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The Truth About Breast Cancer

Published: October 24, 2013 By: Tiffany Wilson
Julie A. Bradley, M.D.
Steven P. Cuffe, M.D., FACPsych
Shahla Masood, M.D.
John D. Murray, M.D.

The UF Health Breast Center team answers questions and talk about the future of breast cancer treatment

You have breast cancer.

Those four words can paralyze a patient. But the best reaction is the opposite: to take action, gathering information about the cancer and the options to treat it, said Shahla Masood, MD, professor and chair of pathology and laboratory medicine at UF Health Jacksonville and medical director of the UF Health Breast Center – Jacksonville.

Although a breast cancer diagnosis can cause a sense of panic, it’s critical to take the time to find out what type of breast cancer it is, how extensive it is and what the treatment options are, Masood said during her annual public forum, "What Everyone Should Know About Breast Health." The free forum, which has served 5,000 people since it began in 2000, features a multidisciplinary panel of UF Health physicians who answer guests’ questions about breast cancer. It’s held each year in early October in honor of Breast Cancer Awareness Month.

"Breast cancer is no longer a single disease that can be treated by a single physician — there are different characteristics in every patient," Masood said when the forum began. She said each patient deserves a personalized plan and should feel free to seek a second opinion before undergoing treatment.

Here are some of the questions and the answers discussed during the forum:

Besides a lump, are there any other signs to look for during a breast self-exam?

Nipples pulling inward, bleeding from the nipples, a change in the breast’s shape (shrinking in or growing bigger), redness and lumps in underarms. Pain in the lymph nodes and even back pain may also be a sign. — Laila Samiian, MD, FACS, assistant professor of surgery and chief of breast surgery

I have dense breasts. Do I need anything besides a mammogram?

Dense — also known as fibrous — breasts can make it harder to find a small lump. In some states, there is legislation pending that would require us to notify patients they have dense breast tissue and may need to undergo more screening. It’s very important to let the technologists know if you have any signs of breast cancer or any changes in your breasts. Then we will give you a more thorough exam instead of a routine screening. — Martha Wasserman, MD, assistant professor of radiology and chief of women's imaging

If a biopsy from my breast shows it’s not cancerous, do I still need to get yearly mammograms?

Absolutely. Just because a biopsy was not cancerous doesn’t mean you can't develop cancer somewhere else in the breast. — Wasserman

How much will cancer grow in one day?

Breast cancer grows over years, not days. In rare cases, the cells in a young woman can grow more quickly, but even then taking a few weeks to get some information is OK. Some patients receive a diagnosis and want their surgery tomorrow, but that’s not always the smartest way to go because you want to get all the information first. — Samiian

What does a pathologist do, and what is a pathologist’s role in breast cancer treatment?

A pathologist is involved in making the diagnosis. We sample the tissue, look at it under a microscope and define the tumor. There are many kinds of cancer, and there also are many look-alikes that can mimic cancer. That's why it's important to have more than one pair of eyes look at that tissue. — Masood

Will radiation affect my white blood cell count?

Not typically. There's a lot of promise for even less side effects with proton therapy, a newer modality. We're one of just two or three centers in the U.S. pursuing it as a possibility for breast cancer, and here’s why it could make a major difference: Protons can be stopped at a certain depth, so they don’t go through your body the way traditional radiation does. We’ve seen a higher risk of heart disease in patients who receive radiation on the left breast, because the heart is also on the left. With proton therapy, we could treat the chest wall without affecting the heart or lungs. We're applying for grants to continue a study on this. My prediction is that, over the next 10 years, proton therapy will become an increasingly common treatment for breast cancer in the left breast. — Julie Bradley, MD, assistant professor of radiation oncology

I’m a triple-negative breast cancer survivor. Are there any tests I need to take now that treatment is over?

If breast cancer doesn't appear in your screenings for two years, you are cured. About 90 percent of breast cancer is curable. It can still appear somewhere else, however, so it is important to continue with breast cancer screenings. — Fauzia Rana, MD, associate professor of medicine and chief of hematology and medical oncology

After a mastectomy, can cancer cells return with breast implants?

It's been documented that cancer doesn't return because of the implants, but you still need to give yourself regular breast self-exams. Bring any lumps up to your doctor. It could just be scar tissue, but you still need imaging to be sure. — John Murray, MD, assistant professor of surgery

I had reconstructive breast surgery 35 years ago after my breast cancer was removed. Now I'm experiencing pain when I raise my arms. Is that typical?

Breast implants are not lifelong devices. They're not meant that way. Scar tissue will build up, and you will need to have your breasts examined by your doctor and possibly a plastic surgeon. The future for plastic surgery will be using regenerative tissue matrices. That methodology involves fat grafting — using liposuction to obtain fat from your own body, and then gently layering it around the implant. That type of tissue does not create scar tissue. — Murray

Is breast cancer associated with depression and other psychological effects?

Being diagnosed with and treated for breast cancer can cause major physical and psychological stress. Up to one-third of breast cancer patients develop depression. Other effects include anxiety, panic symptoms, even post-traumatic stress disorder. These conditions impact your quality of life and can even affect your mortality. Signs include social withdrawal, difficulty sleeping, a sense of hopelessness and — at the worst time — reduced energy, when you’re already exhausted from chemotherapy treatments. Taking care of yourself can help you avoid these effects. Try to eat healthy, exercise, get enough sleep and meditate. Family members can help by supporting you, listening and helping you navigate the health system. If you or your family notice signs of depression, seek help. — Steven Cuffe, MD, professor and chair of psychiatry

Julie A. Bradley, M.D.
Steven P. Cuffe, M.D., FACPsych
Shahla Masood, M.D.
John D. Murray, M.D.

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