Ask Us Anything About… Breast Cancer

Screen opens inside a private office where two individuals are standing next to each other in front of traditional bookshelves. Standing on the left is Scott Gilbert and on the right is Dr. Daleela Dodge .

Scott Gilbert – From Penn State Health Milton S. Hershey Medical Center, welcome to Ask Us Anything About Breast Cancer. I’m Scott Gilbert. This is the latest in a series of conversations we’re billing as Ask Us Anything About. And you’ll find them here on our Facebook page. And it’s a chance for you to learn about a range of medical topics. Did you know that one in eight women in the US will develop invasive breast cancer? As October is breast cancer awareness month we want to take the opportunity to address some important questions. Some of those include how can you understand your risk? What screening options are available? And when cancer is detected what factors determine the course of treatment? Here to help us answer those questions today is Dr. Daleela Dodge. She is a breast surgeon at Penn State Breast Center. Thank you for being here Dr. Dodge.

Dr. Deleela Dodge – Thank you. I’m glad to be here.

Scott Gilbert – Let’s start by talking about screening. Because I know the American Cancer Society sparked some debate last year by suggesting that most women can wait until age 45 to have their first mammogram. Another organization says it’s 40. Another one says 50. How should women navigate those waters and try to figure out when is right for them to get their first mammogram?

Dr. Deleela Dodge – So the first thing we want you to be aware of is that those screening recommendations are for the woman with an average risk of breast cancer. There are two groups of women that stand out as being at higher risk of developing breast cancer. Those women who have a family history of breast cancer especially when the breast cancer has occurred in the premenopausal years. And also those women who have mammographically dense breasts. Which until you get your first mammogram you don’t know if you have mammographically dense breasts or not. The screening guidelines that have been developed are as a result of a preventive task force meeting that saw a lot of downsides to screening mammography. That included a lot of callbacks and what we call false positives. Where you do a biopsy and the biopsy turns out to be benign. And the woman has to balance that against her own concerns about developing breast cancer. We also know that of the women who have breast cancer diagnosed under the age of 50. About 60 to 80% of them do not have a strong family history of breast cancer. So just because you don’t have a strong family history of breast cancer does not mean you won’t develop breast cancer at a younger age. It has to be a conversation with your doctor, and we also recommend that you consider having one or two of the risk models such as the Gail model, the NCI or the BRCAPRO model performed to look at your own risk. Again if there’s any family history of carrying the BRCA gene mutation or other genetic mutations associated with breast cancer. You’re not talking about those women. Those women start at a much earlier age.

Scott Gilbert – But as you said though a very large percentage of breast cancer’s caught before the age of 50, involve women with no family history.

Dr. Deleela Dodge – That is absolutely correct.

Scott Gilbert – Okay. Well there are some excuses we hear sometimes. You know women will say I’m afraid that mammogram is going to be too painful. Or I simply don’t have the time. Do you hear those excuses a lot as a practitioner?

Dr. Deleela Dodge – Absolutely. We all have very busy lives. And in our busy lives we all are looking for some way to make them less busy. But screening mammography definitely saves lives. And the vast majority of women that I see today in my office do not feel anything or find any symptoms. So screening mammography is the key to early diagnosis.

Scott Gilbert – When we talk about family history are we talking about immediate family such as somebody’s mother? Or can it go even broader than that? Are there other family members we should keep an eye on?

Dr. Deleela Dodge – Well any family history of a male member with breast cancer is a big red flag for carrying the gene mutation and having a higher risk. And that’s any male member. A history of ovarian cancer in your family also increases your risk of carrying one of the gene mutations and increasing your risk of breast cancer. And while first-degree relatives those like mother and sister carry more risk for you. Second-degree relatives your aunts, your cousins also will add to your risk.

Scott Gilbert – You’re watching Ask Us Anything About Breast Cancer from Penn State Health Milton S. Hershey Medical Center. I’m Scott Gilbert alongside Dr. Daleela Dodge. She’s a breast surgeon at Penn State Breast Center. We welcome your questions whether you’re watching this as a live feed on Facebook here on Monday at noon. Or even if you’re watching after the fact feel free to post your questions to the comment field of this Facebook post and we will track down an answer for you. And make sure we post it as a reply. Now we’ve been talking a lot about mammography but there are other types of screenings that depending on a woman’s risk factors and some other items may be appropriate. We’re talking about things like 3-D mammography, whole breast ultrasound. When do those screening techniques come into play?

Dr. Deleela Dodge – So 3-D mammography is similar in its place now to what digital mammography was 10 years ago to analog mammography. It’s an improvement. I think it’s an improvement that is going to eventually be present in all screening and diagnostic settings. Now at Hershey we’re using it in the screening setting. And there are many other centers in the state who are currently using TOMO or 3-D mammography for their screenings. The reason for that is that the callback rate is about 30% lower. So less women being called back for what turns out to be nothing. And about a 6% better pickup rate for breast cancers. Automated breast ultrasound is being used in some centers and we have it available here for women who have very dense breasts. Because we know that in the women with dense breast tissue we can miss cancers.

Scott Gilbert – How would a woman know if she falls into that category? Of having dense breast tissue?

