Holistic Wellness Approach for Women in High Risk Program

Hoag is elevating the standard of care for women at increased risk of developing breast or ovarian cancer. By taking a more holistic approach, we’re supporting the mind, body and soul, in addition to offering surgery and medication.

“We refer to these women as ‘pre-vivors,’” said Heather Macdonald, medical director of the Hoag Breast & Ovarian Cancer Prevention Program located inside Hoag Health Center Irvine – Sand Canyon. “Our philosophy is ‘ These are well people. And we want to keep them that way.’”

By drawing together a multidisciplinary team of experts in meditation, fitness, nutrition and sexual and mental health, the new program will educate and empower high risk women throughout the community.

To read more about our meditation, fitness, nutrition, and sexual and mental health experts, please click the icons below or continue to scroll down.


Bringing Meditation off the Mountaintop
Anusha Wijeyakumar, Wellness Coach


If you can breathe, you can meditate. If you can meditate, you can reduce your risk of developing cancer.

“Our breath links our body and mind,” said Anusha Wijeyakumar, MA, RYT, CPC wellness coach for Hoag for Her Center for Wellness. “But you say ‘meditation’ to people and they say, ‘Oh I can’t do that.’ They have this image of sitting in the lotus position for 45 minutes on a mountain top.”

Wijeyakumar brings meditation down from the mountaintop and into a comfortable office in Irvine. The meditation and mindfulness coach is part of the multidisciplinary team at Hoag’s Breast & Ovarian Cancer Prevention Program, which is aimed at helping high risk women improve their odds of avoiding or beating breast or ovarian cancer.

Several studies have shown a correlation between stress and increased risk of cancer. Meanwhile, magnetic resonance imaging (MRI) studies of the brain have found that meditation and mindfulness techniques have a lasting effect on stress reduction.

“When you’ve been told that you are at increased risk of cancer, you might not want to be alone with your thoughts,” she said. “The key reason that mindfulness helps is that it brings us into the present moment, and away from the past and future projections.”

In an initial meeting, Wijeyakumar will spend 30 minutes with a woman, assessing her emotional health, lifestyle and concerns. The wellness coach will also lead a short breathing exercise to teach basic stress reduction techniques.

The effect of stress on the brain, the way it suppresses the immune system and limits our thought processes, made sense when our caveman ancestors had to avoid imminent threats. But today the stress hormone cortisol often does more harm than good. Meditation can help remind our brains that there are no saber-toothed cats crouching behind the aisles at Costco.

“We are able to self-regulate through our breath via forced exhalation,” she said. “When you explain it to people like that, they say, ‘Oh yeah, I can do that. I can take a deep breath.’”


Actively Avoiding Breast Cancer
Nicole Ervin, Certified Personal Trainer


Certified personal trainer, Nicole Ervin, BS, CPT is particularly interested in helping high risk women reduce their odds of developing cancer through exercise. Not only is she a fitness coach at Hoag for Her Center for Wellness and the fitness instructor of Hoag’s new high risk program, she is also the niece of a breast cancer survivor.

“Knowing that it’s in my family, makes me especially attuned to what these women are experiencing,” said Ervin. “These are healthy women who are looking to take preventative measures so they don’t develop health problems.”

Through the Breast & Ovarian Cancer Prevention Program, Ervin will assess a woman’s activity level, fitness interests, nutrition and lifestyle. She can then help that client stay accountable to her regimen, suggest fitness routines, and offer motivation and support.

“We’re pioneers in terms of incorporating practitioners like me who can look holistically at the patient,” she said. “We want to address the mind, body and soul, and we’re leveraging specialists who can do that.”

Peer-reviewed studies have found that high-risk women who regularly engage in five hours of aerobic exercise per week may lower the amount of estrogen-sensitive tissue in the breast. Researchers suggest this might help women who are at higher risk of developing cancer to lower their odds.

“No matter what, staying active for a minimum of 30 minutes, three times a week, is ideal,” Ervin said. “I always encourage my clients to stay active.”

If clients wish to work out with Ervin, the Hoag Health Center Irvine facility offers strength and resistance training equipment to help women meet their fitness goals. Ervin also trains clients in Newport Beach at Hoag for Her Center for Wellness.

