Breast cancer patient Ana Galdeano receives a check-up from surgical oncologist Alfredo A. Santillan-Gomez, M.D., M.P.H.
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Ana Galdeano didn’t think she was at risk for breast cancer. She was a 40-year-old mother with no history of the disease among her parents or seven brothers and sisters. But during a self-examination in June of last year, Galdeano found a lump in her breast.

“I told my husband, ‘I found a cancer,’” she said. Her husband told her not to worry.

Galdeano went to the Cancer Therapy & Research Center (CTRC) at the UT Health Science Center San Antonio, where a biopsy revealed that she did have cancer.

She met with surgical oncologist Alfredo A. Santillan-Gomez, M.D., M.P.H., and listened to her options: mastectomy of one or both breasts, breast conservation surgery, chemotherapy and delayed breast reconstruction.

Galdeano didn’t take long to make up her mind. “The doctor told me if we remove both breasts, it will be less risk, and we can rebuild both,” she said.

With a supportive husband and family, that’s what Galdeano chose over the prospect of a lifetime of worry. She also had genetic counseling, where she discovered, to her relief, that she does not have a high genetic risk for breast or ovarian cancer.

Now, she’s healthy and feeling well, she said. Dr. Santillan agreed. “She looks like she never had surgery,” he said.

New surgeons
Dr. Santillan, an assistant professor, has worked in CTRC’s Division of Surgical Oncology for a year. He is one of three new surgeons in the division that was launched about 40 years ago by Anatolio Cruz, M.D., professor of surgery and the first chief of surgical oncology at the Health Science Center.

Dr. Cruz described Dr. Santillan as talented at a wide array of surgeries. Dr. Santillan graduated from Monterrey Tec Medical School in Monterrey, Mexico. He received a master’s degree in public health from Harvard University, received his general surgery training at Texas Tech University and completed a fellowship at Moffitt Cancer and Research Center in Tampa, Fla.

Other recent additions to the division are Ismail Jatoi, M.D., Ph.D., professor and the new chief of surgical oncology, and Boyce Oliver, Jr., M.D., professor of surgical oncology.

“I’ve known Dr. Jatoi for many, many years,” Dr. Cruz said. “He was the surgical oncologist at BAMC (Brooke Army Medical Center) before he went to Bethesda Naval Hospital. He has extensive experience in research and treatment of breast cancer and is very well known in this regard. Dr. Oliver is a product of our residency program here who went to M.D. Anderson for his fellowship. He’s just superb.”

Developing the specialty of surgical oncology
Surgical oncology has had its growing pains. Dr. Cruz explained that when he came to San Antonio to help start the division in the late 1960s, “it was a culture shock.” Working at the old Robert B. Green Hospital downtown, Dr. Cruz labored in old-style hospital wards where all the patients were grouped together.

Dr. Cruz saw — and instituted — many changes.

“In the early days there was no formal training for surgical oncology. I helped design a curriculum in the late ‘80s and early ‘90s to give an extra two years of fellowship training after general surgical training,” Dr. Cruz said. The specialty of surgical oncology is “the only way that surgeons can stand toe-to-toe with other disciplines in cancer care.”

A leader in cancer clinical trials
He also led the division as a major participant through protocol design and patient accrual in some important clinical trials, including the controversial comparison of radical mastectomy to simple mastectomy and other less radical procedures. The study showed no significant difference in outcomes, Dr. Cruz said. But he recalls getting a lot of pushback from other doctors at the time.

“They would call us on the phone in the middle of the night,” he said. “This was the first major change in surgical procedures” for treating breast cancer.

Dr. Cruz retired from doing surgeries earlier in the decade, but still sees patients and teaches in the Health Science Center residency program. He said the division, after a period of change, is now fully staffed and is ready to accommodate more patients.