By TOAN NGUYEN, MD, AND VANESSA PROWLER, MD
At Hollis Cancer Center, we are committed to providing you and your family with compassionate care centered on you and your needs. Certain questions seem to be on everyone’s minds, so we want to provide peace of mind by answering more commonly asked questions. Our first set of questions and answers can be found here.
QUESTION: What does having dense breast on a mammogram signify?
ANSWER: About 50% of the population has dense breast on mammography, and 10% of women have extremely dense breast tissue. Dense breasts can make it harder for your radiologist to detect small cancers because dense tissue and small cancers often have the same appearance on a mammogram. Additionally, having dense breasts on a mammogram increases your risks of developing breast cancer. There are additional screening methods available if you have dense breasts.
QUESTION: Are self-exams recommended?
ANSWER: While there are no studies that prove self-exams per se improve survival, we recommend that all women should be familiar with their breast tissue. If you feel a lump or notice a change in the breast or armpit, you should notify your doctor for an evaluation, even if you have a normal mammogram.
QUESTION: Is there an age to stop screening mammograms?
ANSWER: There is no exact age to stop screening mammograms. The risks of developing breast cancer increases with age. Most expert guidelines suggest stopping screening mammograms if a patient has less than 10 years of life expectancy.
QUESTION: Should I be tested for the BRCA and other breast-cancer related genes?
ANSWER: About 10% of breast cancers occur because of a mutation in one of your genes. That means that most breast cancers are not caused by a genetic mutation. There are certain conditions that would make a doctor more suspicious that you carry that mutation or if there is a significant family history of breast or other cancers. You should discuss with your doctor to determine this likelihood.
QUESTION: What should I do if I have a mutation in the BRCA gene?
ANSWER: If you have tested positive for a mutation in the BRCA gene or one of the other high risk genes, talk to your doctor about options for screening of the breasts and other potentially affected organs. There are surgical and medical options to reduce your risks of developing cancer. Additionally, your first degree relatives may also carry this mutation so it is important to share this finding with them so they can also discuss risk-reducing management with their doctors.
QUESTION: Should I undergo a lumpectomy (removing only the tumor) or a mastectomy (removing the entire breast)?
ANSWER: Patients diagnosed with breast cancer often have the surgical choice between a lumpectomy or a mastectomy. In patients with tumors less than 5 centimeters, there is no proven survival advantage of a mastectomy. A lumpectomy usually requires radiation to the remaining breast to achieve the lowest rates of recurrence, while a mastectomy usually does not require radiation. Patients undergoing a mastectomy often have the option for reconstruction. Additionally, cosmetic and size considerations are important following a lumpectomy so patients and surgeons should have a realistic expectation of how the breast will look after this procedure.
QUESTION: If I have breast cancer in one breast, should I have the other “healthy” breast removed?
ANSWER: Removal of the opposite, healthy breast is called a contralateral prophylactically mastectomy. Many women opt for a double mastectomy because they believe that they will live longer and have better cancer outcomes. Although removal of a healthy, noncancerous breast reduces the chance of developing breast cancer in that breast by 90%-95%, studies have shown that survival is not necessarily improved. Rates of complications are approximately doubled when compared to removal of only one breast.
QUESTION: What is DCIS or “Stage 0” breast cancer?
ANSWER: DCIS or ductal carcinoma in situ is when cells within the lining of the milk ducts become abnormal. DCIS is considered the earliest form of breast cancer. It is noninvasive, meaning it has not spread outside of the milk duct to invade other parts of the breast and body. With improved screening mammography, the rate of diagnosis of DCIS has risen dramatically over the last two decades. The vast majority of patients with DCIS who receive appropriate treatment have excellent outcomes.
About the Authors
Dr. Toan Nguyen and Dr. Vanessa Prowler are fellowship-trained Breast Surgeons at Lakeland Regional Health’s Hollis Cancer Center. To learn more or to make an appointment with Dr. Nguyen or Dr. Prowler, call 863.603.6565.