October is Breast Cancer Awareness Month…..But Don’t Stop There…..Check Your Breast Monthly…..Share These Facts with All of Those You Know…..Take Care ALL YEAR LONG!!!!

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                                                  image8 Image Courtesy of www.blog.thebreastcancersite.com

 

Breast Cancer FACTS…..                                                               image14

 

  1. 1 in 8 Women Will Be Diagnosed in Their Lifetime
  2. 40,000 Women Die Every Year, in the USA!!
  3. 1% of Breast Cancer Cases Are Diagnosed in MEN!!!
  4. When Detected Early, Stage 0 or 1, the 5 Year Survival Rate Approaches 100%!!!!!
  5. Stage II Breast Cancer, 93% 5 Year Survival
  6. Stage III Breast Cancer, 72%, 5 Year Survival
  7. Stage IV {Metastatic Disease, Cancer Spread Outside of the Breast and/or Armpit (Axilla)}, 22% 5 Year Survival

 

***EARLY DETECTION IS THE KEY TO SURVIVAL!!!!!*****

 

RISK FACTORS:

Increased Risk:                                                                       Decreased Risk:

  1. Personal History of Breast Cancer                                     1. Exercise
  2. Family (Genetic) History                                                     2. Breastfeeding
  3. Obesity                                                                                     3. Control Weight
  4. Alcohol                                                                                     4. Limit Radiation and Pollution Exposure
  5. Hormone Replacement Therapy
  6. Oral Contraception (Birth Control Pill)
  7. Smoking

 

*****WASHINGTON State has the HIGHEST RATE OF BREAST CANCER*****

*****UTAH has the LOWEST RATE of BREAST CANCER******

 

Do African American Women Have a More Aggressive Form of Breast Cancer?

Yes.

Higher Risk of Triple Negative {ER-Estrogen Receptor, Negative. PR-Progesterone Receptor, Negative and Her-2-Neu, Negative} Tumors.

Triple Negative Tumors Occur at an Earlier Age and Have a Higher Mortality (Death) Rate.

Death Rate is 42% Higher in Black Women, Compared to Whites.

 

Why?

  1. Often Diagnosed at Later Stage of Disease
  2. Poor Access to Screening Mammogram
  3. Triple Negative Breast Cancer Diagnosis…..More Aggressive Tumor…..Poorer Prognosis
  4. Lack of Health Coverage

 

What Can We Do to Improve Survival of Breast Cancer?

 

  1. Monthly Breast Exam
  2. Annual Doctor Visits
  3. Tell Your Family if You Have Been Diagnosed with Breast Cancer!!!
  4. Screening Mammogram, Starting at Age 40, or as Recommended by Your Physician, or Other Healthcare Provider

 

Do African American Women Require Earlier, Before Age 40, Screening MAMMOGRAMS?

It Depends.

Talk to Your Primary Doctor, or Other Healthcare Provider, About Your Personal and Family History.  Depending Upon Your Risk Factors, Your Doctor May Recommend Earlier Screening.

 

Genetic Risk:

The Majority of Patients Diagnosed with Breast Cancer Do Not Have a Family (Genetic) History of Breast Cancer

However, When You Have a Genetic Mutation in the Following Genes, the Risk of Being Diagnosed with Breast Cancer Increases from 12.5% to 85%.

  1. BRCA1                                                                                   image15
  2. BRAA2

These Genetic Mutations Account for 20-25% of All Hereditary (Inherited) Breast Cancers.

Having These Genetic Mutations Also Increased the Risk of Ovarian Cancer from 1.7% to 50%.

Source: www.drbaileyskincare.com

 

 

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Signs/Symptoms of Breast Cancer:

image17 Image Courtesy of Adam, Inc.

 

  1. Lump/Mass (Breast or Armpit)
  2. Nipple Discharge (NOT ALL DISCHARGE MEANS CANCER!!!!)
  3. Skin Changes/Dimpling/Thickening/Redness
  4. Change in Nipple Position/Appearance Compared to Other Side/Inverted
  5. Breast May Be Warm or Itch
  6. Pain (The Majority of Breast Cancers Are NOT Painful)

www.cancer.org/cancer/news/features/breast-cancer-symptoms-what-you-need-to-know

 

www.nationalbreastcancer.org/breast-cancer-symptoms-and-signs

#KnowYourLemons                             image20 Click to Enlarge.

