Written by Karri L. Moser
Photo provided by Dr. Craig Shriver
Dr. Craig Shriver joined the Army as an undergraduate student looking for a way to fund his education. Although he had no plans to pursue a full time Army career, he kept staying.
Thirty years later, Shriver is spearheading innovations and advancements at the Breast Care and Research Center of Excellence as the Director of the John P. Murtha Cancer Center at Walter Reed National Military Medical Center.
One of his first notable innovations in Army medicine involved the biopsy and removal of lymph nodes for breast cancer patients. In the mid 1990’s, Shriver began to explore the idea of doing a biopsy of lymph nodes rather than removing all of them at the first sign of cancer. The innovative idea was unfunded and unheard of at the time. Shriver credits Walter Reed National Military Medical Center and the Army in general for allowing him to pursue the idea further. After his findings were published in 1998, the world realized it could be done and the doors were opened to funding for more research. Now the practice of removing all lymph nodes is virtually archaic and Shriver’s method is the standard in both military and civilian medical facilities.
“I’m most proud of the lymph node protocol,” he said. “Everyone avoids taking all the lymph nodes because of our research in the Army.”
The depth of Shriver’s research and medical advances only grew from there. He now heads the largest bank of breast tissue in the world. This has opened the doors to unlimited and life-altering research and treatment advancements. Not only is the sample supply the largest, but, as Shriver describes it “It is the best supply because of the protocols our center put in place. This abundance of samples has allowed the Breast Care and Research Center to explore research opportunities that can’t be experienced anywhere else in the world,” he said.
The tissue bank has allowed Shriver to find ways to distinguish between cancers. The Army medical professionals involved in the research are now able to sub-divide patients and create targeted treatment for certain types of cancer.
The research and tissue bank has led to changes in how breast cancer is viewed in general. Shriver insists not all cancers need radical treatment. He contends discoveries made from the tissue bank have led to the ability to pinpoint exact types of cancer, and to the realization that not all breast cancers require removal of breasts or chemotherapy.
“The Army healthcare system is unraveling the genetic make-up of breast cancer. A biopsy will help us to determine if chemotherapy is needed or if a simple follow up appointment is sufficient for monitoring,” he said. “Someday, we aren’t going to call it cancer. We will be able to more appropriately name things and be more precise with a different diagnosis,” he said.
Shriver believes the day is coming when doctors will be re-educated. They will be able to confidently tell people that the type of cancer they have will not require harsh treatments such as chemotherapy, based on the genetics of the tumor. He calls this new outlook a shift in viewing breast cancer as a chronic disease.
Through the research at the tissue bank, the approach to how breast cancer is surgically treated is also evolving, according to Shriver.
“Many choose a mastectomy and implants out of fear,” he said. “We need to refocus and re-educate patients. There are many [cases] where genetics show a simple lumpectomy without chemotherapy is all that is needed. These patients may not even need radiation.”
His approach and the benefits of his research exemplify a belief that the direction of future breast cancer care centers will be the idea of minimizing—both surgery and treatment. He believes a focus on genetics is the key to reinventing and improving cancer treatment in every respect.
The move toward minimization and targeted treatment is not just seen as being the best for the patient, but best for budgets also. There are 400 new breast cancer cases each year at Walter Reed. Chemotherapy treatments cost thousands of dollars each time the treatment is administered. With genetic marker testing, it has been found nearly one third of the women diagnosed can avoid chemotherapy altogether. The genetic marker testing costs around $2,000, which is a considerable savings over unnecessary chemotherapy.
Aside from remarkable research findings and evolutionary methods of treatment, Shriver is credited with life-changing innovations in how patients are handled at the Murtha Cancer Center. In 2011, Shriver and his team of Army doctors and researchers wanted to work with specialists and designers to create a patient care center. This entailed taking a different approach from the moment a patient was diagnosed. Typically, a doctor relays a diagnosis. The patient then calls and sets up an appointment with a specialist. Then, the patient continues to seek out further specialists, social workers, or any other medical professional who needs to be involved in their care and treatment. Through the idea of patient-centered care, the treatment plan is based on the convenience of the patient, not the providers.
“We made it patient-centered. Once a patient is diagnosed, we arrange all the care with all of the specialists instead of the patient seeking out different doctors and specialists,” he said. “All of the providers agree to a comprehensive plan together. Patient-centered care makes sense. It is more efficient and that’s how we do it in the Army.”
Being able to do the kind of research that has had a global impact on how breast cancer is diagnosed and treated has made the experience of being an Army doctor beyond rewarding for Shriver. He believes the top notch medical care and the ablility to take advantage of the innovations are earned benefits for service members and their families. He insists beneficiaries have had access to the best cancer care possible over the last decade.
“It is a much better experience for our patients and that is part of why I stayed in the Army,“ he said. “Family members sacrifice too, and we are happy to provide the best care we can to everyone.”
Through his work at the Murtha Cancer Center, Shriver continues to explore cutting edge cancer research that continues to change medicine globally, all with the mindset of minimizing costs, minimizing harm, and maximizing benefits for the patient.
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