PROACTIVE BREAST CARE 101 Candy Warinner

Transcription

1 PROACTIVE BREAST CARE Candy Warinner My name is Candy Warinner and I am a breast cancer survivor. My story began with my first breast biopsy at the age of twenty. At age thirty-two my OB/GYN sent me to a general surgeon who specialized in breast disease and breast surgery. I was sent to him because my breasts were very cystic and therefore difficult to interpret on a mammogram. Doing a clinical breast examine was challenging also. I spent the next twenty years having mammograms, breast ultrasounds, biopsies and eventually MRI s as part of my yearly screening. I began to read articles on breast cancer because in the back of my head I heard a voice that seemed to be telling me, educate yourself now about breast health, screening and breast cancer. I learned that I needed and already had a doctor who specialized in breast disease but I needed more people on my team. I continued to see the same radiologist who had been recommended and whom I felt was very knowledgeable in breast screening. I believed that my doctors needed to know my breast health not just treat it. I learned that with my particular breasts maybe a mammogram wasn t conclusive and to question my doctor whether I needed to have a breast ultrasound added to my yearly screening. My doctor and I were both on the same page and that became my yearly screening plan. I also saw my breast doctor every six months to evaluate my findings on my monthly self breast exam. If I needed to see him sooner then I would make the call and go in. As my breasts and my breast pathology started to change I began seeing him every three months. I eventually started having MRI s on a yearly basis also. In July of 2006 I was diagnosed with DCIS (duct carcinoma in-situ) high grade. Even though I had secretly anticipated the diagnosis I still had a hard time comprehending, you have breast cancer. Because of all the breast issues I had experienced over the years I opted for bilateral mastectomies with reconstruction. My cancer was in the left breast but I had been diagnosed in the right breast with ADH (atypical ductal hyperplasia). The final pathology in both breasts was negative for invasive cancer and sentinel nodes were negative also. My journey which had begun so many years ago had come to an end. Being proactive and educated about breast health had paid off. Empower yourself today. Don t wait until you hear the words, you have breast cancer, to start educating yourself. Start today and it will truly be beneficial to your tomorrow. Candy Warinner candy.warinner@carondelet.com

2 Definition of Medical Terms Related To Breast Cancer Adjuvant therapy- treatment given after the primary treatment to increase the chances of survival. It may include chemotherapy, radiation, hormone therapy, or biological therapy. Aspirate- fluid withdrawn from a lump (often a cyst) or a nipple. Axillary lymph node- a lymph node in the armpit region that drains lymph channels from the breast. Axillary lymph node dissection- surgery to remove lymph nodes found in the armpit region. Biological therapy- treatment to stimulate or restore the ability of the immune system to fight infections and other diseases. Biopsy- the removal of cells or tissue for examination by a pathologist. Calcifications- on a mammogram, breast calcifications can appear as large white dots or dashes (macrocalcifications) or fine, white specks, similar to grains of salt (microcalcifications). Carcinoma in situ- cancer that involves only cells in the tissue in which it began and that has not spread to nearby tissues. Chemotherapy- treatment with drugs that kill cancer cells. Clinical breast exam- an exam of the breast performed by a health care provider to check for lumps or other changes in the breast. Core biopsy- the removal of a tissue sample with a needle for examination under a microscope. Cyst- a sac or capsule in the body, it may be filled with fluid or other material. Ductal carcinoma in situ- a noninvasive cancer in which abnormal cells are found only in the lining of the milk duct of the breast. Excisional biopsy- a surgical procedure in which an entire lump or suspicious area is removed for diagnosis. Fine needle aspiration- the removal of tissue or fluid with a needle for examination under a microscope. Her2- positive breast cancer- a breast cancer that tests positive for a protein called human epidermal growth factor receptor 2 (Her2), which promotes the growth of cancer cells. HER2-positive breast cancers tend to be more aggressive that other types of breast cancer. Hormone- A chemical made by the glands in the body. Hormone therapy- treatment that adds, blocks, or removes hormones.