http://knowyourlemons.com/signs-of-breast-cancer/

 

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Mammogram SCREENING:

 

Current Recommendations:

  1. General Population-Annual Screening Mammogram, Age 40 and Older
  2. If You Have a Higher Risk of Developing Breast Cancer, Your Screening Frequency Will Vary.
    1. Lifetime Risk of 20% or more (Based Upon Your Risk Profile, Ex.Claus Model)
    2. Known BRCA1 or BRCA2
    3. First Degree Relative {(Parent, Sister, Brother or Child) with BRCA1 or BRCA2 mutation, and have not had genetic testing themselves}.
    4. Radiation to the Chest, 10-30 years of age
    5. Have Li-Fraumeni syndrome, Cowden syndrome, or Bannayan-Riley-Ruvalcaba syndrome, or have first-degree relatives with one of these syndromes
    6. Personal History of Breast Cancer

 

****If You Are Higher Risk, Please Talk with Your Doctor, or Other Healthcare Provider, to Determine at What Age to Start Your Screening Mammograms!!!!!*****

 

Source: American Cancer Society, www.cancer.org

 

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How and When to do Your MONTHLY Breast Exam:

  1. Pre-Menopausal (Still Getting A Period)
    1. Plan to do Your Breast Exam 7-10 days after the start of your period, so that there is minimal swelling and discomfort
    2. Start on the outer aspect of the breast and use the flat pads of the Index, Middle and Ring Fingers.  Apply constant pressure and proceed in a circular motion from the outer aspect of the breast, moving toward the nipple as the fingers trace a path from a large circle to a small circle.  MAKE SURE TO INCLUDE THE NIPPLE and AREOLA IN THE EXAM!!!
    3. Do Not Lift Off of the Breast During the Exam…..Otherwise, You May Miss a Small Lump During the Exam.  If You Have to Reposition Your Fingers, Make Sure You Start at the Same Spot Where You Left Off.
  2. Postmenopausal (Already Gone Through Menopause)
    1. Plan to do Your Breast Exam the Same Day, Every Month.  First Friday….the 5th….Whatever it is, Stick to that Date.

 

image18 Click to Expand                image19Click to Expand.

 

If You Are Diagnosed, the Most Common Types and Terms You Will Hear are as Follows:

  1. DCIS (Ductal Carcinoma In Situ)
    1. Abnormal Cells Inside the Milk Duct.
    2. The Cells Have Not Invaded Beyond the Milk Duct, Therefore it is ‘Non-Invasive’
  2. Invasive Ductal Carcinoma
    1. The Most Common Type of Invasive Breast Cancer
    2. The Cells Have Invaded Beyond the Milk Duct
  3. LCIS (Lobular Carcinoma In Situ)
    1. Abnormal Cells in the Lobules/Milk Glands
    2. Uncommon Diagnosis
    3. There is an Increased Risk of Being Diagnosed with Invasive Breast Cancer after this Diagnosis.
  4. Inflammatory Breast Cancer…..Data via www.cancer.org
    1. Rare, 1% of all Breast Cancers
    2. Younger Age at Diagnosis, Average 52 vs. 57 for general population
    3. More Common in African American Women
    4. More Common in Overweight/Obese Patients
    5. At least Stage IIIB at Diagnosis, because it has already INVADED THE SKIN
    6. More Aggressive, Higher Recurrence Rate (Cancer Returns After Treatment) and Higher Mortality Rate (57 Month Survival for Stage III, 21 Months for Stage IV)
  5. Paget’s Disease
    1. Rare
    2. Involves Nipple and Areola
    3. Usually Occurs in Women Older than 50
    4. There is Usually DCIS or Invasive Ductal Carcinoma Associated with Paget’s Disease
    5. Usually Presents with Flaky/Scaly/Thickened/Hardened Skin of the Nipple/Areola
    6. Inverted Nipple
  6. Phylloides Tumor
    1. Rare
    2. Usually Occurs in Women in their 30s and 40s
    3. Usually benign
    4. Tend to Recur (Return After Surgery)

 

Surgical Treatment Options:image22image26 Click to Enlarge.

 

  1. Lumpectomy/Partial Mastectomy- The Tumor and Surrounding Breast Tissue is Removed, Only.
  2. Mastectomy-The Breast Tissue, Skin, Nipple and Areola are Removed.
  3.  Nipple-Sparing Mastectomy-Breast Tissue is Removed.  Skin, Nipple and Areola are Preserved and Left In Place.
  4. Axillary (Armpit) Lymph Node Dissection.

