Q: I’ve had a mastectomy and chemotherapy. What is my chance of having breast cancer in my other breast? Should I have had a double mastectomy?

 

A: Although most women who have been diagnosed and treated ask this particular question, the truth is it is difficult to tell the actual chance of reoccurrence because so many factors are involved. In general, most reoccurrences occur 3 – 5 years following treatment. Secondly, reoccurrence does not only happen in the affected breast or the opposite breast – reoccurrence can be local (in the vicinity of the initial tumor or in the remaining breast tissue after mastectomy), can be regional (occurring in the lymph nodes of the initial tumor area), and can also be distant (occurring at a distance from the initial tumor site including: the opposite breast, the bones, the lungs, or the brain). Some common factors that play a part in reoccurrence include: lymph node involvement in the initial tumor site, tumor size (and what stage you were in when the tumor was found), tumor grade (how much the cells in the tumor resemble normal cells when looked at under a microscope), and the amount of hormone receptors found in the tumor. To be proactive, it is recommended that the patient who has been diagnosed and treated for breast cancer have a good working relationship with his/her health care team (medical oncologists, primary care doctor, pathologists, etc.). Having a good medical team is essential so that you can seek help or advice regarding your diagnoses. Knowing and recognizing abnormalities so that it can be reported to your healthcare provider is vital as well. Other things that can be done to reduce your risk of reoccurrence include: continuing regular screenings (mammograms,self-breast exams, and clinical breast exams), exercising, and reducing stress. More women are opting for preventative mastectomies to reduce their risk; however, try to keep in mind when making your decision that although the breast tissue may be removed, the lymph nodes may still be in place and that is how most cancers in general can spread.

Q: If I have implants, do I still need to do exams? How are they different?

A:¬†Most breast centers will ask if you have implants before the procedure is scheduled. It is still wise to get mammograms even with implants – – but the procedure will take about 10-15 minutes longer than a mammogram for someone who doesn’t have implants. Also, an ultrasound may accompany the mammogram to get a better view of the tissue beneath and around the implants. Clinical breast exams (exams where a practitioner or physician examines the breast) are also still recommended because even though implants are present, the surrounding lymph nodes still need to be checked for abnormalities.

Q: How can I remind myself to do my monthly exam?

A: Monthly exams should be done at the same time each month about 5 days after your period, for instance: if your cycle ends on the 5th, you can try to do the self-exam on the 10th, and then stick to the 10th of each month if your cycle is regulated. For those who are post-menopausal or have had a hysterectomy, try the same day of each month as well.

Q: What are signs, other than a lump, that I should see my doctor?

A: Some abnormalities to look for other than a lump: drainage from the nipple (if you are not breastfeeding), change in the shape of your breast, pain in the breast area that won’t go aways, inverted nipple, swelling, warmth, redness or darkness in the breast area, dimpling of the skin

Q: What can I do to reduce my risk of getting breast cancer?

A: Some ways we can reduce our risk of getting breast cancer includes: reducing stress, reducing alcohol intake, avoiding hormonal therapy (if possible), breast-feeding, maintaining a healthy weight, exercising

Q: Do birth control pills increase my chance of developing breast cancer?

A: Birth control pills may slightly increase your risk, so if you opt for birth control pills, try a combination pill or a low-dose pill. Those types are better for you because they have a small amount of hormones in them

Q: Is breast cancer mainly genetic?

A: Studies have shown that breast cancer is NOT mainly genetic – only a small percentage of breast cancer cases (5 – 10%) account for new breast cancer cases. About 80% of breast cancer cases are spontaneous

Q: What race is more likely to get breast cancer?

A: Caucasian women are more likely to get breast cancer; however, African-American women are more likely to die from it. African-American women have more aggressive tumors. Other factors that contribute to that population’s mortality rate could be: lack of insurance, economic barriers, misconceptions about health care, hidden fears about being proactive and seeking help

Q: Is the BRCA 1 & 2 gene testing accurate?

A: The gene testing can be pretty accurate if the procedure is done correctly; however, it can be costly and the results may take a very long time to get back. Also, just because you may carry the gene does not guarantee that you will be diagnosed with breast cancer.

Q: Are there different types of breast cancers?