3 Incisional biopsy- a surgical procedure in which a portion of a lump or suspicious area is removed for diagnosis. Invasive breast cancer- cancer that has spread beyond the layer of tissue in which it developed and is growing into surrounding healthy tissues, also called infiltrating cancer. Lobular carcinoma in situ- a condition in which abnormal cells are found in the lobules of the breast. Some authorities consider this a pre- cancer. MammoSite- is a targeted radiation therapy that works from the inside, meaning that a higher daily dose can be used for a shorter period of time- 5 days vs. 5-7 weeks. MammoSite places the radiation source inside the lumpectomy cavity (the space left when a tumor is removed) This delivers radiation to the are where cancer is most likely to recur. Metastasis- a spread of cancer from one part of the body to another. Neoadjuvant therapy- treatment given before the primary treatment, may include chemotherapy, radiation or hormonal therapy. Oncotype Dx- is a test that examines a breast cancer tumor tissue at a molecular level, and gives information about a patient s individual disease. This information can help individualize breast cancer treatment planning and identify options. Radiation therapy- the use of high-energy radiation from x-rays, gamma rays, neutrons, and other sources to kill cancer cells and shrink tumors. SAVI- an evolution in radiation therapy for early-stage breast cancer. Delivering treatment from inside the breast, SAVI uses multiple catheters to direct radiation where it is needed most. This unique design allows for unparalleled dose sculpting ability that minimizes exposure to healthy breast tissue and reduces complications. Sentinel nodes- the first lymph node(s) to which cancer cells are likely to spread from a primary tumor. Stereotactic biopsy- a biopsy procedure that uses a computer and a 3-dimensional scanning device to find a tumor site and guide that removal of tissue for examination. References: What you need to know about breast cancer, U.S. Department of Health and Human Services 100 questions & answers about breast cancer, Zora K.Brown and Harold P. Freeman MD and Elizabeth Platt. Genomichealth.com Mayo Clinic.com Cianna Medical.com Mammosite.com

4 PROACTIVE BREAST CARE 101 EDUCATING AND EMPOWERING WOMEN Questions most asked by women: 1. If I have no family history of breast cancer, am I still at risk? Yes, over 85% of diagnosed breast cancers there is no family history. 2. If I do have a family history do I only worry if it s on my mother s side? You need to know your family history on both sides. 3. At what age do I need a mammogram? The American Cancer Society recommends that most women begin getting mammograms at the age of 40 and continue yearly afterwards. 4. Does breast cancer hurt? If it progresses, cancer can be a very painful disease. But if you wait for breast cancer to hurt, you might not catch in time. Breast cancer rarely hurts, says Christy Russell, MD, an associate professor of medicine at the Keck School of Medicine at the University of Southern California, chief of medicine at USC/Norris Cancer Hospital, co-director of the USC/Norris Breast Center, and a spokeswoman for the American Cancer Society. Most breast cancers appear as a non-painful lump. That does not mean that if you have a painful lump it s not breast cancer, but that is a very unusual symptom. 5. Can trauma to the breast cause breast cancer? No, injury is not associated with the development of breast cancer. Often a woman will injure her breast to find a cancer shortly thereafter. The reality is that a cancer is more prone to bruising and bleeding. Do antiperspirants cause breast cancer? There is no reliable evidence to support this rumor. 6. Do men develop breast cancer? Even though breast cancer mostly affects females, men can develop breast cancer. If a male discovers a lump or any abnormality, such as dimpling of the breast or nipple discharge, they need to see their doctor and have a mammogram and/or breast ultrasound. A biopsy may be warranted. 7. Can breast cancer come back? It is important to remember that not every woman who has had breast cancer will face a recurrence. A recurrence can be a local, regional or distant. A local recurrence is in the vicinity of the initial tumor. A regional recurrence is in the lymph nodes within the region of the original cancer. A distant recurrence occurs at a distance from the original site (for example, in bone, liver or brain). 8. Are self breast exams that important? Yes. Breast self-exam (BSE), or regularly examining your breasts on your own, can be an important way to find a breast cancer early, when it s more likely to be treated successfully. Not every cancer can be found this way, but it is a critical step you can and should take for yourself. 9. Clogged milk duct or breast cancer. Taken from exploringwomanhood.com is a story of a young mother. Susan Lloyd felt a lump in her breast. She was weaning Abbie, her daughter, and thought it might be a clogged milk duct. However, when the lump didn t go away, she went to the doctor. Unfortunately, at age 29, with a 3-yearold son and a 4-month old daughter, Susan was diagnosed with breast cancer. Even though this may not be the norm, be vigilant and if necessary persistent in your breast care. References: Everydayhealth.com American Cancer Society Susquehanna Health About.com Breast Cancer Breastcancer.org Exploringwomanhood.com

