“Put simply, my career mission as a breast cancer surgeon and cancer researcher has not been to practice the proverbial “standard of care”, but rather to raise the standard of care,” according Dennis R. Holmes, M.D., F.A.C.S. “It is only through innovation that we can continually improve the effectiveness, safety, and quality of breast cancer care for the benefit of those affected by the diagnosis.”
That philosophical approach to breast cancer care is just one of many reasons that Dr. Holmes is held in high regard by the international breast surgery community for his role as a visionary leader and change agent. With over 50 peer-review medical journal publications of his innovative work and collaborations, Dr. Holmes has long experience with many breast cancer treatments that are still relatively new to most breast and general surgeons. The following 6 examples demonstrate Dr. Holmes’s foresight, leadership, team work ethic, and commitment to developing fledgling ideas into effective practice-changing practices that improve breast cancer care for women.
- Holmes’s leadership skills and commitment to “raising the bar” is a key reason that Dr. Holmes was selected to serve as Program Chair of the 3,000-member American Society of Breast Surgeon’s 20th Annual Meeting. With an emphasis on innovation and a focus on elevating the standard of care, the consensus view was that the 2019 20th annual meeting was the best in the society’s 21-year history. Since serving as program chair, Dr. Holmes has been appointed chair of the American Society of Breast Surgeon’s newOnline Surgical Video Library Committee, committee member of the new Oncoplastic Surgery Certification Program, and committee member of the new Lymphedema Prevention Surgery Course and Lab. These appointments are further evidence of the value that Dr Holmes’s peers place in his work ethic, leadership skills, and ability to guide the development of emerging concepts into structured programs that improve outcomes for patients.
- Oncoplastic Surgery (OPS). In 2002, Dr. Holmes choose to train as a breast surgeon at the University of Southern California (USC) Oncoplastic Surgery Breast Fellowship Program, the only such fellowship program in the United States at the time. Oncoplastic surgery combines breast conserving surgery and plastic surgical techniques to optimize cancer resection while preserving or enhancing breast appearance and patient quality of life. Long before OPS was popular, Holmes chose the USC fellowship program because he had the vision to see that OPS would someday become the preferred approach to performing breast cancer surgery. After excelling as a trainee, Dr. Holmes was invited to join the USC breast fellowship surgical faculty, and over the next 9 years became the Co-Director and then Director of the USC Breast Fellowship Programs, in the process playing the central role in the training of 22 breast fellows who have gone on to practice breast surgery across the U.S. As an educator and early adopter of OPS, Dr. Holmes later served on the faculty of the American Society of Breast Surgeons (ASBS) Beginner OPS course to teach other surgeons how to perform OPS. He then went on to serve as co-chair of the Beginner OPS course, co-developer and co-chair of the society’s first Intermediate Level OPS course, and now serves as a member of the OPS Workgroup which developed and manages the society’s new OPS Certification Program and regional OPS courses. Partly due to Dr. Holmes efforts, the current position statement of the American Society of Breast Surgeons is that all women undergoing breast surgery should have access to oncoplastic surgery and it’s the society’s mission to ensure member surgeons are appropriately trained. Dr. Holmes also serves on the faculty of the recently launched Beginner OPS course of the American College of Surgeons, which is now committed to providing OPS training to its members.
