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Family Matters: Couple offers a unique breast cancer care center for women

By: Sara Lavenduski - 10.04.10

Robert Kuske, MD, and Coral Quiet, MD, a husband-and-wife radiation oncology team, long dreamed of establishing a facility exclusively for women with breast cancer. Dreams do come true, along with a lot of hard work. Now, Arizona Breast Cancer Specialists (ABCs) has three locations in the state in Scottsdale, North Phoenix, and Gilbert.

Drs. Robert Kuske & Coral Quiet
Drs. Robert Kuske and Coral Quiet

In the year since its inception in 2009, ABCs has proved to be a unique facility. The doctors had a strong client base when they started, as well as the respect of physicians and patients. It has quickly become the go-to place in Arizona for women who have had recent positive breast biopsies. Drs. Quiet and Kuske were also named No. 1 Top Docs for radiation oncology by Phoenix Magazine.

In 1984, Dr. Kuske established himself in the field of radiation oncology in breast cancer. After positions at the Washington University School of Medicine in St. Louis and the department of radiation oncology at the Ochsner Clinic in New Orleans, he co-founded New Orleans Tulane Cancer Centers radiation oncology program.

Dr. Kuske has also held a professorship in the field of human oncology at the University of Wisconsin and was the original developer of partial breast irradiation in 1991. He is the principal investigator of the RTOG Phase II clinical trial for APBI and co-principal investigator of the NSABP/RTOG Phase III trial, which compares 5 days of partial breast irradiation to 6 weeks of whole breast irradiation.

As a surgery intern at the University of Chicago, Dr. Quiet planned to specialize in mastectomies and immediate reconstructions. However, after 2 years in surgery, she began studying radiation oncology. She realized she preferred performing breast conservation treatments on conscious patients, instead of mastectomies on anesthetized patients.

She relocated to Arizona in 1993, where she couldn't locate one center catering specifically to breast cancer. To make matters worse, 80 percent of patients were receiving mastectomies instead of breast conservation treatments with lumpectomies and radiation. Dr. Quiet, fearing that women were not obtaining adequate information before making treatment decisions, cofounded the Arizona Institute for Breast Health (www.aibh.org), a nonprofit organization that offers a pro bono second opinion service to recently diagnosed women.

Since 2000, Drs. Quiet and Kuske have developed and studied a new single-entry brachytherapy device, SAVI, that treats women with early stage breast cancer, while preventing high doses to the skin and ribs. "Dr. Quiet and I saw the opportunity to build a breast cancer-focused radiation oncology sub-specialty group that would be unique within the United States," Dr. Kuske says. "Women with breast cancer are seeking sub-specialists in surgery, radiation oncology, and even medical oncology. A physician who focuses his or her entire career on solving problems related to breast cancer treatment can provide a higher level of expertise, knowledge, and care than many general oncologists."

Dr. Kuske explains the distinctiveness of the facility. "In building this practice from the ground up we were able to purchase equipment that is specific to breast cancer and create a feminine atmosphere and ambience that would provide peace and calmness," he says. "We have also been able to attract an excellent staff, including front office, therapists, nurses, dosimetrists, physicists, and physicians."

Drs. Quiet and Kuske agree that the short-term goal is "to provide innovative, superb, patient-focused care for breast cancer patients receiving radiotherapy." As for the long-term, they are determined to make a solid scientific contribution to the field of medicine and maintain a reputation as a center of excellence for women who need breast cancer radiotherapy.

Both physicians stress the importance of early detection, which provides a greater chance of breast conservation therapy as a treatment option. "We place high priority on minimizing normal tissue exposure to radiation. We carefully restrict heart dose in left breast cancers, and pulmonary dose in all breast cancers, using brachytherapy, IMRT, heart shields, breath-hold techniques, respiratory-gating, and prone positioning," says Dr. Kuske.

Drs. Quiet and Kuske are asked by new brachytherapy companies to test new devices, and continue to conduct clinical trials to contribute to randomized breast cancer trials. They educate patients, medical students, residents, physicists, and other physicians about the various techniques they use.

"We foresee a future where breast cancer treatment is not 'cookbook,'" they say, "but customized to each individual woman."

Sara Lavenduski is a former editorial intern at rt image. Direct comments and questions to editorial@rt-image.com.