Breast Cancer Awareness Columns

Breast Conservation vs Mastectomy

For decades it has been thought that lumpectomy and radiation was equivalent to mastectomy in the treatment of early breast cancer. Equivalent in that no matter which procedure is done, the long term survival from breast cancer is the same. Today the evidence is tending to show that breast conservation with lumpectomy and radiation may even have a better survival benefit than mastectomy. So why are more women opting for mastectomy if it doesn’t mean longer survival? Some patients require mastectomy. Patients with a genetic predisposition can have up to an 85% chance of developing breast cancer. These patients require prophylactic mastectomies to prevent the development of a future breast cancer which could threaten their lives. Patients with extensive cancers that are too large for lumpectomy require mastectomy. Mastectomy may be the only option in patients with multi-centric breast cancer which means disease is in more than one quadrant of the breast or patients with recurrent breast cancer. However, the majority of breast cancer patients do not require mastectomy. The “Angelina Jolie” trend began when this famous actress opted for bilateral mastectomies with reconstruction after she was diagnosed with the breast cancer gene. But most breast cancers are found in an early stage and only 5% of breast cancer patients have the genetic mutation. In these patients breast conservation is still the best choice. There are less risks of complications and breast conservation may result in better survival. Lumpectomy with radiation is still the treatment of choice for early breast cancer.

How To Deal With Stress

The holiday season should be a time of love, cheer, and joy. Personally speaking, I find myself becoming stressed out. Planning holiday parties, cleaning the house, and trying to find the perfect gift for a long list of family and friends can be exhausting. Most of the times, I actually look forward to the end of the holidays. This year I decided to try the following tips to help manage my stress:
• Explore the true meaning of the holidays.
• Take time for yourself.
• Get organized. Make a list and prioritize.
• Delegate chores to other family members.
• Since money can be major contributor to stress try the following; buying only what you need, limit eating out, shopping for bargains, and making handmade gifts (they are more personal).
• Be aware of your own state of health. If you think you are feeling down or stressed, then do something about it. It’s okay to seek out professional help!
• When making time for your family and friends, enjoy movie and game nights at home.
• Incorporate a healthy nutritional diet and exercise into your life. Exercise increases neurotransmitters in our brain that produce euphoric effects on the body!
• Have fun and enjoy the moment!
At the BCWHI, we recognize how important it is to help others in achieving an optimal state of health.

Please visit our BCWHI webpage on other helpful articles on living a healthy life.

Women Should Begin Annual Screening Mammography at Age 40

Women Should Begin Annual Screening Mammography at Age 40 Until recently there was only one standard for breast cancer screening in the United States: for women of average risk for breast cancer begin screening mammography at age 40 and undergo mammography annually. Now we have other guidelines from different institutions in the healthcare field, resulting in confusion in the general population. The American College of Radiology continues to endorse the original guidelines as detailed above. Here are a few important reasons why starting mammography later or having fewer mammograms is a bad idea: One in six breast cancers occur in women ages 40-49. Scientists best studies show that, for women ages 40-84, there is a 40% reduction in breast cancer death for those who participate in annual screening compared to those who do not. Even the institutions that have changed their recommendations acknowledge that the risk of breast cancer increases substantially for women beginning at age 40. These institutions acknowledge that mammograms save lives in women ages 40 and older. For women who choose to follow different screening guidelines, the protection afforded by screening mammography decreases. For example, for a woman who chooses the US Preventive Services Task Force recommendations of undergoing biennial screening ages 50-74, the mortality reduction is 23%. The American Cancer Society’s recommendations offer a 33% reduction. endtheconfusion.org is an excellent resource for more information on breast cancer screening. The best protection against breast cancer is to stick to the original guidelines!

MEN CAN GET BREAST CANCER

It is a rare occurrence but men can get breast cancer.  This happens in one out of a hundred cases.  When it happens the prognosis depends on the stage and grade of the cancer, just like in women.  And it is treated in a similar fashion with mastectomy, lymph node sampling, possible radiation, chemotherapy and hormone therapy if indicated.

 

Male breast cancer is usually detected as a painless lump.  Once a breast lump is found, men can get mammograms too, to determine the nature of the lump.  A core needle biopsy is often the next step.  Because of the limited amount of male breast tissue, these procedures are usually easier to perform than the same procedure in women.

