Author: Erin Pearson

To close out Breast Cancer Awareness month, we reached out to a few Pacific Medical Center care providers with some important questions we could all benefit from.

According to the National Breast Cancer Foundation, on average, every two minutes a woman is diagnosed with breast cancer in the United States. Awareness matters. By being aware, we can better support each other and do what we can to maintain our own health.

Answers provided by: Dr. David M. White, Dr. Christopher Smith and Dr. Sharmila Ahmed.

When talking about breast cancer, we often put the focus on women, but it also affects men. What should people know when it comes to the ways breast cancer impacts both men and women?

Dr. White: Women with a family history, particularly with a genetic component should see their primary care physician at least 10 years before their family member’s (was diagnosed with) cancer to discuss and evaluate. Breast cancer in younger women is on the rise. Men can get breast cancer as well, and approximately 1 percent of breast cancer patients are male. Symptoms for men include breast pain; a mass; nipple changes, including discharge/blood; and breast enlargement. Men who have a family member with a genetic form of breast cancer are at an increased risk.

What advancements are happening in breast cancer treatment?

Dr. Ahmed: Treatment for breast cancer is advancing quickly. The ability to target treatment to a specific genetic mutation has now become increasingly common. Over the past few years, there have been a variety of new advancements for treatments. For advanced breast cancer with a genetic mutation — known as BRCA mutation — another new drug, Talazoparib that targets a particular pathway, was approved in October 2018.

When it comes to prevention, what do you recommend patients do to lower their risk?

Dr. Ahmed: I often get questions about how to prevent breast cancer. My response continues to be that it is important to focus on screening with mammograms and exercise. Diet may also play a role and should be rich in fruits, vegetables, fish, and olive oil. And alcohol consumption should be reduced.

How should people talk to their primary care doctors about their risk for breast cancer? What questions should they be asking?

Dr. Smith: Talk to your doctor about the best screening program for you. Women with an average risk of breast cancer — most women fall under this category — should begin yearly mammograms at age 45. Women should be able to start the screening as early as age 40, if they choose. At age 55, women should have mammograms every other year, though women who want to keep having yearly mammograms should be able to do so. Regular mammograms should continue for as long as a woman is in good health.

In your opinion, what are some of the most common misconceptions about breast cancer that people need to be aware of?

Dr. Ahmed: It is commonly thought that wearing a bra, using underarm antiperspirant, or carrying a cell phone in your bra can cause breast cancer, which is a misconception. (Another misconception is that) breast cancer always gives a sign, such as a lump, and that a mammogram is not needed.

What questions do you hear most often from your patients? And how do you answer those questions?

Dr. Ahmed: We often hear questions about treatment and the side effects. I tell my patients that side effects during treatment are variable. There are four different types of treatments, which include surgery, radiation, hormonal therapy, and chemotherapy. Surgery can cause swelling and discomfort; radiation can cause skin peeling and fatigue; hormonal therapy can cause hot flashes; and chemotherapy has the most side effects, but there are new ways to prevent side effects, including hair loss with the availability of cooling caps. Supportive medications also are given to prevent other side effects. Nowadays, most side effects are tolerated well, and many women continue to work during treatment.

As you may know, 1 in 8 women are impacted by breast cancer in their lifetime, as it’s the most common cancer in American women. Knowing that this is the second leading cause of cancer death in women, treatment is most successful when breast cancer is detected early.

As part of Breast Cancer Awareness Month in October, Dr. David White, MD, FACS from Pacific Medical Centers (PacMed) offers his insight into common misconceptions, for men and women, regarding breast cancer risks, facts and signs. Additionally, he shared that PacMed follows the American Cancer Society guidelines for breast cancer.

Dr. White is a surgeon at PacMed’s Canyon Park, First Hill and Northgate clinics and shares 8 tips regarding breast cancer prevention:

1. Women with a family history, particularly with a genetic component should see their primary care physician at least 10 years before the onset of the family member’s cancer to discuss and evaluate.
2. Breast cancer in younger women is on the rise.
3. Men can get breast cancer as well and approximately 1 percent of breast cancer patients are male. Symptoms for men include breast pain or mass, nipple changes, including discharge/blood and breast enlargement. Men who have a family member with a genetic form of breast cancer are at increased risk.
4. Current treatments are focused on breast conservation when appropriate, which greatly reduces the physical and psychological challenges of surgery.
5. See your physician if you have the following: breast masses or bloody/black nipple discharge. Changes in your own breasts should be taken seriously.
6. Breast cancer screening guidelines are variable, so patients must discuss a breast screening plan individualized for them.
7. Currently, there are many genetic associated breast cancers to scan for.
8. New mammographic techniques have improved the sensitivity of mammograms.

As part of Breast Cancer Awareness Month in October, I chatted with Sharmila Ahmed, MD from Pacific Medical Centers, who answered some of my most asked questions regarding prevention, screening and treatment options for breast cancer. My maternal grandmother passed away in 1996 from her second battle with breast cancer, and my sister began her own battle in 2015 and is now a survivor!

How quickly is breast cancer technology and treatment advancing?

• Treatment for breast cancer is advancing quickly. And screening has improved too! We now have digital breast cancer screening available compared to only routine mammograms.
• For example, we have digital breast scanning known as three-dimensional mammography. Studies show that using this technology can result in a 41 percent increase in the detection of invasive cancer, a 15 percent decrease in recall rates and a 29 percent increase in the detection of all breast cancers. This is available at Pacific Medical Centers and is particularly helpful for women with dense breasts.
• The ability to target treatment to a specific genetic mutation has now become increasingly common.
• Over the past few years there have been a variety of new advancements for treatments. For advanced breast cancer with a genetic mutation known as BRCA mutation, another new drug Talazoparib that targets a particular pathway was approved in October 2018.