 

****The Information Below

is Not Meant to Be Confusing or Completely Comprehensive****

Many Patients Who Are Diagnosed with Breast Cancer Will Require Biopsy, or Complete Removal, of the Lymph Nodes in the Armpit (Axilla).

The Information Below Will Give Information Regarding Why You May Require this Additional Procedure.

Please Note, Every Patient and Diagnosis are Unique and Therefore Your Indications for Requiring Any Particular Treatment May Vary from What You Read Here, in Books or on Other Social Media Resources.

****As Always, Consult and Discuss Your Diagnosis and Treatment with Your Primary Physician, Surgeon and Oncologist****

What is a Sentinel Lymph Node?              

                                                image23                             image25      

The First Node/Nodes That Drain a Cancer

 

Indications for Sentinel Lymph Node Biopsy:

1. T1/T2 Invasive Breast Cancer with NO Palpable (Able to Feel) Axillary Lymph Nodes

2. NO Palpable (clinically negative) Lymph Nodes Following NeoAdjuvant (Before Mastectomy) Chemotherapy.

3. DCIS Sufficient, or Extensive Enough, to Require/Warrant a Mastectomy

4. DCIS with Suspected or Proven Microinvasion

 

What is a Sentinel Lymph Node Biopsy?

 

Selective Biopsy (Surgical Removal and Pathological Inspection) of Usually 2-3 Axillary (Armpit) Lymph Nodes (Small Swellings of the Lymphatic/Immune System)

http://www.ascopost.com/…/asco-guideline-update-extends-se…/

https://www.ncbi.nlm.nih.gov/pubmed/21411254

https://www.breastsurgeons.org/…/PerformancePracticeGuideli…

 

What are the Indications/Reasons to Perform a Formal (Remove All of the Axillary Lymph Nodes) Dissection?

A. The clinically node-positive axilla (lymph nodes can be felt in armpit on physical exam), confirmed by fine needle aspiration or core biopsy, in a
patient for whom neoadjuvant (before surgery) chemotherapy is not planned.

B. Occult (hard to find) breast cancer presenting as axillary node metastasis.

C. SLN positive patients who fall outside the Z0011 selection criteria (i.e. >2 SLN positive, matted
nodes, mastectomy, or breast conservation without whole-breast RT)

D. Inflammatory, clinical stage T4, or high-risk T3 breast cancer.

E. Failed SLN (Sentinel Lymph Node) mapping.

F. Inadequate prior ALND (Axillary Lymph Node Dissection) with residual clinically suspicious nodes

G. Sentinel or axillary nodes which remain positive after neoadjuvant chemotherapy.

H. Axillary recurrence following previous breast cancer treatment.

https://www.breastsurgeons.org/…/PerformancePracticeGuideli…

 

What are the Benefits of a Sentinel Vs. Axillary Lymph Node Dissection?

 

Decreased Risk of:

1. Lymphedema (Chronic/Painful Swelling of the Arm/Arm Pit/Hand)
2. Numbness
3. Limited Shoulder Mobility
4. Chronic Pain



RESOURCES:

http://www.PlannedParenthood.org

The Most Important and Essential Thing That You Can Do, is to Take Control and Personally Manage the Aspects of Your Health care that are Within Your Reach:

  1. Self Breast Exam
  2. Annual Physical Exam with Your Primary Doctor, Healthcare Provider or Local Health Clinic
  3. Find Out About Your Family History and SHARE this Vital Information with Your Loved Ones
  4. Limit Alcohol Intake
  5. Increase Physical Activity, as Recommended by Your Healthcare Provider
  6. NO SMOKING
  7. Control Your Weight.  Obesity is Associated with Increased Mortality (Death) and Morbidity (Abnormal Health)
  8. Stay Educated!

 

If There is Anything Else You Would Like to Discuss or Add, Please Leave a Comment Here or on Our Other Social Media Platforms!!

 

As Always,

Be Safe. Be Well. Take Care.

Lisa Whitty Bradley, M.D., FACS

CEO & Founder

Chicks With MDs, LLC

 

Please Follow Us on Twitter, Instagram, Facebook and LinkedIn.

 

***The Feature Image Artwork is Courtesy of @Peniel_Enchill,  www.penielenchill.com

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