5 Risk Factors for Breast Cancer 1. The number one risk factor for breast cancer is being a woman. 2. Women who started their menstrual periods under age 12 and ended after age 50. This exposes women to many more years of estrogen and progesterone. 3. Women who have never been pregnant or had their first child after age 30 have a slightly higher breast cancer risk. Having many pregnancies and becoming pregnant at a young age reduces breast cancer risk. Pregnancy reduces a women s total number of lifetime menstrual cycles, which may be the reason for this effect. 4. Obesity. Excess fat elevates estrogen levels. 5. Alcohol The use of alcohol is clearly linked to an increased risk of developing breast cancer. Women who consume 1 alcoholic drink a day have a very small increase where as women who have 2-5 drinks daily have about 1and a half times the risk of women who drink no alcohol. 6. Breast cancer risk is higher among women whose close blood relatives have been diagnosed with the disease. 7. About 5% to 10% of breast cancer cases are thought to be hereditary, resulting directly from gene defects (called mutations) inherited from a parent. 8. The most common cause of hereditary breast cancer is an inherited mutation in the BRCA 1 and BRCA 2 genes. In normal cells, these genes help prevent cancer by making proteins that keep the cells from growing abnormally. If you have inherited a mutated copy, (cells now abnormally growing) of either The BRCA 1 or BRCA 2 from a parent, you have a high risk of developing breast cancer during your lifetime. The risk may be as high as 80% for members of some families with the mutations. Women with these mutations also have an increased risk for developing ovarian cancer. 9. Jewish women of Ashkenazi (Eastern Europe) origin have an increased risk of carrying the BRCA 1 or BRCA 2 mutation. 10. Overall white women are slightly more likely to develop breast cancer than are African-American women, but African-American women are more likely to die of this cancer. Asian, Hispanic, and Native-American women have a lower risk of developing and dying from breast cancer. 11. Women who, as children or young adults, had radiation therapy to the chest area for another cancer have a significantly increased risk for breast cancer. Breasts are more susceptible to damage from radiation when given during adolescence. Radiation treatment after age 40 does not seem to increase breast cancer risk. 12. Using combined hormone therapy, (estrogen and progesterone) after menopause increases the risk of getting breast cancer. The increase in risk can be seen with as little as 2 years of use. Combined HT (hormone replacement therapy) also increases the likelihood that the cancer may be found at a more advanced stage. The increased risk from combined hormone therapy appears to apply only to current and recent users. A woman s breast cancer risk seems to return to that of the general population within 5 years of stopping combined treatment. 13. The use of estrogen alone after menopause does not appear to increase the risk of breast cancer significantly, if at all. But when used long term (more than 10 years), estrogen replacement therapy has been found to increase the risk of ovarian and breast cancer in some studies. References: American Cancer Society

