Evelyn Hidalgo Benefits from Multidisciplinary, Integrated Breast Cancer Treatment

One night in February 2022, Evelyn Hidalgo was awakened by a sharp pain in her left breast. “I did a breast self-exam and felt a little bump near the nipple,” she says. “I promised myself I would call my gynecologist in the morning.” 

Hidalgo’s gynecologist was out of town, and another doctor in the same practice examined the lump and referred her to a breast clinic for a mammogram and ultrasound. She was called back to the clinic for a biopsy when the studies showed three small masses, one of which proved to be malignant. 

“My doctor then referred me to Dr. Peguero at Memorial Hermann Greater Heights Hospital,” Hidalgo says. 

Julio Peguero, MD, is a hematologist/oncologist affiliated with  Memorial Hermann Cancer Center – Greater Heights. Hidalgo’s treatment team also included Mike Ratliff, MD, an affiliated surgeon who specializes in general and breast disease surgery, and affiliated radiation oncologist Aparna Surapaneni, MD. The three physicians have worked together for many years.               

“Ms. Hidalgo, like each of our breast cancer patients, was evaluated separately by a medical oncologist, surgeon and radiation oncologist who discuss their findings first with the patient and later with each other at our breast cancer conference,” says Dr. Ratliff, who chairs the Breast Cancer Leadership Team and Breast Cancer Planning Committee that oversee the breast cancer program at Memorial Hermann Greater Heights. “After our individual visits with her, I presented her case at a round-table discussion with Dr. Peguero, Dr. Surapaneni and other specialists, including pathologists, breast radiologists, plastic surgeons and other clinicians dedicated to the care of the breast cancer patient. We take several test results into account when trying to understand an individual’s unique cancer.”

Using National Comprehensive Cancer Network® guidelines and the results of Hidalgo’s pathology and tumor marker testing, the team recommended chemotherapy first, followed by surgery and radiation therapy. “With larger tumors, chemotherapy is advised to shrink it before surgery to allow for a breast-conserving procedure. With small cancers such as hers, which was 10 millimeters, treatment typically begins with surgery,” Dr. Ratliff says. “But her Ki-67 – a protein found in the nucleus of cancer cells – was elevated, which tends to suggest a more aggressive cancer. In her particular case, the marker was very helpful in guiding us in our order-of-treatment decisions.”         

They also used a genetic tumor test that produces a 41-gene tumor recurrence score to show whether the cancer will respond more to endocrine therapy or chemotherapy or both. “Her genetic tumor test score was notably elevated, with a recurrence rate likelihood estimated at 19%  or one in five,” he says. “It’s a very objective test that has been studied with thousands of patients to show its accuracy and to guide physicians in treatment decisions. It has saved many women from undergoing chemotherapy and helped others who have benefited greatly from the treatment.”           

Hidalgo, who works in programming for Univision Radio, started six months of once-weekly chemotherapy in May 2022 at the age of 41. She continued working throughout treatment. “Three-and-a-half weeks after completing chemotherapy in October 2022, I had a lumpectomy and removal of my nipple and a biopsy of two sentinel lymph nodes. The lymph nodes were negative, and pathology showed no residual cancer in my breast.”

In January 2023, Hidalgo started 16 sessions of radiation therapy with Dr. Surapaneni.

“She was a wonderful patient, with an excellent attitude,” Dr. Surapaneni says. “It was a lot for someone her age to go through. She tolerated chemotherapy and radiation therapy well and continued working through her entire treatment. This is a testament to her willpower and fortitude and ability to push through the difficult times in her life.”

“Ms. Hidalgo had a complete pathologic response to her treatment, which is a good sign for her,” Dr. Ratliff says. “In addition, she has the added benefit of being a candidate for endocrine therapy because her cancer was estrogen- and progesterone-receptor positive. Studies have shown that five years of endocrine therapy lowers a woman’s likelihood of having a recurrence of her breast cancer or developing a new endocrine-sensitive breast cancer altogether in either breast in her lifetime. There are no guarantees, but when a patient is a candidate for endocrine therapy and takes it, the long-term risk of developing another breast cancer is significantly reduced. Her overall prognosis is very good. We’re very glad to see that.”

The breast cancer treatment program at Memorial Hermann Cancer Center – Greater Heights is accredited by the American College of Surgeons National Accreditation Program for Breast Cancer (NAPBC), which ensures that patients receive the highest standard of care. The NAPBC provides the structure and resources to operate a high-quality breast center. Accredited programs follow a model that facilitates multidisciplinary, integrated, comprehensive breast cancer services. The center was reaccredited for the fourth time in early 2023.