‘Less is more’ for Santa Rosa breast cancer surgeon

Elizabeth ‘Lisa’ Tito, a college athlete with ambitions of treating bones, joints, tendons and muscles as an orthopedic surgeon, had expected to start medical school after graduating in 1987 with a biology degree from Bates College in Lewiston, Maine.

But after turning in her medical school application too late to receive an acceptance, she said she instead found herself working as a volunteer at a hospital in Winterton, South Africa, a rural area where families lived in huts without running water.

There, Tito worked with a translator to treat young patients suffering from diarrhea due to a lack of access to sterilized water.

During mobile clinics, Tito said, she weighed growing babies on scales that had been set up under trees, while at a nearby community center, mothers were taught how to grow food and treat dehydrated children.

She said she also obtained experience in the hospital’s operating room, where primary care doctors — not trained as surgeons — did “the best they could” to treat their patients.

Her job was to hold the medical textbook and turn the page so the operating doctor knew what to do next.

“That’s when I realized I didn’t want to be an orthopedic surgeon, I wanted to do all of it,” Tito said. “What I saw in our operating room in Africa … we were saving lives.”

‘Empower them with knowledge’

Nearly 35 years after her six-month stay at the South African hospital -- which ended with her admittance to Dartmouth College’s Geisel School of Medicine, where she trained as a general surgeon -- Tito believes she has found her calling.

Working with breast cancer patients, she oversees Providence Medical Group’s Breast Center at Santa Rosa Memorial Hospital as its medical director and surgeon.

Driving Tito’s work: A fierce commitment to individualized, patient-centered medical care, along with her relentless pursuit of the latest breast cancer data -- the latter of which has led to less intrusive treatments and more post-breast surgery patients recovering in the comfort of their own homes, rather than a hospital bed.

The majority of Tito’s patients are breast cancer patients. In her first visit with them, she said, she operates in “quarterback” mode, developing a treatment plan and sending orders to the medical oncologists, radiologists, medical assistants and other staff who need to be involved.

Her top priority is to prepare her patients for the journey ahead, Tito said.

“My first job, my goal, is to empower them with knowledge to understand what’s going on and make them feel calm,” she said. “They walk in stressed, and they walk out like, ‘We can do this.’”

‘Thoughtful and yet tough’

Harmony Susalla, a 52-year-old Gualala resident, said Tito’s ability to explain in simple terms what was happening to her body, and the best options for care, was especially important to her as she underwent treatment for breast cancer in 2017.

Susalla said she was raised in a Christian Science household, which meant she and her family relied on prayer rather than medical treatment. She said was raised with a limited knowledge of the human body and medicine, as well as a belief that talking about an illness made it more real.

When Susalla met with Tito soon after she was diagnosed with breast cancer in August 2017, she said she explained her religion and its impact on her upbringing.

What followed was a monthlong process of preparing for surgery as Tito worked through Susalla’s questions and concerns. Though Tito had determined that Susalla needed only one breast removed, Susalla wanted a double mastectomy.

Susalla ultimately stuck with her decision to have both breasts removed, Tito said, but only after Tito had fully informed her of all her options.

As part of the process, Tito said she read a book on Christian Science to better understand Susalla’s background.

“She never made me feel stupid or like an alien,” Susalla said of Tito. “She was very kind, very considerate, very thoughtful and yet tough.”

The journey to Sonoma County

After graduating from medical school in 1992 and working as a general surgeon in Cooperstown, New York, Tito quickly realized she wanted to specialize in breast cancer surgery. She enjoyed working with women with breast cancer and was intrigued by the challenging and evolving nature of breast cancer research, she said.

The shift led her to a job at the Women & Infants Hospital in Rhode Island in 2001, where she taught training doctors about breast cancer surgery. Tito was then tapped to develop a breast cancer program in Taunton, Massachusetts, a leadership role that gave her the opportunity to assemble her own team, as well as work with the community to shape and raise money for the program, she said.

“It’s, ‘I’m a surgeon but there’s another hat I wear,’ ” Tito said.

Tito then worked as the medical director of a breast cancer center in Plymouth, Massachusetts, for seven years before moving to Santa Rosa’s Fountaingrove neighborhood with her family in mid-August 2017.

Two months later, the Tubbs fire would force her and her family to flee their home.

While her house survived the fire, Tito said her move to Sonoma County came with other challenges. Among them was learning to navigate the breast cancer treatment of a different patient population than she was used to, she said. That included a group of people who are mistrustful of Western medicine.

“What I had to do is listen to them and also explain in a way so they understand, and they get to make up their mind,” Tito said.

A ‘less is more’ approach to care

Advances in breast cancer research and treatment have led the field, overall, to settle on a “less is more” approach to care, Tito said.

For example, taking a sample of the lymph nodes used to be commonplace in breast cancer treatment just a few years ago, though Tito has stopped the practice for a group of patients over the age of 70 with certain types of breast cancer.

“We’ve learned that the cancer is so well-behaving in this population that the chance of that information affecting what we do or causing any trouble for those women is so small,” Tito said.

Fear of the cancer’s spread can also lead many patients to believe it’s safer to remove their breasts, though that’s not necessarily true, Tito said. As she puts it, the goal for her and her team is to remove the concentrated lump of cancer in the breast and stop it from shedding cells elsewhere in the body, usually through a combination of surgery, medicine or radiation.

Most of the time, she can do both while preserving some of the breast, Tito said.

She’s also shortened the number of weeks her patients undergo radiation therapy, from seven to about four weeks, a practice she adopted over the previous couple of years. She said this leads to less complications and better outcomes for her patients.

Before arriving in Sonoma County, she also began sending most breast surgery patients home soon after their operations, rather than keeping them at the hospital overnight. The chance of complications is small and most of her patients can manage the pain at home, she said.

“The field is catching up to me, finally,” Tito added.

Sharon Willis Doughty, a patient navigator who works at the Breast Center with Tito, said the doctor’s commitment to “treating the whole patient” transferred over to how she cares for others on her team.

Before the pandemic, it was not uncommon for Tito to invite her colleagues to talk about nutrition over lunch, on hikes or other wellness-related activities, Willis Doughty said.

Willis Doughty, a breast cancer survivor who also manages Providence Medical Group’s wellness program, said she also appreciates Tito’s eagerness to answer any question that her colleagues bring to her.

“It’s her willingness to teach us, just like she does the patients, in layman's terms so we understand and know where she’s coming from,” Willis Doughty said. “That was really important for me because I want to know what I’m talking about.”

For Tito, working on a team is one of the most important parts of her job. She learned the power of working with others as a college shortstop, a position Tito likened to the “generals on the field.”

“I’m so lucky to have this position in this job,” Tito said. “People say, ‘How can you do it, it’s so hard?’ But I say, ‘No, it’s not. I didn’t give them breast cancer but I get to take it away. And I’m on an amazing team.’ … There’s so many pieces of the puzzle that make my job easy.”

You can reach Staff Writer Nashelly Chavez at 707-521-5203 or nashelly.chavez@pressdemocrat.com. On Twitter @nashellytweets.