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Meet Health Services Researcher Dr. Ellie Proussaloglou

January 12, 2024
by Elisabeth Reitman

Dr. Proussaloglou on her breast surgical oncology fellowship and the transition from trainee to attending.

Ellie Proussaloglou, MD, assistant professor of surgery (breast surgical oncology) attended Duke University where she majored in biology (genomics) with a certificate in genome sciences and policy. She obtained a medical degree from the University of Chicago Pritzker School of Medicine. She then completed her residency in Obstetrics and Gynecology at Brown University/Women and Infants Hospital of Rhode Island and fellowship in Breast Surgical Oncology at Yale University. As a health services researcher, Dr. Proussaloglou studies financial toxicity, surgical care, high-risk genetic mutation carriers, and looks for opportunities to maximize positive patient outcomes and health-related quality of life.

What inspired you to choose OB/GYN and Breast Surgery?

My mother is a breast pathologist and I was inspired from a young age to be a physician specializing in women’s health. In college I studied biology with a focus on genomics and received a certificate in genome sciences and policy; this sparked an interest in thinking across disciplines. After graduation, I worked in healthcare consulting for two years. This experience reaffirmed my desire to work with patients, but also gave me an inside look into the business side of healthcare, mainly drug pricing and novel biomechanical interventions. During medical school at the University of Chicago I was fortunate to work on research with Dr. Jonas de Souza, an oncologist, who developed one of the main tools used to study financial toxicity called FACIT-COST.

Most breast surgical oncologists are trained through general surgery and complete a breast surgical oncology fellowship. When I was in medical school, I was deciding between general surgery and OBGYN residency. I knew I loved operating, but I was drawn to focus on reproductive health through Obstetrics & Gynecology, which would allow me to be a surgeon while prioritizing patient care continuity

I completed my residency training at Brown University as it was a high-volume surgical training program with an emphasis on helping trainees find their passion and think outside of the box. As OBGYN residents at Brown, we rotate on the breast surgery service and get that hands-on training, so I was able to participate in research, cases, and clinics with both breast surgical oncology and gynecologic oncology.

The research and the continuity of care I was hoping to establish with patients lent itself to the breast surgical oncology field. Furthermore, I love open surgery and the tactile feedback of soft tissue planes, plus the ability to achieve a cosmetic result after cancer surgery. I applied to breast surgical oncology fellowship and was thrilled to match at Yale for the final step of my training. I bring my OBGYN training to patient counseling about the impact of cancer on fertility, pregnancy, sexual health, and menopausal symptoms; I hope it helps my patients feel heard and their concerns understood.

I bring my OBGYN training to patient counseling about the impact of cancer on fertility, pregnancy, sexual health, and menopausal symptoms; I hope it helps my patients feel heard and their concerns understood.

Ellie Proussaloglou, MD

What excites you about the future of surgery and genetics?

One of my clinical interests is the care of unaffected high-risk mutation carriers (e.g. BRCA1 and BRCA2) . The way that we as physicians counsel patients is understudied. For breast cancer, there are three very effective ways to screen or mitigate risk of disease in these highest risk patients. One is high-risk screening with alternating every six months MRI and mammogram. You would often start imaging at around the age of 25. The second is prophylactic bilateral mastectomies, removing all of the breast tissue to significantly decrease one's lifetime risk of breast cancer by about 95%. The third is using risk reducing medications like tamoxifen, which is an anti-estrogen therapy that's used in cancer care but can decrease risk by 50%.

If a 35-year-old woman had bilateral breast cancer and was a BRCA mutation carrier, I might counsel her that given how high risk she is, the benefits of removing both breasts likely outweighs the risks. But for someone who doesn't have cancer and is high risk, how do we balance the loss of sensation of the chest wall with decreased risk of cancer? It's not just a question of intimacy or the inability to breastfeed a child... You're not going to feel a hug from the front on your chest wall. Some patients say, ‘I saw my mother or sister go through breast cancer in her twenties, thirties, or forties. I don’t want my breasts.’ Others hesitate on how to make decisions about a major surgery, possible reconstruction and balancing that with everything else in their life.

We don't currently have data that answers how to best counsel these unaffected high-risk patients. My hope is that this research will help give us the evidence to create tools to help patients make the right decision for themselves.

As I alluded to earlier, we are getting better at finding the right surgery for the right patient. If anyone has BRCA, they're also seen in a specialized Department of Obstetrics, Gynecology and Reproductive Sciences clinic led by Dr. Elena Ratner and PA Johanna D’Addario for gynecologic risk-reduction counseling and care. We have an all-star team here at Yale working on these clinical and research questions; building those connections is something that I'm passionate about.

What specifically made you want to come to Yale for fellowship and stay on as faculty?

When I interviewed with Dr. Rachel Greenup, the Fellowship Program Director and Section Chief, we talked about her research, which centers largely on financial toxicity and breast cancer care. I had this immediate feeling of mentorship, seeing someone so accomplished in clinical and research who is also a kind and empathetic leader. I could tell that she would make sure that I graduated fellowship with the training and research mentorship I was searching for, and the sponsorship to launch an academic career.

In terms of making the transition from fellowship to being an attending, I wanted to join an institution where being an academic surgeon in the true sense—a researcher, a busy clinician, and an educator— was valued and encouraged. At Yale, I was also offered an incredible opportunity to work with Dr. Veda Giri and our genetic counselors to build out high-risk breast clinics and the breast cancer genetics program.

All of my leaders and colleagues at Yale are brilliant, but also kind, collaborative, and supportive. That’s what makes Yale so special.

What areas outside of Breast Surgery do you seek to create impactful research collaborations or partnerships?

The goal of doing research is to improve patient care. I am hoping that the work I am doing on the care of high-risk mutation carriers helps us develop tools to help them make the right decision for themselves. This collaborative work involves the Departments of Obstetrics and Gynecology and Surgery, along with colleagues in Cancer Genetics and Prevention, Surgery Health Services and Outcomes Research, Genetic Counseling, Medical Oncology, Radiology, Social work, and beyond.

It is also important to partner with the community; how do we ensure that the research and care we're providing is representative of our patients’ needs? There are elements of patients’ identity that are very important and may influence their decision-making. We can't practice medicine in a silo and it is important to collaborate and also to advocate on behalf of our patients, locally, on a state level, and nationally when possible.

What are your interests outside of the clinic?

I love to travel and explore, both locally and internationally. My husband Beck and I love trying new restaurants and coffee shops. I am also a bookworm; my ideal Saturday is hanging out at home reading a book with a big cup of coffee and my two cats by my side, maybe going for a quick workout or run by the water, and then seeing friends in the evening. I feel fortunate that my mentors and colleagues have become my friends. Two of my partners from Yale were even able to join for my wedding earlier this summer! These are the relationships that fuel me and make that make Yale Department of Surgery a special place to work.

Submitted by Elisabeth Reitman on January 12, 2024