“The key is to make it fun,” Ervin said. “Everyone needs to feel encouraged to start.”

Ervin said her personal connection to breast cancer makes her grateful to work with women at Hoag and to help them make sense of their elevated risk.

“I feel honored to be able to work with this program and with people who are taking their lives seriously,” she said. “I want to do whatever I can to help them feel empowered."


Prevention with Every Bite
Yasi Ansari, Registered Dietitian


One headline says soy is bad for you. The next says it’s good. Coffee can prevent cancer, cause cancer or have no effect on cancer – depending on the week.

For most people, it’s easy to take the contradictory reports about nutrition and cancer with a grain of salt. But for a woman whose doctors have told her she is at an increased risk of developing breast or ovarian cancer, food can be a powerful method of prevention. Making the most informed choices becomes paramount.

As part of Hoag’s new high risk program, registered dietitian, Yasi Ansari, MS, RD, CSSD, helps women develop eating habits based on hard clinical data.

“The research is constantly changing, so I work with them to show them what the most up-to-date research shows,” she said. “Based on that, we talk about the best plans for them.”

Ansari anticipates that many women will ask about stories they read in the paper – particularly about soy. The plant-based protein is sometimes viewed with suspicion for its possible link to increased estrogen and possible role in cancer.

“When I show them what today’s research says, it helps people to stop being afraid of food. It’s never one food source that causes cancer,” she said. “The goal is to work with the patient to give them research-based information, and to underscore that moderation is key.”

Providing medical nutrition therapy, Ansari complements the work of other experts in the Hoag Breast & Ovarian Cancer Program – fitness, sexual health and mental health – who address the lifestyle and emotional care that can be so critical to keeping cancer at bay.

“I have worked at a cancer hospital with patients after they’ve already been diagnosed, and for a hospital like Hoag to initiate a program like this is incredible,” Ansari said. “To allow women to prevent cancer and spend the time to educate women on how their emotional, nutritional and physical needs influences their risk is something I am excited to be a part of.”

She believes other hospitals will soon follow suit.

“My mom passed away of ovarian cancer. If we had a program like this, imagine how wonderful that would have been,” she said. “This is a program that will help set the standard of care and hopefully decrease cancers and cancer deaths. With fitness, nutrition and mental health – I think we will be giving them the world.”


Recognizing the Importance of Sexual and Mental Health
Dr. Stephanie Buehler, Licensed Psychologist and AASECT-Certified Sex Therapist


A renowned sex therapist, Dr. Stephanie Buehler, MPW, PsyD, CST has heard just about everything. So when she heard of a new program that co-mingles the mental and physical health care of women at high risk of developing breast or ovarian cancer she knew history was in the making.

“We’re pioneering having someone like myself be there from the very first appointment,” Dr. Buehler said. “It’s very exciting.”

Through Hoag’s new Breast & Ovarian Cancer Prevention Program, a woman will meet with a mental health professional during her first office visit.

“For a lot of women when they have an illness or are at high risk of developing an illness, mental health goes to the bottom of the priority list,” Dr. Buehler said. “It can take two years or more before they come into an office like mine. They obviously have to take care of their physical well-being, but that doesn’t mean they can’t take care of their mental health concurrently.”

Mental and sexual health care will be particularly important for patients who decide to undergo prophylactic surgery.

“You’re faced with a change to your body image, your concept of femininity and sexual function. You’re faced with the fact that you really are mortal,” Dr. Buehler said. “I want to give women upfront education. That’s a big part of this.”

In addition to mental and sexual health, women in the program will meet with a fitness counselor a meditation and wellness consultant, and a dietitian to try to improve their odds at avoiding cancer.

“We want you to have an optimal quality of life,” Dr. Buehler said. “For women who decide to have surgery, sometimes that means discussing the sexual changes that may occur after. To have someone go through and talk to them about what to expect and give them ideas of things that they might think about doing in the future might relieve some anxiety.”

Dr. Buehler anticipates that many of her conversations with women in the high risk program will center around acceptance. Of their risk. Of their bodies. Of their role in staying well."

Couples who are dealing with this come into my office and say, ‘I never thought I would be here.’ So a piece of it is normalizing what is happening,” she said. “I’m here to help.”


For more information on how each member of our expert team approaches high risk women, call 888-521-8786.