Dr. Deleela Dodge – We will actually tell the woman after her mammogram whether she has dense breasts, extremely dense breasts if that is so. Unfortunately about 50% of women are going to fall into one of those two categories.

Scott Gilbert – I have a friend who has beaten breast cancer twice. And in the beginning of every month on her Facebook page she posts a notice to remind her friends it’s time to do your self exam ladies. She does it every single month. How important is that self exam? And how often do important finding surface from that?

Dr. Deleela Dodge – Well one of the interesting things is that breast self-examination that was one of the keystones of diagnosis. Is no longer considered something that we should be doing. We’re supposed to be breast aware. Breast aware means know your breast, know what they feel like, and report any changes to your doctors. But the concern was that women were feeling all kinds of things that turned out to be nothing. Same thing as our concerns about screening mammography. It is very important however that we do examine our breasts. And that we do it on a routine basis. And I like the concept of doing it at the beginning of the month. It’s an easy way to remember to do that.

Scott Gilbert – So being aware, being self aware is very important?

Dr. Deleela Dodge – Any thickness, lump, discharge especially that’s spontaneous. Or any other change in our breast such an area of redness that just doesn’t go away or doesn’t respond to antibiotics. Those are warning signs of cancer. Dimpling on the breast. Changes in the contour of the breast.

Scott Gilbert – Just a reminder to post your questions for Dr. Dodge in the comment field below this Facebook post and we’ll post those. We’ll pass those along to her here and ask her to answer those. In this edition of Ask Us Anything About Breast Cancer. Demographically speaking what groups of women are at the greatest risk of developing breast cancer?

Dr. Deleela Dodge – Well all women are at risk. The women that are at least risk are actually those of Asian descent. In the premenopausal years black women are at much higher risk of developing breast cancer than are Caucasian women. But in the postmenopausal years it flips. And Caucasian women are more at risk than are those who are black. So it changes depending on your age. But we all have a significant risk of developing breast cancer.

Scott Gilbert – Now with all types of cancer we hear that everyone’s cancer is different. Each tumor is different. So if one woman has a tumor in the left breast, another woman has a tumor in the left breast of the same size. It could be two very different types of cancer right?

Dr. Deleela Dodge – There are four major types of breast cancer in terms of their markers and their aggressiveness. We can’t really talk in detail about those. But it’s important to know that there are breast cancers that grow very slowly and that recur more rarely. And then there are breast cancers such as triple negative breast cancers that grow very quickly and are extremely aggressive. And are responsible for a large proportion of the deaths from breast cancer. And just because you’ve had one type of breast cancer doesn’t mean you can’t develop the other type of breast cancer as well.

Scott Gilbert – So let’s talk a little bit about treatment options and what determines a course of treatment. There are a wide range of treatment options obviously. There can be chemotherapy, there can be radiation. And of course surgery as well. What determines and I know this is a very broad topic to get into with just a few minutes left. But what are some of the factors that determine that course of treatment?

Dr. Deleela Dodge – Well we actually are multidisciplinary team here as are all good breast centers. And we meet and we discuss every patients case so that we can optimize the way they’re treated. Pretty much everything starts in radiology with imaging. And then most women will see a surgeon next. But surgery as the first treatment for breast cancer isn’t always the right choice. Sometimes we’ll give systemic treatment chemotherapy or anti-hormonal therapy before we have surgery for various reasons. And radiation is part of the treatment paradigm certainly when we conserve the breast and sometimes even if we require a mastectomy. So it’s a complex treatment tree that we go through. Most importantly it needs to be done with all the experts together and then working on the same page.

Scott Gilbert – As we begin to wrap things up I want to go back to that first concept. I think the key take away here is going to have to do with screening and when women should get that first mammogram. And how often they should. But really it sounds like your advice is it all begins with a conversation with your physician correct?

Dr. Deleela Dodge – And that should occur at your 40th birthday or even earlier. Especially if there’s a family history of early premenopausal breast cancer. In which case you should really be talking to your physician before the age of 40. But a nice way to celebrate your 40th birthday is to have that conversation with your physician. Have any kind of risk model done. And then make a decision as to where mammography screening fits into your life. I’m hoping that most of you will choose to have early screening. Because it does save lives.

Scott Gilbert – We have additional information for you on line from Dr. Dodge in fact. Last weeks Penn State Medical Minute is dedicated to holistic health and breast cancer. And integrative medicine and how all that interplays. So there’s some very interesting stuff we didn’t have time to touch on today. But I hope you’ll go and check that out at pennstatehealthnews.org. Also this Thursday we will have a call in show and also web chat from WHTM TV ABC 27. Some of the experts from Penn State Breast Center will be involved with both the web chat and the call-in show. You can find details elsewhere right here on our Facebook page for Penn State Health Milton S. Hershey Medical Center. You can also find out more information about the breast center at PennStateHershey.org/breast. The phone number to call is our Careline 800-243-1455. Dr. Dodge thank you for your time today I appreciate it.

Dr. Deleela Dodge – Thank you Scott, it was great.

Scott Gilbert – And thank you for watching, Ask Us Anything About Breast Cancer. I’m Scott Gilbert.