Surgeon Dr. Denise Fraser provides patients with state-of-the-art care

By Janet Hefler - December 8, 2005

Before Dr. Denise Fraser joined Martha's Vineyard Hospital's surgical staff in 2002, a woman diagnosed with breast cancer on the Island had little choice but to journey to the mainland for surgery and follow-up care, services that were not available here. As a general surgeon with an expertise in breast care, Dr. Fraser has helped make it possible for the hospital to offer state-of-the-art treatment to women right here on the Island.

From 1999 to 2002, Dr. Fraser started and ran a breast health program at Roger Williams Medical Center in Providence, associated with Boston University Medical School.

Although breast cancer is the leading cause of cancer deaths among women ages 40 to 59, Dr. Fraser's outlook on the disease is positive. Reflecting on the numerous patients she has treated, Dr. Fraser said, "Most patients I evaluate do not have breast cancer. I know 85 percent of breast biopsies are not breast cancer. That's reassuring."

Smiling often, Dr. Fraser's manner is warm and friendly. Her conversation is fast-paced during an interview that she squeezed in between seeing patients and heading off to a parent-teacher conference. Multitasking is the norm in Dr. Fraser's roles as chief of surgery, wife, and mother of two boys - Douglas, 13, and Brian, 9.

Her specialization in breast procedures evolved from her experiences as a general surgeon in the fast-paced environment of northern Virginia, just outside of Washington, D.C. "As a general surgeon, I see a lot of breast cancer," Dr. Fraser said. "In northern Virginia, I would say more than half of the office patients walked in with breast problems."

She spent her first two years in practice handling level one trauma cases at Fairfax Hospital in Virginia. "I remember one night, I had 15 new people with severe injuries that I had to evaluate the next morning before office hours, besides the other 40 or so we had in-house," Dr. Fraser said.

As the northern Virginia area grew and so did her commute to work, she and her husband Jim, both originally from Long Island, decided they would pursue their goal to seek a less hectic lifestyle further north.

With a large portion of her practice already devoted to patients with breast problems, the opportunity to run the Rhode Island program caught Dr. Fraser's interest. Since most breast cancers are curable, she viewed working with patients who would live for many years as one of the program's most positive aspects.

"In surgery, we don't really get to develop a relationship with many of our patients, because you fix a hernia and they go away, or you take out an appendix, and they go away," said Dr. Fraser. "So these are patients I get to see for many years, and you get to develop a relationship. It's kind of a nice balance."

Although the slower pace and office hours of the breast health program worked better for Dr. Fraser and her family, after three years she found she missed doing general surgery. Feeling dissatisfied, she called Martha's Vineyard Hospital to see if a surgeon was needed.

"I had only been here once, but we love islands, we love the water and we like fishing," she said. Her husband, a hydrodynamics engineer, could continue his work as a consultant anywhere.

Dr. Fraser's call coincided with the resignation of another surgeon, Dr. Richard Koehler, in January 2002. She was interviewed and hired right away.

Appointed chief of surgery in 2004, she said she enjoys her Island career. "I like the variety here, and I am a lot more happy, I think."

While all of the hospital's surgeons can perform breast surgery, Dr. Fraser thinks many women seek her out because they are more comfortable with a female surgeon. Although Martha's Vineyard Hospital does not have a formal breast health center, she said the coordination of services and follow-up offered there perform the same function.

"We can pretty much do everything that you would get in Cape Cod or Falmouth or in Boston," said Dr. Fraser, who added that she is not insulted when some of her younger patients prefer to seek care in Boston. "If you are 30 years old and you think you're going to get better care up there, that's fine. Everybody has to find out where they are comfortable. But if they have a complication, we can take care of them here."

One of the newer procedures that Dr. Fraser performs, when appropriate, is a sentinel node biopsy. "I did some of the research protocols with the American College of Surgeons when I was in Rhode Island," she said. The procedure involves injecting a blue dye into tissue near a breast tumor, which flows through the lymphatic system to the sentinel nodes, the first lymph nodes where cancer cells are likely to have spread. Dr. Fraser then looks for the dye and removes the node or nodes, which are checked by a pathologist for cancer cells.

Keeping informed about mainstream treatments, Dr. Fraser works closely with a group of medical oncologists on Cape Cod. Starting in January, members of the Cape Cod practice will rotate seeing cancer patients at the hospital on a Friday once a month. Radiation therapy is provided off-Island.

Developing a good relationship with other medical providers who could offer additional services took time and effort on Dr. Fraser's part. "It is hard, you know, starting out with nothing, and then making a network," she said.

One of the doctors she works most close with is Dr. Debra Hall, a radiologist who comes to the Island once a week from Massachusetts General Hospital in Boston. Dr. Hall confers with Dr. Fraser after reading all of the mammograms, and performs needle localization procedures to identify the areas of breast lesions for surgical removal.

For women who have undergone a mastectomy, reconstruction surgery is available from a plastic surgeon who comes to the Island twice a month. Dr. Fraser provides post-operative care.

In meeting with patients after surgery, Dr. Fraser encourages them to bring someone with them, "their spouse or a good friend or just another set of ears, because patients only hear about 10 percent of what you're telling them," she said. She takes the notes for them, so they can listen.

To help breast cancer patients find treatment resources, Dr. Fraser developed a booklet for them and also gives them information from the American Cancer Society.

Unfortunately, Dr. Fraser said nothing better has been found yet for routine screening for breast cancer than a mammogram, an x-ray of the breast under compression that most women find uncomfortable, and a physical exam.

A new treatment, the MammoSite Radiation Therapy System, looks promising for treating early stage breast cancer, Dr. Fraser said. The new device consists of a hollow catheter to which an inflatable balloon is attached.

The device is implanted into the breast in the cavity left by removal of a tumor and the balloon is inflated. A radioactive "seed" is then placed into the catheter, providing partial breast irradiation in a week to 10 days rather than six weeks. Dr. Fraser cautioned that the treatment is still experimental and only patients with tumors less than a centimeter may fit the protocol.

In the meantime, her goal is to provide her patients with topnotch care that is not a ferry ride away.