Meet Top Doctor 2014: Dr. Samira Khera
Meet 2014 Top Doctor Samira Khera of HealthAlliance of the Hudson Valley in Kingston
Medicine as a career runs in Samira Khera’s family. A surgeon who specializes in breast surgery, her father was a pediatrician in Corning, where she grew up. And she’s always been drawn to studying cancer. “When I was a kid in the 1970s, President Nixon was waging a ‘War on Cancer’; I was in elementary school and remember researching cancer in the library,” Dr. Khera says. After graduating from high school, she went to Wellesley College in Massachusetts. “I also worked for a cancer info hotline; it helped give me a good foundation and knowledge base.”
But the disease also hit closer to home. “When I was in college, my father was diagnosed with chronic lymphocytic leukemia,” she says. “Having to deal with his cancer as a family member also gave me valuable insight into what it’s like for patients’ families.”
Dr. Khera went on to graduate from medical school at Georgetown University in 1997. She did her surgical residency at the Guthrie clinic in Pennsylvania, then trained at Tufts University in Boston and the University of Massachusetts, followed by a fellowship at the Moffitt Cancer Center in Tampa, Florida.
Dr. Khera says her favorite mentors during training taught her more than just the nuts and bolts of medicine. “It was also about how to treat the patient as a whole person. I wanted to be a surgeon capable of providing compassionate care and looking holistically at the patient — understanding the emotional components of what they’re going through and supporting that.”
For instance, she recalls one of her mentors hugging patients, even back when many doctors projected a rather aloof demeanor. “I always try to emulate that warm behavior,” she says. “We gave little stuffed bears to each patient who was getting cancer treatment, and now I give little toy doggies to my cancer survivors coming through surgery. Little gestures of caring mean a lot to patients.”
Dr. Khera, who lives in Hudson, is affiliated with both the HealthAlliance of the Hudson Valley and Columbia Memorial Hospital. Her medical practice includes screening for cancer, genetic testing, breast biopsies, lumpectomies, mastectomies, and other breast treatments.
“I’m also kind of the quarterback in patients’ treatment; we help coordinate medical and radiation oncology, genetic testing, and consultation for various treatments and possible breast reconstruction. And I stay in close contact with other medical providers who are part of the team as patients transition through different aspects of treatment.”
Based on their medical and family backgrounds, Dr. Khera screens some women for the possibility of being at high risk for breast cancer. About 25 percent of those tested do end up having a greater risk of contracting the disease. “I can then do a higher level of surveillance for them,” she says; preventative tactics using chemo or other medications might be appropriate, and/or yearly MRI screening in addition to twice-yearly breast exams and a yearly mammogram. “With these added tools, we can find, treat, and cure more early-stage breast cancer, and save more lives.”
In many cases, cancer nowadays can be viewed as a chronic treatable disease, she adds. “I emphasize steps they should take to optimize the quality of their life — weight management, good nutrition, exercise, and stress reduction to those patients. And I also urge all patients to be their own advocates for their heart health. Cancer patients are at higher risk for heart disease, possibly due to a radiation history or hormone therapies. In general, heart disease is now more of a women’s disease — and a bigger cause of death for men and women than cancer. I urge women to work with their physician and get good screenings for heart disease. For many of my early-stage cancer survivors, I’m less worried about cancer for them, I’m just as concerned with their heart health.”
In 2012, Dr. Khera added vein treatments to her practice. “It involves treating venous disease, such as varicose veins, that affects millions of men and women.” Some varicose vein problems are hereditary, Dr. Khera says, and some plague people who stand on their feet a lot. “Waitresses, hair stylists, nurses, and construction workers are among those prone to it,” she says. “If untreated, it can lead to discomfort, swelling, and skin changes.” She treats conditions such as venous insufficiency, where faulty veins cause blood to pool in the legs. “A lot of people with these conditions are suffering, and we’re trying to get the word out that treatment is available,” she says.
“Breast health is becoming more individualized in terms of screening,” says Dr. Khera. In addition to testing for BRCA gene mutations when appropriate (this can help indicate if a woman has a higher-than-average risk of developing cancer), Dr. Khera’s practice also utilizes the new BREVAGen test. It uses a simple swab to obtain DNA from cells lining the cheek; then it checks for and analyzes seven genes associated with breast cancer. “It’s a significant new tool we can use,” the doctor says. “And there’s more screening being done in general, especially since New York State passed a law (in 2012) that women with dense breasts must be notified by letter from her physician because dense breasts are considered a risk factor for cancer.”
“More and more drugs now work as targeted treatments for breast cancer,” says Dr. Khera — and screening techniques continue to improve. “One of the newer tools is Mammoprint, a genomic profile tool, which analyzes 70 genes to determine how much a particular patient might benefit from chemo.” Regarding radiation, small balloon catheters can now be inserted at the treatment site, targeting radiation to the area of the cancer where it needs to go. This is used for early stage breast cancer and in some cases, it reduces the number of radiation sessions needed. “Breast reconstruction is also evolving all the time, such as mastectomies that can, in some cases, spare the nipple to give the reconstructed area a more natural look.”