Habits that May Lead to Breast Cancer

Around the globe, breast cancer affects millions of women. One in eight women is predicted to have breast cancer during their lifetime in the United States alone. While there are several risk factors that you can’t control, such as a family history of breast cancer or dense breast tissue, there are certain behaviors and lifestyle choices that may have a significant impact on lessening your risk. Eliminating the habits that you can control can help decrease your risk of developing breast cancer.

Poor Diet

About 30 to 40 percent of all malignancies are considered to have some connection to diet. You cannot avoid developing breast cancer with diet or food alone. However, certain meals may improve your body’s health, strengthen your immune system, and lower your chance of breast cancer. According to research, eating a range of foods that are high in nutrients, including fruits, vegetables, legumes, and whole grains, may help you feel your best and provide your body with the energy it needs. Animal studies suggest eating food cultivated without pesticides may help prevent the unfavorable cell alterations linked to pesticide usage.

In nations where the traditional diet is plant-based and low in total fat, breast cancer is less prevalent. However, studies on American adult women haven’t shown a link between dietary fat consumption and a woman developing breast cancer. A high-fat diet throughout adolescence, however, may increase a girl’s risk of developing breast cancer later in life, even if she doesn’t go on to gain weight or become obese.

Further study is required to fully comprehend how nutrition affects the risk of breast cancer. However, it is undeniable that calories do matter, and fat is a significant source of calories. Being overweight or obese, which are breast cancer risk factors, may be brought on by high-fat diets. Because excess fat cells produce estrogen, which may promote the development of extra breast cells, overweight women are considered to have a greater chance of developing breast cancer. Breast cancer risk is increased by this additional growth.

Lack of Exercise

Regular exercise benefits your health in a variety of ways, one of which is a decreased risk of breast cancer. Over the last 20 years, several studies have consistently shown a relationship between increased physical activity and a decreased risk of breast cancer.

It is unclear exactly how exercise reduces the chance of developing breast cancer. It is believed that exercise controls estrogen and insulin, two substances that may promote the development of breast cancer. Regular exercise also aids women in maintaining a healthy weight, which supports hormone regulation and immune system health.

Unfortunately, there is no magic number of hours a woman should exercise each week to prevent breast cancer. We do know that more is preferable to less, and that some is better than none. Additionally, more intense exercise is more productive than less intense exercise. All people should exercise for at least 150 minutes per week of moderate effort or 75 minutes per week of vigorous intensity, ideally spaced out over the course of the week, according to the American Cancer Society.

Brisk strolling, dancing, leisurely biking, yoga, golfing, softball, doubles tennis, and routine yard and garden upkeep are some examples of moderate-intensity exercises. Jogging, running, rapid cycling, swimming, aerobic dancing, soccer, singles tennis, and basketball are some examples of high-intensity exercises. Along with your regular daily activities at home and at work, all of these extracurricular activities include stair climbing and walking from your vehicle to the garage.

Exercise has the additional benefit that it keeps you from merely sitting around. The probability of acquiring breast cancer and several other forms of cancer, as well as obesity, type 2 diabetes, and heart disease rises with sitting time, regardless of how much exercise you receive when you’re not sitting, according to an increasing body of research. Many of us spend most of our workdays seated at a desk. Because of this, it’s even more crucial to include activity throughout your day.

Certain Types of Birth Control

There is a small increase in the risk of breast cancer associated with the current or recent usage of oral contraceptives. According to studies, women’s breast cancer risk is 20–30% greater while using birth control pills (and immediately after) than the risk for women who have never used the pill. However, since the absolute risk of breast cancer for the majority of young women is low, this additional risk has only a little effect.

Women’s chances of developing breast cancer start to decrease after they quit using oral contraceptives. The risk eventually drops to the same amount as women who have never used the pill. Despite the increased risk of breast cancer , birth control pills also lower the risk of uterine and ovarian cancer in addition to preventing pregnancy. Just like with previous, higher-dose versions of the drug, modern, lower-dose tablets have been associated with an increased risk of breast cancer.

Some alternative contraceptives contain (or release) hormones, just like birth control pills do. Depo Provera users who have been using it for extended periods of time may be at a higher risk for breast cancer than women who have never used it.

Research on IUDs that release hormones and breast cancer research have conflicting results. IUDs don’t increase the risk of breast cancer, according to some research. According to other studies, women who use hormone-releasing IUDs may have a 20% greater chance of developing breast cancer (similar to birth control pills). According to other research, women who previously used hormone-releasing IUDs may be more likely to develop breast cancer after menopause.

Discuss the advantages and disadvantages of any contraceptive pill with your doctor before using it (or if you already are and haven’t done so).

Not Getting Routine Mammograms

Low-dose x-rays of the breast are called mammograms and can help doctors identify a breast cancer diagnosis. Regular mammograms are one of the best breast cancer screenings that may assist in detecting early stage breast cancer, when treatment has the best chance of being effective. Years before physical breast cancer symptoms appear, a mammogram may often detect breast abnormalities that might be cancer. Results from decades of research definitively demonstrate that women who receive routine mammograms are more likely to have breast cancer discovered earlier, are less likely to require an invasive breast cancer treatment like chemotherapy and surgery to remove the entire breast (mastectomy), and are more likely to recover from the disease.

Mammography is not flawless at detecting breast cancer cells. Dense breast tissue can make it harder for radiologists to see breast cancer on mammograms. Although most breast cancers will be detected, some will be missed. A woman will probably need more testing (such as additional mammograms or a breast ultrasound) in order to determine if anything seen on a screening mammogram is cancer. Additionally, there is a slight possibility of receiving a cancer diagnosis that, if not discovered during screening, would never have given rise to any issues.  It’s crucial that women undergoing mammograms be aware of what to anticipate and the advantages and limitations of screening. As you age, your risk of developing breast cancer increases. Breast cancer screening through mammography is vital for women over age 40.