- Intraoperative Radiotherapy (IORT). When Dr. Holmes first learned about IORT in 2003, he recognized its potential to greatly reducing the emotional and physical burden of radiation and potentially overcome the fear that many women have of this important breast cancer treatment. After a 3-year effort to develop an IORT program at University Southern California Norris Cancer Center, Dr. Holmes led USC to join the Targited Intraoperative Radiotherapy (TARGIT)-A clinical trial as one of the first U.S. cancer centers to join this international clinical trial. The TARGIT-A trial was a multicenter, 3,400-patient randomized controlled trial comparing single-dose partial breast targeted IORT given during lumpectomy surgery to 6-weeks of daily traditional whole breast radiotherapy given after surgery. Following the closure of the TARGIT-A trial to further patient enrollment in 2009, Dr. Holmes co-developed the TARGIT United States Phase IV Registry Trial, a 700-patient U.S.-based clinical trial that has since completed enrollment, and is currently a co-investigator in the ongoing TARGIT-B trial investigating the use of IORT in combination with whole breast radiation for the management of high risk breast cancer. In 2015, he founded the TARGIT Collaborative Group, a national IORT quality improvement, research, and advocacy organization comprised of breast surgeons, surgical oncologists, radiation oncologists and physicists, and later led the design and launch of the TARGIT Collaborative Group’s Quality Collaborative, a prospective quality improvement initiative aimed at setting benchmarks and international standards for IORT. In addition to publishing multiple journal articles on novel applications of targeted IORT, Dr. Holmes recently co-authored the long-awaiting long-term results of the TARGIT-A trial which firmly established single dose targeted IORT at the time of lumpectomy at an effective alternative to 6-week daily whole breast radiotherapy administered after surgery. Behind the scene, he also played a key role along with others in securing IORT technical and professional billing and reimbursement codes and insurance coverage for hospitals, radiation oncologists, and surgeons – a necessary step to make IORT available to women around the country.
- Cryoablation (tumor freezing). Holmes started performing cryoablation of benign breast tumors (fibroadenomas) in 2002 because he believed it had potential as an alternative to surgery for selected patients with early stage breast cancer, especially non-aggressive breast cancers. After years of performing and teaching cryoablation to his breast fellow trainees, Dr. Holmes traveled to Japan to study with a surgeon who years earlier had already begun treating breast cancers with cryoablation. Later that year, Dr. Holmes joined the American College of Surgeons Oncology Group’s Z1072 cryoablation-followed-by-surgical removal feasibility trial, the first large scale study of breast cancer cryoablation in the U.S. After Z1072 trial published its results in 2016, showing cryoablation to be effective at killing breast cancer, Dr. Holmes single-handedly launched the FROST (Freezing without Resection Of Small Tumors) Trial, the first U.S. trial investigating the use of cryoablation without subsequent surgery as a treatment for stage I breast cancer. Currently, Dr. Holmes is in the process of launching two new cryoablation clinical trials: the first study of cryoablation in the management of DCIS (stage 0 breast cancer) and the first human study investigating the potential of cryoablation as a strategy for preventing invasive breast cancer. He recently published a journal article challenging national recommendations to delay breast surgery during the pandemic, proposing instead the use of cryoablation as a definitive or stopgap measure for managing breast cancer when medical resources are limited, such as during a pandemic.
- Lymphedema Prevention Surgery. Over 10 years ago, Dr. Holmes introduced Axillary Reverse Mapping (A.R.M.) into his practice after learning of some promising studies suggesting that it could reduce the risk of breast cancer-related lymphedema by facilitating the identification and preservation of arm lymphatic drainage. Following adoption of additional surgical techniques to reduce lymphedema, Dr. Holmes co-developed the American Society of Breast Surgeons first Lymphedema Prevention Surgery Course and Cadaver to teach breast surgeons basic techniques to prevent, detect, and treat breast cancer-related lymphedema. At the present time, Dr. Holmes remains one of few breast surgeons skilled at performing axillary reverse mapping and lymphatico-venous anastomosis to reduce the risk of lymphedema after lymph node surgery.
- Value-based breast cancer care. Value-based healthcare is the next frontier where innovation, patient-centered care, and cost-effective healthcare come together. There are many recent developments (including the ones listed above) that enhance quality of life and lower the cost of healthcare, while effectively managing breast cancer. “These advancements have limited usefulness if efforts are not made to upgrade healthcare practices nationally,” say Dr. Holmes. “Through the American Society of Breast Surgeon as well as through my independent efforts, I am committee to playing a role in promoting the wide-spread adoption of effective value-based breast cancer healthcare practices.
Collectively, these efforts exemplify Dr. Holmes’s steadfast commitment to developing elevating the standards of breast cancer care through innovation, collaboration, educations and mentoring with the overall goal of enhancing the effectiveness, quality, and safety of breast cancer care for all women.
For more information about Dr. Holmes, visit his YouTube Channel here.