Pictures of mothers and babies cover one wall of her office at Hadassah Hospital Ein Kerem, but Dr. Shani Paluch-Shimon is neither a gynecologist nor an obstetrician. Director of the breast cancer center at Hadassah’s Sharett Institute of Oncology, she is a global authority on breast cancer. The babies in her photo gallery were born to patients during supervised breaks in their cancer treatments or conceived from eggs or ovarian tissue extracted before therapy and later reimplanted.

Dr. Paluch-Shimon pointed out one of the young mothers on her wall. The woman had early-stage breast cancer and transferred to Hadassah after her oncologist elsewhere told her to enjoy her three children and quit dreaming of a fourth. (She and other patients quoted in this article asked that their names not be used.)

“We judged that a planned and appropriately timed pregnancy was possible and safe for her,” Dr. Paluch-Shimon said of this patient. “We temporarily stopped her hormone therapy and, 10 months ago, she safely delivered a beautiful little boy.”

For the best outcomes, according to Dr. Paluch-Shimon, treatment must be tailored not only to the biology of each patient’s disease but also to her personal story. “The clinical battle—surgery, radiation and chemo-, immuno-, hormonal or biological therapy—is only one aspect of coping with cancer.”

Australian-born Dr. Paluch-Shimon, 49, is a pioneer in empowering women to make informed choices throughout their deeply personal breast cancer journeys. An international expert on breast cancer, she is the first Israeli to serve as an editor for the Clinical Practice Guidelines committee of the European Society for Medical Oncology (ESMO), which represents 177 countries and is widely regarded as the leading cancer authority outside the United States. In this position, she is responsible for defining and updating global standards and directions for breast cancer care, from large hospitals to remote and resource-limited settings.

“Many women worldwide receive breast cancer treatment in community settings rather than specialized tertiary centers,” she explained. “Some are treated by general rather than breast-specialized oncologists or live in areas with limited resources. International guidelines help ensure them access to the highest standard of care. They influence cancer protocols for literally millions of women, with studies showing better outcomes for patients who receive guideline-based therapy.”

Hadassah’s breast cancer center, which Dr. Paluch-Shimon has headed since 2020, models her vision of empowered, integrated holistic care. Patients are supported by a dedicated nurse coordinator who guides them through the maze of appointments, tests and treatments prescribed by a team of surgeons, oncologists, radiologists, psychologists, social workers and other specialists. This personalized psychosocial support helps patients make decisions in line with their values and goals.

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“A woman after her childbearing years, for example, will make different treatment choices from a young, single woman,” Dr. Paluch-Shimon said.

Dr. Paluch-Shimon’s vision of proper patient care has been shaped by her own family’s experience. Her mother, living in Australia, was diagnosed with breast cancer at age 48—six weeks before Dr. Paluch-Shimon’s wedding in Israel and before she had chosen oncology as a specialty. “My mom managed to come, scheduled chemo during her visit and lived 10 more years—long enough to know the first of my three children,” the doctor recalled.

Indeed, her mother’s joy in holding her first grandchild was one of two pivotal experiences. The other was her mother’s interaction with her surgeon in Australia.

“Instead of supporting her patient’s acceptance of her body with the changes brought by chemotherapy,” she said, the female surgeon “instructed my mom to cover her bald head when she came to the hospital because it upset other patients.”

Dr. Paluch-Shimon applies those lessons around acceptance to her patients today. “It isn’t for me to challenge their beliefs or value systems, especially at a time when they and their families are under enormous duress,” she said. “My job is to understand them as they struggle to cope with their illness according to their own world view.”

This, she added, can sometimes be challenging.

She recalled treating an Arab patient from East Jerusalem with advanced metastatic cancer whose dying wish was to see her husband one last time. “He wasn’t in Israel, so we approached the authorities to expedite his visa,” Dr. Paluch-Shimon said. “We were unsuccessful. Our patient’s husband was, it turned out, a security threat. But our duty was to put aside the knowledge he was a terror suspect and continue treating her with compassion.”

Another challenging case concerned a haredi mother of four. In her mid-20s, she was among the one in 40 Ashkenazi women—compared with one in 250 to 300 in the general population—who carry a BRCA mutation. Her illness was initially treatable, but returned and spread to her liver, causing her abdomen to swell. The couple hid the severity of her illness from her family and community, telling everyone that she was pregnant. Hospitalized near the end of her life, her children thought she was at Hadassah to give birth.

“This was very hard for our whole team, but our view wasn’t relevant,” Dr. Paluch-Shimon said.

However, she did insist on a discussion with the soon-to-be bereaved husband to make sure he understood the significance of his wife carrying the BRCA mutation for their children. “When his mother wouldn’t allow me to speak to him sleeveless, I returned with a sweater.”

“ ‘Look what a mitzvah you’ve done!’ ” she recalled the woman tell her dying daughter-in-law. “ ‘You’ve made the doctor dress modestly.’ ”

Breast cancer care in younger women is among Dr. Paluch-Shimon’s particular interests. She has introduced at Hadassah’s breast cancer center a clinical service for patients aged 45 and below. “Six to seven percent of all new annual breast cancer diagnoses occur in this group,” she said. “With young children at home or still hoping to start a family, they confront a disease located in a deeply feminine organ associated with identity, sexuality and intimacy.”

Prevention and early detection of breast cancer in this group is a key research focus at the center. Another is the disparity in care in culturally diverse and underserved populations across Israel’s socioeconomic and ethno-religious spectrums. Supported by a grant from the prestigious United States-based Breast Cancer Research Foundation, Dr. Paluch-Shimon and Hadassah psycho-oncologist Michal Braun are looking at the stage of the disease as well as prognosis, quality of life, side effects and anxiety in different Jerusalem populations. They are among only a handful of Israelis ever to receive this grant.

Key findings so far show that both haredi women and Muslim women are more likely than other groups to be diagnosed at later stages, have significantly shorter survival time and face a far higher risk of dying from the cancer. Haredi patients showed the highest health-related quality of life, the lowest rates of depression and the highest self-reported spiritual well-being. Arab patients were at the opposite end of this spectrum.

“Uncovering such gaps is critical because they impact prevention, screening and treatment as well as emotional well-being and overall outcomes,” Dr. Paluch-Shimon said.

Hadassah’s approach to breast cancer continues to value not just the science but the person behind the diagnosis. “Today, quality of life is part of all treatment assessments, with the patient, not the doctors, defining that quality of life,” Dr. Paluch-Shimon said. “We can’t know what our patients want unless we ask them.”  

Wendy Elliman is a British-born science writer who has lived in Israel for more than five decades.