What are the survival rates now, and how does that compared to five or ten years ago?

• Based on data from the American Cancer Society it is shown that women with localized breast cancer now have a 99 percent survival rate based on women diagnosed with breast cancer between 2008 and 2014. This is an improvement from survival rates from the 1990s.
• While breast cancer mortality has dropped dramatically since the 1980s, it is thought that improvements in breast cancer treatment are more likely responsible for this reduction in mortality than screening.

What are some of the misconceptions that still linger regarding breast cancer for men and women?
Common misconceptions regarding breast cancer include:

• That only women can develop breast cancer
• You need a family history of breast cancer to get breast cancer
• There are no behaviors or preventative methods to reduce the risk of breast cancer
• Wearing a bra, using underarm antiperspirant, or carrying a cell phone in your bra can cause breast cancer
• Breast cancer always gives a sign such as a lump and that a mammogram is not needed

Knowing that men can get breast cancer too, what is the screening process like for men?

• The screening process for a male is a physical exam. If a lump is detected, it should be followed by a mammogram and a biopsy may also need to be performed.

What are some of the most common questions patients ask you?

• I often get questions about how to prevent breast cancer. My response continues to be that it is important to focus on screening with mammograms and exercise. Diet may also play a role and should be rich in fruits, vegetables, fish and olive oil and alcohol consumption should be reduced.

Knowing that every patient experiences something different while going through treatment, what can someone typically expect (I.E. chemo side effects, etc.)?

• Side effects during treatment are variable. There are four different types of treatments which include surgery, radiation, hormonal therapy and chemotherapy.
• Surgery can cause swelling and discomfort
• Radiation can cause skin peeling and fatigue
• Hormonal therapy can cause hot flashes
• Chemotherapy has the most side effects, but there are newer ways to prevent side effects including hair loss with the availability of cooling caps. Supportive medications are given to prevent other side effects.

Nowadays, most side effects are tolerated well, and many women continue to work during treatment.

What are your thoughts on engaging in ancient methods of medicine (acupuncture, etc.) while going through chemotherapy?

• Acupuncture and massage therapy are helpful for women with breast cancer who are having symptoms of swelling or discomfort. The most recent data shows that acupuncture can reduce the side effects of joint pain caused by aromatase inhibitors drugs.
• Massage therapy is now frequently used after surgery to help patients recover.

What are the current thoughts behind monthly self-breast exams and yearly mammograms? Is this still the best way for early detection?

• The best method for screening women is using a mammogram. We no longer suggest self-breast examinations, as this has been proven to be less effective than mammograms.
• Mammographic scans can be done every one-to-two years depending on each individual’s risk level, group and age. Talk to your doctor to find the right screening program for you.
• PacMed follows the American Cancer Society’s guidelines for breast cancer screening.

Can mammograms come back negative but then also turn out to be something of concern later?

• Unfortunately, mammograms are not perfect and are limited, so it is important to follow-up on symptoms and to repeat testing or do additional evaluations.

How should people handle negative results and keep this in mind for future screenings?

• Having a normal or negative mammogram can be concerning. However, it is important to follow up and continue to participate in screenings to reduce the risk of breast cancer. Approximately 230,480 American women are diagnosed with breast cancer annually, so we all know someone who has breast cancer.
• The majority of breast cancers in the United States are diagnosed as a result of an abnormal screening study, although a significant number are first brought to attention by a patient.

Dr. Sharmila Ahmed is a Cardiologist at PacMed.

As part of October’s Breast Cancer Awareness Month, Pacific Medical Centers is spreading knowledge about the most common cancer in American women—and the second leading cause of cancer death in women. One in eight women is impacted in her lifetime, and treatment is most successful when breast cancer is detected early. Two healthcare providers offer insight into their recommendations and screening advice. (Pacific Medical Centers offers a full suite of diagnostic imaging services.)

Dr. Christopher Smith, MD, FACP explains that women at high risk – because of family history, a breast condition or another medical reason – may need to begin screening earlier and/or more often. Dr. Smith encourages everyone to “talk to your medical provider to be sure about when to start screening.” He also shared that PacMed follows the American Cancer Society guidelines for breast cancer screening.

Dr. Smith’s (Medical Director of Quality and Primary Care Physician) insights for women at average risk for breast cancer:

• Women with an average risk of breast cancer – most women fall under this category – should begin yearly mammograms at age 45.
• Women should be able to start the screening as early as age 40, if they choose.
• At age 55, women should have mammograms every other year – though women who want to keep having yearly mammograms should be able to do so.
• Regular mammograms should continue for as long as a woman is in good health.
• Talk to your doctor about the best screening program for you.

Additionally, Dr. Gurpreet Dhillon, MD shares that the goal of digital mammography is early detection, which reduces deaths, extends life expectancy and improves quality of life. “Screening mammograms have reduced the mortality rate from breast cancer by one third while also enabling less surgery, fewer mastectomies and less frequent or aggressive chemotherapy,” Dr. Dhillon said.

Dr. Dhillon’s (Radiology Physician) insights on 2D vs 3D mammography:

• 3D mammography acquires multiple images of the breast at different angles and allows radiologists to see around overlapping structures.
• When women have mammograms and an abnormal finding is detected, they will be called back for additional imaging. Because 3D imaging eliminates most summation artifacts—or overlapping breast tissue that can resemble cancer—that can often show up on 2D imaging, this results in fewer women being called back.
• Additionally, fewer patients will experience short-term anxiety waiting for their second test results.
• 3D mammography lowers recall rate and has higher cancer detection rates over 2D mammography.
• 3D mammography offers a 41 percent increase in detection of invasive cancer and a 49 percent increase in positive predictive value.