5 Important Questions About Breast Cancer

By Alexa Kyle, PA  |  11/3/2015

In honor of Breast Cancer Awareness month, Physician Assistant Alexa Kyle of the Dyson Breast Center at Vassar Brothers Medical Center answered questions from women on Facebook. If you are a woman over 40 or have a medical or family history that puts you at risk, make this the time you get a mammogram. The best way to fight cancer is to detect it early.

Q: Breast cancer runs in my family. I'm 34 now and I always get my yearly physical. Is it too early for my mammogram? Should I get a DNA gene test to see if I will get it?

A: If you have a first-degree relative with breast cancer, mammogram screening should begin 10 years prior to that family member’s age of diagnosis. For example, if your mother was 42 years old when she was diagnosed, your screening should take place at 32. Otherwise, you should get an annual clinical breast exam and mammograms starting at 40.

The recommendation to test for BRCA 1/2 mutation includes the following criteria:

  • Breast cancer in two or more close relatives, such as a mother and two sisters
  • Early onset of breast cancer in family members, often before age 50
  • History of breast cancer in more than one generation
  • Cancer in both breasts in one or more family members
  • Frequent occurrence of ovarian cancer
  • Family history of male breast cancer
  • One or more BRCA positive relatives
  • Eastern and Central European (Ashkenazi) Jewish ancestry, with a family history of breast and/or ovarian

If you are interested (and you or your physician believe you qualify), genetic counseling is available at Health Quest.

Q: What are your thoughts on the new research regarding ductal carcinoma in situ (DCIS) that shows invasive treatment may offer no benefit?

A: Due to improvements in early detection, DCIS has become more frequently diagnosed. The discussion among experts is whether DCIS is being over-treated for its survival outcome. Our center is hoping to enroll in studies for treatment decisions involving DCIS and its outcomes.

Q: Can you explain the difference between a Mammotome biopsy and a needle biopsy?

A: Mammotome® is the brand name of a vacuum-assisted biopsy device, which is a type of needle biopsy. There are many on the market.

A core needle biopsy (CNB) consists of a hollow needle, which is used to withdraw small cylinders (or cores) of tissue from the abnormal area in the breast. The needle is usually put in 3 to 6 times to get the samples, or cores. The healthcare provider doing the CNB usually uses ultrasound or X-rays to guide the needle into the right place.

Vacuum-assisted biopsies can be done with systems like the Mammotome®. For these procedures, the skin is numbed and a small cut (less than 1/4 inch) is made. A hollow probe is put in through the cut and guided into the abnormal area of breast tissue using X-ray, ultrasound or MRI guidance. A cylinder of tissue is then pulled into the probe through a hole in its side, and a rotating knife inside the probe cuts the tissue sample from the rest of the breast. These methods allow multiple tissue samples to be removed through one small opening. They are also able to remove more tissue than a standard core biopsy. Vacuum-assisted core biopsies are done in outpatient settings. No stitches are needed, and there’s usually very little scarring.

Q: What is the risk of lymphedema after breast cancer surgery? What should I watch for and what actions should I take if I notice swelling?

A: Lymphedema is a potential side effect of breast cancer surgery and radiation therapy that can appear months or even years after treatment ends. Lymph is a thin, clear fluid that circulates throughout the body to remove waste, bacteria and other substances from tissues. Edema is the buildup of excess fluid. Lymphedema occurs when too much lymph collects in any area of the body. If lymphedema develops in people who have been treated for breast cancer, it usually occurs in the arm and hand, but sometimes it affects the breast, underarm, chest, trunk and/or back. Patients may feel a tingling or numbness before they notice any swelling.

Learn more about lymphedema signs and symptoms and contact your healthcare provider if you experience any symptoms. Health Quest offers a Lymphedema Remediation Program led by a certified lymphedema therapist who teaches manual lymph drainage, compression, bandaging, skin care and exercise.

Q: Is there anything new in regard to Triple Negative Breast Cancer treatment? Can its recurrence be prevented?

A: Triple negative breast cancer is when the breast cancer cells tested negative for estrogen receptors, progesterone receptors and HER2, making the breast cancer unresponsive to therapies that target these hormones or HER2.

Triple-negative breast cancer accounts for 15 to 20 percent of invasive breast cancers diagnosed in the United States each year, and is more common in younger women, African Americans, Hispanics and BRCA1-mutation carriers. With no identified molecular abnormalities that can be targeted with medication, the standard treatment is chemotherapy. We can also refer patients to fantastic medical oncologists in our area who are involved in clinical trials being performed for drugs to target this type of breast cancer.

In regard to recurrence, we know exercise and healthy living can help. The American Cancer Society recommends 150 minutes of exercise per week to help reduce the risk of future breast cancer. That’s only a 30-minute brisk walk per day for five days!

Learn more about Health Quest’s breast health services and the newly expanded Dyson Breast Center.And remember to make breast health a priority for yourself and all the women in your life.