6 Screening tools for detecting breast cancer: Mammograms, Ultrasound and Magnetic Resonance Imaging 1) Mammograms: For women with dense breasts a digital mammogram increases the ability to detect abnormalities in the breasts. 2) Breast ultrasound: A breast ultrasound uses sound waves to make a picture of the tissues inside the breast. A breast ultrasound can show all areas of the breast, including the area closest to the chest wall, which is hard to study with a mammogram. A breast ultrasound is used to see whether a breast lump is filled with fluid (a cyst) or if it is a solid lump. 3) 3D Mammography (Tomosynthesis): This new type of mammography produces a 3D image of the breast, providing doctors with a clearer view through overlapping breast tissue. The result is a more detailed picture, making breast abnormalities easier to see, even in dense tissue. 4) 3D Ultrasound: Three-dimensional (3D) power Doppler ultrasound helps radiologists distinguish between malignant and benign breast masses, according to a study published in the November issue of Radiology. Using 3D scans promises greater accuracy due to more consistent sampling over the entire tumor, said the study s lead author. 5) MRI or Magnetic Resonance Imaging: In breast MRI, a radiologist will use a scanner to capture many cross-sectional images of the breast. A computer will compile these scans into 2-D and 3-D images. During the imaging process, contrast dye is given intravenously to highlight lesions and masses that otherwise may not be visible in a mammogram. References: Mayo Clinic University Hospital Mayo Clinic Web MD Health Imaging JCL.com (John C. Lincoln) Save a Life Today! It maybe YOUR own!

7 QUESTIONS TO ASK YOUR DOCTOR The more informed you are the better equipped you will be to make informed decisions regarding your healthcare. DIAGNOSIS What stage is my breast cancer? Has the cancer spread to my lymph nodes or to other parts of my body (metastasis)? Am I node negative or node positive? How does my node status affect my risk for recurrence? Is this a new cancer or a recurrence? If this is a recurrence of my previous breast cancer, is the recurrence local, regional, or distant? What does this mean for my treatment and outlook? What treatment choices are appropriate for my stage of cancer? Are there any other medical issues I should know that could affect my breast cancer treatment? TUMOR TESTING What kind of tests will be done on my tumor? Row will the test results affect my treatment options? Is my breast cancer hormone receptor positive (estrogen and/or progesterone receptor positive)? Will this affect my treatment options? Is my breast cancer HER2/neu positive? Will this affect my treatment options? SURGERY What type of surgery do you recommend and why? Are there other surgical options for me? Can breast reconstruction be performed at the time of surgery or later? What can I expect with surgery? What are the side effects I can expect with surgery? Where will my surgery be done? How long will I be in the hospital? How long will it take to recover? After my surgery, what kind of follow-up care will I receive? RADIATION Do you recommend radiation therapy and why? How many radiation treatments will I receive? How long will treatment take? How will the radiation be given? What are the side effects I can expect with radiation therapy? What do you recommend for managing the side effects of radiation therapy? After I finish radiation, what kind of follow-up care will I receive? CHEMOTHERAPY Do you recommend chemotherapy and why? What type of chemotherapy do you recommend and why? How will chemotherapy be given? How many chemotherapy treatments will I receive? How long will my treatments take? What are the side effects of chemotherapy? Will these side effects last a long time? After I finish chemotherapy, what kind of follow-up care will I receive?

8 HORMONAL TREATMENT Do you recommend hormonal treatment and why? What kind of hormonal treatment is best for me and why? When will I start the hormonal treatment and how long will I need to take the hormonal treatment? How will the hormonal treatment be given? What are the side effects of hormonal treatment? Will these side effects last a long time? What do you recommend for managing the side effects of hormonal therapy? Will I need follow-up care after hormonal treatment and for how long? RECURRENCE What is my risk for recurrence? What steps can I take to help reduce my risk of cancer coming back? What symptoms might indicate a breast cancer recurrence? What is my risk for other types of cancer? Is there anything I can do to reduce that risk? Will I need tests to screen for cancer and how often? Do I need to change my diet? Can a nutritionist help me with this? References: "Understanding Breast Cancer and Treatment Options," provided as an educational service by Astra Zeneca. Recommended Books: Breast Cancer for Dummies by Ronit Elk,PhD and Monica Morrow,MD Dr. Susan Love's Breast Book by Susan M. Love,MD with Karen Lindsey Bigger Than Pink by Lori C. Lober,CSP MIRM with Lara Moritz - an excellent book of one woman's journey diagnosed with stage 4 breast cancer and her determination to fight for her life using complementary medicine combined with traditional treatment. EDUCATION IS EMPOWERING!