Breast Cancer Answers
We just want to take a break from our usual content to express our support for the amazingly brave Giuliana. She has shown incredible grace and courage this week and we wish her all the best in her fight against breast cancer. Although it’s going to be difficult, we know that she will come out of all this stronger than ever.
In light of the recent events, we felt it is our duty as a leader in health and wellness to share what it really means to be diagnosed with breast cancer and how we can all fight back against this terrible disease. Our partners and friends at Bright Pink connected us with two members of its incredibly knowledgeable, esteemed, and progressive board of advisers — breast surgeon Dr. Kathy Yao and plastic surgeon Dr. Mike Howard. Here are their answers to the questions we all need to know:
Giuliana is still very young. How common is it for a woman under the age of 40 to develop breast cancer?
Approximately 10% of breast cancer is diagnosed in women between the ages of 35 and 44.
What is different about breast cancer in young women versus breast cancer in older women?
Younger women who present with cancer have a higher risk of recurrence but they respond better to chemo than older patients. Tumors in older patients tend to be slower growing. They have estrogen receptor positive tumors and get more benefit from hormonal therapy.
When should women start getting clinical exams and mammograms? Is it ever too early?
Dr. Yao: I would recommend a yearly mammogram starting at 40 unless there is significant family history. If that’s the case, a mammogram should be done at an age that is 10 years younger than the affected relative was diagnosed. Clinical breast exams should be done yearly starting at 40. It’s recommended that women between the ages of 20-39 get a clinical exam every three years, but if someone is high risk then I would start yearly exams at 30.
What is the best way to screen for breast cancer? What new advances have been made in detection?
The best way to screen for breast cancer is still a mammogram. We use an annual MRI to watch high risk patients. There have been no new developments in imaging for screening.
What happens once a woman is diagnosed with breast cancer?
Most women will see a breast surgeon to discuss surgical resection, since this is usually the first step in breast cancer management. After surgical resection, patients will see a medical oncologist and a radiation oncologist to discuss chemotherapy, hormonal therapy, and radiation therapy treatments that will decrease the risk of recurrence.
Note: Because G caught hers early, she will only be needing the mastectomy.
What are the main risk factors when it comes to breast cancer?
If a woman has the BRCA gene mutation (which can indicate up to an 87% risk of breast cancer and a 54% risk of ovarian cancer), family history, use of hormone replacement therapy, previous chest wall radiation (common in childhood cancer survivors), previous breast biopsies especially ones that show atypia or LCIS, and obesity. Less significant factors include early menarche (onset of menstruation), late menopause, being nulliparous (never having given birth to a live baby), and dense breasts.
What are the most popular treatments for breast cancer in young women? How successful are they?
Young patients with breast cancer respond well to chemotherapy. Younger patients also derive benefit from radiation and hormonal therapy (tamoxifen).
A recent paper in the Journal of the National Cancer Institute showed that younger women with estrogen receptor negative tumors who have stage I and II tumors may also benefit from a contralateral mastectomy. Presumably these patients are BRCA carriers and at high risk for subsequent breast cancers.
Note: Because G is opting for a mastectomy, she does not need to go through the other treatments. Catching breast cancer early affords the opportunity to have choices and reduces the need for additional treatment. Early detection truly saves lives.
What exactly happens during a mastectomy?
Mastectomy is a surgical procedure that involves removing the breast tissue — the glands beneath the nipple and skin, above the chest muscles. Depending on how invasive the cancer is, a surgeon may also choose to remove tissues such as the nipple, the breast skin and/or axillary lymph nodes. However, when caught early, modern surgery techniques have made saving external tissue and one’s nipples a possibility. The decision to remove these additional structures is made on a case by case basis, based on each individual’s treatment need.
What is breast reconstruction?
Breast reconstruction is a plastic surgery procedure which replaces the breast tissue removed during a mastectomy. Today, an implant (filled with silicone or saline) or a patient’s own tissue (often referred to as a “flap”) are the basic reconstruction options. Breast reconstruction is generally a very successful procedure with high patient satisfaction.
Is breast reconstruction the same as when a woman gets implants? What is different about implants after a mastectomy versus getting implants for cosmetic reasons?
Breast reconstruction following mastectomy differs from breast implant surgery (or “breast augmentation”) performed electively for cosmetic purposes. In breast augmentation, implants are placed behind the breast gland or behind the chest muscle to enhance the appearance of the existing breast. Breast reconstruction uses an implant or flap to create an entire breast mound, as all of the tissue has been removed. While both procedures may use implants and share similar techniques, substantially different planning is required for the two procedures.
Does having implants (for cosmetic reasons) increase a woman’s risk of developing breast cancer?
No. Large population studies here in the US demonstrated similar, if not lower, rates of breast cancer in women with cosmetic breast implants as compared to those without implants.
Does the double mastectomy and the breast reconstruction happen in the same surgery or is there a period of time the patient goes without breasts?
For the vast majority of women, mastectomy and reconstruction may be done at the same time and reconstruction is started at the time as the mastectomy. For some women, there may be secondary surgeries needed a few months after the initial phase for size, shape, and implant style adjustment. There are very rare occasions, however, when your surgeon may recommend that reconstruction be delayed after mastectomy. This would be thoroughly discussed during consultation with a breast surgeon and plastic surgeon.
Note: G is planning to have it all done at the same time.
For even more information, please visit Bright Pink’s website.
xx, The FabFitFun Team