A: Breast cancer is not just one disease, but a number of different types. Some different types of breast cancer include: invasive ductal carcinoma (the most common type), inflammatory breast disease, HER2+ subtype, and metastic carcinoma.

Q: Does screening and treatment options differ for men with breast cancer?

A: Screenings and treatment options for men are very similar. Men can and do get mammograms (if they have a significant amount of breast tissue); otherwise, they are referred for ultrasounds if they have abnormalities and very little breast tissue. Treatment options are just about identical to that of women – men have had mastectomies, radiation, and chemotherapy, just to name a few.

Q: What is the best screening tool for detecting breast cancer?

A: Mammograms are arguably still the best screening tool for detecting breast cancer. They reduce mortality rates by about 37%. They are also used in conjunction with other screening tools such as ultrasounds and MRI’s. Mammograms should be done yearly starting at age 40; if you are at a higher risk due to family history or other factors, a baseline should be done at age 35.

Q: What are the differences between and ultrasound and a mammogram? Which is more accurate?

A: An ultrasound is a painless imaging test that sends high frequency sound waves through the breast. They can determine if abnormalities are solid or fluid-filled, but they do not detect actual cancer. They are most effective with dense breast tissue, and they can also give you false – positives (meaning they can say cancer was detected when it actually wasn’t present). A mammogram is when each breast is compressed horizontally and obliquely and an x-ray is taken of each breast. This procedure is not so much painful, but it is uncomfortable for most. Mammograms can give false – negatives (meaning they may not be able to detect something cancerous when it actually is cancer present). It is recommended that both the mammogram and ultrasound be done together.

Q: What is the importance of a biopsy? Does getting a biopsy mean you have breast cancer?

 

A: A biopsy is a procedure where a needle is used to draw sample tissue and/or fluid from a lump to be studied. If you are recommended for a biopsy, it DOES NOT mean you have cancer. However, the results from a biopsy is what determines IF YOU HAVE CANCER OR NOT.

Q: What is the most common type of breast cancer?

 

A: Invasive ductal carcinoma is the most common type of breast cancer. INVASIVE – meaning it has spread to nearby tissue, DUCTAL – meaning it initially presented itself in the ducts of the breast that make milk, and CARCINOMA – meaning a malignant (or cancerous) tumor.

Q: What does ‘invasive’ mean?

A: Invasive means to invade or infiltrate. in regards to breast cancer, it refers to a tumor that has spread or is capable of spreading to nearby tissue and other areas.

Q: What are some common benign types of tumors?

A: Some common types of tumors that are non-cancerous include: fibro adenomas (these are hard/firm areas that move around during a breast exam), breast cysts (these are fluid-filled areas that move around during your menstrual cycle), and pseudolumps (these are hardened areas that don’t change shape or size)

Q: Does everyone receive radiation as treatment for breast cancer?

A: Everyone does not receive radiation as treatment for breast cancer. Treatment options depend on the type of cancer you have, as well as what stage of cancer you are in. Treatment options can be surgical, or they can include a combination of surgery and radiation/chemotherapy/hormonal therapy, etc.

Q: What is the difference between a mastectomy vs. a radical mastectomy?

A: A mastectomy is the surgical removal of one or both breasts. A radical mastectomy is when the breast underlying the chest muscle including the pectoral muscle and lymph nodes extending to the axilla are surgically removed.

Q: Does preventative mastectomies reduce your risk of getting breast cancer?

A: Although more people are now opting for preventative mastectomies to reduce their risk, the mastectomies only remove the breast tissue (unless they are radical mastectomies). If only the tissue is removed, you may still be able to get breast cancer in the lymph nodes.

Q: How is staging determined?

A: Staging is determined by the size of the tumor found in centimeters, the lymph nodes involved, and if the cancer has spread (and its location). there are 4 stages of breast cancer, with sub stages stemming from stage 4.

Q: What is a clinical breast exam and how often should you get one?

A: A clinical breast exam is when a practitioner of physician does your breast exam. These are usually done when a pap smear is done as well. Clinical breast exams should be done every 3 years starting at 20; and every year starting at age 40.

Q: At what age should you get a baseline mammogram?

A: Baseline (first-time) mammograms should be done at 30 – 35 if you are ‘high risk’, and at age 40 if you are average risk.