Part 2 in a breast cancer series (read part 1)

Our Fresno surgical oncologist’s tips on fighting breast cancer through screening & unique breast cancer treatment plans

 

Aside from skin cancer, breast cancer is the most common cancer found in American women. According to the American Cancer Society, each woman has a 1 in 8 chance she will develop breast cancer within her lifetime. Approximately 1 in 39 women will die from breast cancer. With these high statistics, it is important that women know the basics about breast cancer signs, screening and treatments.

Spotting breast cancer signs before you can see or feel them: the mammogram

As with any cancer, early detection is key to less treatment and better quality of life. Although it is important to conduct self-screenings and pay attention to any change in look, feel and discharge, we want to find your cancer before you can feel it. The best way to do that is by getting your mammogram.

Patients, family members and fellow physicians have all asked me when they should begin receiving mammograms. This question is difficult because the different medical societies don’t agree. It depends on why you are screening and what your likelihood is of getting cancer.

Differing views on when to initiate mammograms

Generally, national screening guideline recommendations are made by looking at survival rate and comparing it to the cost of screening and false positives, not how many lives mammograms can save. This has led to the suggested age range of 50 to 74 (on average, 10 years before end of life) for mammogram screenings, with mammograms every other year.

However, if you look at the American Society of Breast Surgeon’s guidelines and the National Comprehensive Cancer Network (NCCN) guidelines, they recommend mammograms starting at age 40 because there’s a 15% increase in survival if cancer is found earlier. With earlier testing there are more false positives (showing cancer that is actually not there), which requires callback imaging and biopsies that end up negative. These false positives are due to denser breast tissue found in younger women.

We see this give-and-take and try to balance early detection with the cost and stress of false positives. To do that effectively, we often need to individualize screening guidelines.

 Related Reading: Navigating mammogram guidelines

Why family genetics and history factor into breast cancer screenings

I suggest you learn more about your family history of cancer and genetics in order to properly assess your individual threat. This will tell you how diligent you should be in checking for breast cancer signs, and how early and often you should get your mammogram. Although the genetic testing will have to be performed by a professional clinician, you can do your part by learning about your first-degree relatives’ genetic predispositions. First-degree relatives include your mother, sisters, grandparents and daughters.

If you are in any of the following situations, you are at higher risk and should consider beginning screenings at a younger age and having mammograms annually instead of every two years.

• You have a first degree relative with breast cancer or multiple second-degree relatives with breast cancer.
• You already have a known genetic defect.
• You have had a previous cancer biopsy for any reason.
• You had atypia (structural abnormality in a cell) on a biopsy.

Better breast cancer treatment through a unique plan

Breast cancer treatment plans are as unique as the person being treated. Don’t compare your treatment to others who have had cancer. Do ensure, however, that you have a trustworthy and multidisciplinary team that can come at your cancer from all angles and find the best treatment plan for you.

We have made giant strides in breast cancer treatment. In the past, surgery for breast cancer would remove much larger amounts of tissue, including the chest wall muscle, skin and all lymph nodes above and below the clavicle. This technique left women maimed and in great discomfort.

Now we can give neoadjuvant chemotherapy to shrink the tumor to nearly nothing, allowing us to perform a lumpectomy (removal of a tumor and surrounding tissue only) instead of a mastectomy (removal of the breast). When a patient does need a mastectomy, we now offer reconstruction and can sometimes even save the nipple.

One of these things is not like the other

It’s important to remember you shouldn’t avoid certain treatments just because someone you know underwent the same treatment and experienced side effects. Every person’s body is different, and this doesn’t mean you are sure to have side effects as well.

 Related Reading: Dr. Bessudo Weighs in on New Breast Cancer Research

Managing the side effects of breast cancer treatment

The primary treatment methods for breast cancer are surgery, radiation, chemotherapy, antihormone therapy and targeted therapy. These may be used in combination.

Here I want to focus on ways to avoid, manage and heal from some of the side effects of breast cancer treatment from a surgical perspective. There are several steps you can take to make treatment and recovery much more comfortable.

Stretch and lotion

When it comes to radiation, I give patients two pieces of advice. Stretch and use lotion. Radiation is like taking a rubber band and setting it out in the sun: your tissue becomes very tight. Incorporating stretching into your daily activities can help return your tissues to normal elasticity. Swimming and yoga are great exercises to try, or you can stick with simple stretching. No matter how you decide to stretch, do it reliably.

Before and after radiation, treat your skin to a good, thick lotion like cocoa butter with vitamin E. Imagine you are treating a sunburn, as that is essentially how radiation affects the skin. The more you moisturize, the better your skin will look and feel, immediately and years later. Stiffening of the skin from radiation can occur six months to a year after the actual treatment, so what you do right after treatment affects how you look and feel later.

Watch out for lymphedema

Another possible side effect of breast cancer treatment is lymphedema. This occurs when there is a disruption of the lymphatics of the arm during a dissection underneath the armpit. Lymphedema shows up in about 5% of patients who undergo a sentinel lymph node procedure, which is removal of one to three lymph nodes. The chance of lymphedema is as high as 20%-40% when you remove more of the lymph nodes with an axillary dissection and/or add radiation to the axilla lymph nodes.

Look for signs of swelling in the hand and arm as well as the feeling of heaviness. Seek treatment right away if you see these symptoms. Treatment may include lymph drainage or a compression sleeve.

Lifestyle changes to avoid breast cancer recurrence

While proper cancer treatment and management of the side effects from this treatment are very important, it is equally important to make proper lifestyle changes to avoid the return of breast cancer. Here are a few things you can do to improve your overall health and help prevent recurrence.

• Maintain a normal BMI (body mass index): Extra estrogen from excess fat can increase the chance of getting cancer.
• Exercise: This helps you maintain a normal BMI.
• Avoiding excess alcohol also helps maintain a normal BMI.
• Avoid long-term hormonal replacement therapy: Take the lowest dose for the shortest amount of time.
• Don’t smoke. Although this has a closer link to lung cancer, tobacco smoke is a carcinogen that causes abnormal cells and may be linked to additional cancers. Smoking has a dose effect, so stop now! A healthy, tobacco-free body also helps with the surgical process.