 

Unfortunately, men can be carriers of the BRCA mutation for breast cancer.  If a parent has this gene, 50% of their offspring will also get the mutation.  Men that have a BRCA mutation are at much higher risk and have a 1 in 8 chance of developing breast cancer.  These men are also more prone to prostate cancer which because of the BRCA mutation are more aggressive cancers.  So if a sibling, parent or child has the gene, men should be checked for BRCA status.  On the other hand, because male breast cancer is so rare without the gene, all men with breast cancer should be check for a BRCA mutation.

 

Bottom line, if a man finds a lump in his breast he should seek medical attention.

Circadian Rhythm Interrupted

It’s that time of year again when we turn our clocks back one hour. Most people are happy to get an “extra hour” of sleep that night. Unfortunately, daylight saving time may affect your body in several ways. The body’s internal clock is a warehouse of neurons. These neurons are housed deep inside the brain fueling the circadian rhythm. The circadian rhythm is the mental, physical, and behavioral changes that the body follows in a 24 hour cycle. The 24 hour cycle responds primarily to light and darkness in our environment. When the body’s circadian rhythm is interrupted, the effects may include: fatigue, agitation, and Seasonal Affective Disorder (SAD). SAD is a form of depression that occurs in about a half a million Americans during daylight saving time. At the BCWHI, we want you to feel your best at all times. The following tips may help with “falling back.” • Get a good night sleep. Make your sleeping environment a relaxing, dark room. • If you have trouble falling asleep, ask your doctor if it’s okay to take a natural, supplement, such as a low dose Melatonin. • Rather than sleeping in, wake up at your normal time. Sleeping in may cause you to feel more fatigued during the day. • Eat a nutritional healthy diet. Foods containing high amounts of sugar, fat, salt, and caffeine may interrupt sleep. • Incorporate exercise in your daily routine. Exercise helps to jump start the body and produces euphoric effects on the body. • Your body will eventually adjust to the time change. If it does not, call your primary care physician.

Sentinel Lymph Node Mapping

David Arbutina, M.D., FACS

To determine the stage of a cancer, lymph nodes are removed to see if the cancer cells have the ability to grow outside the tissue of origin.  If cancer cells are found growing in the lymph nodes, it signifies that the cancer can grow in other organs.

Historically, lymph nodes were removed based on anatomic location requiring extensive surgery with possible adverse effects.   Removing only the first lymph nodes which drain a cancer site, known as a sentinel lymph node biopsy, is much less likely to cause problems while still answering the important questions.

To find the sentinel node, a tracer of either blue dye, radioactive sulfur colloid or both are injected near the tumor.  These first nodes can then be found using a Geiger counter or surgically exposing the area.  The radioactive tracer can be injected up to 24 hours prior to surgery.  The blue dye is usually injected in the OR at the time of surgery.   Frozen section of the lymph node for immediate pathologic assessment is no longer necessary.

Today, local anesthetic is mixed with the tracer to prevent the burning pain which was the major patient complaint about the procedure.  Studies have shown local does not alter the accuracy of the test.

A positive sentinel node with breast cancer is now frequently treated with only radiation to complete the therapy of the remaining nodes.  However, with melanoma, a positive sentinel node still requires the extensive removal of adjacent nodes but even this practice is being questioned by ongoing research.

SENTINEL LYMPH NODE BIOPSY

David Arbutina M.D., FACS

Lymph nodes act as filters for your body. Arteries deliver nutrient rich blood to the cells. The nutrients are deposited with fluid called lymph which is left behind as the veins return the blood to the heart.  The lymph then travels through tiny capillary like vessels and eventually returns to a large vein in the neck. Since it is returning from tissues like the skin it often contains substances such as bacteria. The lymph nodes act as a protective barrier between these harmful substances and the bloodstream. In essence, they act as guards or sentinels to protect our bodies from harm.

Returning lymph can also carry cancer cells. These cancer cells often get caught in the lymph nodes. If the cancer cells have the ability to enter lymph nodes and grow this signifies a more aggressive cancer which may metastasize elsewhere.  This finding is one of the basis for staging cancer to help determine prognosis and treatment.

