breast cancer. He also has a strong interest in the link among high blood glucose and higher body mass indexes and breast cancer. His research in breast cancer genetics and defining biomarkers for breast cancer has helped lay the groundwork for identifying which patients should undergo genetic testing to determine their risk of breast cancer and what preventive measures should be taken upon determining a genetic link.

“My main research interests throughout my whole career have been about trying to understand who gets breast cancer or not—who’s at high risk,” Euhus says.

Providing ready access to all patients 

A recent explosion in access to genetics information is making it easier to determine who is at high risk for breast cancer, and Euhus wants to ensure that everyone within the Johns Hopkins system has access to this information and genetic services and counselors that help patients interpret results. “We can test 16 to 40 genes at one time. Although not generally recommended at this time, the whole genome can be tested at one time for a reasonable cost,” Euhus says. “But, in my travels, I find that even basic genetic services aren’t available everywhere.”

Euhus aims to reduce this uneven access, particularly within Johns Hopkins. “My overarching goal is to have a seamless breast surgery program across this region, where a patient can go to any one of our facilities and experience the highest quality of care available,” he says. “Part of being the chief of breast surgery is making sure that best practices are adopted across the whole enterprise.”

This includes not just identifying patients most at risk, but treating all breast cancer patients with the most revolutionary treatments available. For women who require a mastectomy, this involves nipple-sparing mastectomies whenever feasible. “Over the years, I’ve come to realize that you can get the whole breast out, and leave the skin and the nipple in most situations. If the nipple is not involved with the cancer, consider sparing it,” Euhus says.

Euhus’ years of experience support his surgical expertise. As with all aspects of breast cancer care, he wants to ensure that as many patients as possible can benefit from the advances he and his colleagues practice daily. Consequently, Euhus is directly involved in tracking how much time it takes from when new patients first call Johns Hopkins to when they’re seen. When he first came to Johns Hopkins, the wait time was approximately three weeks. “Now, we can get almost any new patient with breast cancer in within 24 to 48 hours,” he says.

Euhus’ involvement in dramatically reducing the time between when new patients first call and when they are seen is just one example of how the Johns Hopkins breast cancer community will benefit from his proactive management style.

 

[Side bar/box:]

 Career Highlights

  • Director of Breast Surgery, Division of Surgical Oncology, Johns Hopkins School of Medicine
  • Medical Director of the Johns Hopkins Avon Breast Center
  • Former Director of the Mary L. Brown Breast Cancer Genetics and Risk Assessment Clinic in the University of Texas Southwestern Medical Center’s Center for Breast Care
  • Recipient of the Marilyn R. Corrigan Distinguished Chair in Breast Cancer Surgery
  • Author of the CancerGene software program, used for genetic risk assessment in more than 4,000 cancer centers worldwide.
  • His research has recently been published in the Annals of Surgical Oncology, the Journal of the American College of Medical Genetics, the Journal of Genetic Counseling, and the Journal of the American Medical Association on topics including:
  •                   - genetic testing and axillary lymph node dissection,
  •                   -gene sequencing,
  •                   -improving the genetic counseling process with electronic tools
  •                   - axillary interventions of the breast.