Ask the Doctor

Do women always need to have surgery when they are diagnosed with breast cancer or are there other treatments?

Surgery is the primary treatment for all breast cancers with only a few exceptions. The exception would be inflammatory breast cancer when the disease is too advanced and chemotherapy and radiation are used to treat the breast and the chemotherapy also treats the remainder of the body for any distant spread of the cancer. Even in these cases if the patient responds she may still get a mastectomy during the course of her therapy to prevent local recurrence in the breast, which can often be quite aggressive. There are many occasions when surgery is the only treatment needed for a breast cancer. We find tumors very early now with screening mammograms. Early non-invasive cancers can simple be removed if not too extensive. Also small invasive cancers in women over 70 years of age can be treated with surgery (lumpectomy) and hormone therapy like Tamoxifen and Arimidex.

– Dr. Arbutina

When or at what age should I talk to my daughter about breast health?

During puberty is a good time to address breast health with young women. Discuss monthly breast exams and how breasts change through the month and during menstruation. They should be made aware that any mass in the breast should be evaluated if the mass persists. A transient mass during a period is of no concern.

Dr. Arbutina

Are skin changes of the breast/nipple a sign of breast cancer?

Dimpling of the skin or retraction of the nipple may be a sign of an underlying breast cancer.  Some people are born with inverted nipples and this is not a problem.  But if a change occurs and the skin dimples or the nipple retracts you should seek medical attention to make sure that it is not a cancer.  Benign inflammation usually causes these symptoms but cancer must be ruled out.

Does diet play a role in breast health?

Diet can indirectly affect breast health. A diet high in fats promotes higher estrogen levels, which can increase the risk for breast cancer. Obesity has a positive correlation with breast cancer; however, there are only small changes in the overall breast cancer risk.

What is stereotactic breast biopsy?

A stereotactic biopsy is a technique that uses a computer to take two mammogram views of a suspicious area and with these two views the computer triangulates the location in the breast and directs the core needle to sample that area. It is like GPS for breast biopsies.

How are breast cysts treated?

Most breast cysts need no treatment. If they look like simple cysts on an ultrasound and are not painful then they do not need care. They may even resolve on their own. Sometimes simple cysts can get painful if they enlarge quickly. These painful cysts can be aspirated in the office easily with no need for any anesthesia. If the cyst is complicated with findings that suggest a solid component, then they may need to be biopsied. Bottom line is, however, most cysts need no care.

Does a woman’s weight play a role in breast health?

A woman’s weight does play a role in the risk for breast cancer. The more fatty tissue a body contains the more estrogen that individual will produce. Estrogen is the main stimulant for breast cancer development and growth. Eating right and maintaining a healthy body size is important for good breast health.

What is sentinel lymph mapping?

Sentinel node mapping is used to sample the lymph nodes most likely to be involved with a particular cancer. Instead of doing a much more invasive procedure that removes 15 to 20 nodes, only 1 or 2 specific nodes can be removed to get the same information. A radioactive protein is injected in the area of the cancer and a special Geiger counter is used to fine the targeted nodes. These nodes are then examined by a pathologist to determine if the cancer has spread.

I have a tattoo on one of my breasts. Will this increase my risk of breast cancer?

Tattoos do not increase the risk of breast cancer. They do stain the lymph nodes, however, so if a patient does develop breast cancer it may make caring for the lymph nodes more difficult but this does not alter the overall prognosis.

I have been taking birth control pills for many years. Does this increase my breast cancer risk?

Birth control pills have not been proven to increase the risk of breast cancer. However, later onset of the first pregnancy and fewer pregnancies does increase the risk of breast cancer very slightly so indirectly the pill does affect breast cancer.