Only 15 years ago removing a large area of lymph nodes, referred to as a dissection, would have been undertaken to determine whether the lymph nodes contained cancer cells.  This technique could result in nerve damage, deformity and permanent swelling of the extremity.  Today, by using a selective technique with radioactive markers and a special Geiger counter we can remove only one or two lymph nodes to give us the same vital information. This technique called the sentinel lymph node biopsy has dramatically reduced the complications associated with staging cancer.

Obesity

 

Obesity has been a very heavy topic for the last decade. Have you ever wondered what the medical definition is of obesity? Adult obesity is defined as having a body mass index (BMI) over thirty percent. There are many contributing factors for the increasing rate of obesity in America. Two of the major causes include: lack of physical exercise and poor eating habits.

Most people live a very fast paced and chaotic life; making it difficult to eat  healthy and exercise. It is much easier to stop at a drive through at a fast food restaurant than to cook a nutritionally balanced, healthy meal. At the Breast Cancer & Women’s Health Institute, we are here to help you towards your journey to lose weight. Here are some helpful tips that may help:

Get physician approval before starting any exercise or nutritional program!!!

Ask your doctor for Physical/Occupational (PT/OT) evaluation to determine what your level of exercise should be.

If you are able, walk a little more every day.

Begin with simple, low impact exercise in your home.

Be aware of what you are eating, eat healthy foods and limit your portion sizes.

If you have no dietary restrictions, include more fresh fruits and vegetables in your diet. Avoid foods high in fats and cholesterol.

Surround yourself with positive people who will encourage and support your efforts.

Believe in yourself! You can do this!

BCWHI wishes you the best of luck in your weight loss goals!

Lymphedema

Lymphedema is an abnormal swelling of a body part due to an accumulation of lymph fluid.  Lymph is a colorless fluid which collects and removes waste products from the tissue spaces.  This fluid is absorbed into the lymph vessels and transported to lymph nodes for filtering before returning to the bloodstream.   Lymph nodes exist in clusters throughout the body.  Unlike the blood which is pumped by the heart, the lymphatic system relies on muscle activity to move the fluid.  Lymphedema generally involves an impairment of the lymphatic system resulting in poor circulation of the lymph.

PRIMARY LYMPHEDEMA, by definition, arises from unknown causes, and in some instances is congenital.  SECONDARY LYMPHEDEMA arises as the result of damage to components of the lymphatic system the most common being cancer that blocks the lymphatics and other examples include sports injury, surgery, trauma or infection.

SIGNS & SYMPTOMS:

  • Tightness, swelling or thickening anywhere in the extremity. Initially the swelling may fluctuate but over time it worsens.
  • Complaints of heaviness or aching of the extremity.
  • Inability to wear rings, jewelry, watches or clothing secondary to edema.

Lymphedema therapy is most effective when the condition is treated early.  It is vital that treatment be done by a health care professional, certified in one or more of the recognized decongestive therapy techniques.  The goal of therapy is to route the fluid to functional pathways, prevent backflow as the new routes become established, and use the most appropriate methods to obtain the reduction of the limb after therapy is complete.  Certified therapists have had intensive training to learn the anatomy and physiology of the lymphatic system and know how to route the fluid to functional pathways using manual techniques.

The Shared Medical Appointment

David Arbutina, M.D., FACS

Hearing that you have breast cancer is a devastating occurrence.  It provokes a whirlwind of worry, anxiety and finally a resolve to move on with therapy.  Much of what the patient is initially told about their disease is lost because of anxiety.  Hopefully, a patient is educated about her disease and makes the right therapy choices.  But when the initial therapy is complete, the worry and anxiety go on.  In the back of every cancer patient’s mind there is that nagging concern of whether any cancer remains.  The shared medical appointment is one way we at the Women’s Health and Breast Cancer Institute help women cope with this underlying fear.  Knowledge is the key and this is one way to keep informed.

The shared medical appointment is set up for 5 to 8 breast cancer patients who are returning for their surveillance follow up visits.  These visits are necessary to look for any signs of possible recurrence of their initial cancer and to screen for new breast cancers which these patients are at higher risk.  The patient exams are individual as always.  Questions, however, are addressed as a group.  This group involvement gives the women a chance to see that they are not the only patients with unanswered questions.  It also stimulates questions from the subconscious which when answered allows the group to leave feeling better about their diagnosis.  The more the patient knows about breast cancer the lower their anxiety which actually improves their prognosis.