Use of Tobacco Products

According to research, smoking may significantly increase the chance of developing breast cancer, particularly in women who began smoking as adolescents or who had a family history of breast cancer. Smoking might increase one’s chance of developing breast cancer because specific chemicals in tobacco products may cause out-of-control cell proliferation in the body. Smoking is associated with an increased risk of breast cancer in certain women, despite the fact that it is not thought to be a direct cause. In addition, smoking may make treating breast cancer more difficult and lead to complications from breast cancer surgery. Avoiding tobacco products is an important factor in breast cancer prevention.

Excessive Use of Alcohol

Many studies reveal women who consume alcohol have an increased risk of breast cancer. According to research, the relative risk of breast cancer rose by roughly 7% for every alcoholic beverage taken daily. Compared to women who didn’t consume alcohol, women who had 2-3 alcoholic drinks per day had a 20% increased chance of developing breast cancer.

Alcohol may alter how a woman’s body processes estrogen. Blood estrogen levels may increase as a result of this. Women who drink alcohol have greater amounts of estrogen than non-drinkers do. As a consequence, higher estrogen levels are related to a higher risk of breast cancer. Alcohol and cancer risk can be controlled by limiting the amount you consume.

Hormone Replacement Therapy

Breast cancer risk is elevated by the majority of hormone replacement therapy (HRT) types. However, individuals who take combination hormone replacement therapy (HRT), which combines both estrogen and progesterone, are at a greater risk.

Breast cancer risk is only modestly elevated when HRT is used for less than a year. However, the hazards become more severe and continue longer the longer you use HRT.

HRT-related breast cancer risk varies from individual to individual. The risk may vary depending on your age when you start HRT, any medications you may be on, and overall health.

Breast cancer risk factors are greater for people who take HRT before or shortly after menopause as compared to those who start it later.

Even though there are several potential causes of breast cancer, some behaviors and lifestyle choices may have a big impact. These lifestyle choices, including smoking, drinking alcohol, and eating poorly may all raise your risk. Regular physical activity and maintaining a healthy weight are effective methods to lower your risk. This disease may also arise as a result of certain birth control methods and hormone replacement therapy. If you have any of these risk factors, it’s important to speak to your doctor about them.


Breast Cancer Awareness: A History

March is officially known as Women’s History Month! To celebrate women, the incredible things they have endured throughout history, and to highlight the value of their wellbeing, let’s examine breast cancer awareness throughout history. You are likely to see an influx of this information during October, but Dr. Valerie Gorman of Texas Breast Center emphasizes the importance of breast cancer awareness year-round. Doctors and breast care specialists universally agree that awareness of the realities and risk factors is critical in conquering breast cancer’s devastation.

While the history of breast cancers presumably goes back to the early days of humanity, widespread advocacy for the cancer community and dispelling the shame around breast cancer has had a much shorter timeline. Not only that, but common awareness of this cancer and its symptoms has just become prevalent within the last 50-75 years. Texas Breast Center wants to highlight the journey of awareness for breast cancer and, through doing so, encourage people to check their own breasts and to spread knowledge of both prevention and risks of breast cancer in their communities.

The Origins of Breast Cancer Awareness

When did breast cancer awareness begin?

Women have been at the forefront from the beginning of cancer research initiatives. Early forms of the American Cancer Society founded the Women’s Field Army, giving thousands of women the chance to instigate fundraising and promote research during a time when society handed them few other privileges.1 Despite the advancement of fundraising efforts beginning in 1913, discussing cancer was taboo and deemed unfit for conversations far into the 1900s. Particularly regarding breast cancer, public discourse would identify it solely as a “prolonged women’s disease.”2

Only in the 20th century did breast cancer finally reach public notice. This shift can largely be attributed to former First Lady Betty Ford. She opted for total transparency in her battle against breast cancer during the 1970s, a time when stigmas surrounding breast cancer were a crippling concern for many women. Using her platform, Betty Ford shared the importance of screenings, breast cancer treatment, and solidarity for other American women affected by cancer. This instigated a dramatic reformation in culture surrounding breast cancer, both in the societal support of breast cancer patients and in prioritizing regular doctor exams.

When did widespread breast cancer initiatives arise?

Recognition of the disease began at an individual level first, with women such as Betty Ford speaking candidly about their experiences. From this stemmed the opportunity for structural and organizational levels of awareness to be formed. The best-known cancer charity initiative is the internationally recognized Breast Cancer Awareness Month, taking place annually in October. In 1985, Imperial Chemical Industries and the American Society for the Control of Cancer partnered to create the first national week-long breast cancer awareness event. The initial intent of this was to encourage women to get regular mammograms, a form of breast imaging used to screen for breast cancer. This week later transitioned into a month-long observance of breast cancer survivors and patients.

Nowadays, it is incredibly common for a non-profit organization or a corporation to take part in the annual commemoration. From the NFL to cosmetic companies like Estee Lauder to The White House, public awareness campaigns, donation drives, and stories are spread to raise money and support systems for women who have been diagnosed with this disease. Estee Lauder created one avenue of this in 1992, seven years after the first awareness event, with the pink ribbon, and gave out over a million to initiate a tangible representation of the month’s efforts.3 This image is still easily identified today, commonly known as a symbol of support for patients.

The Importance of Breast Cancer Awareness

Why is breast cancer awareness so important?

Breast cancer awareness is crucial because of the approximate 13% chance of women receiving this diagnosis. (1 out of 8 women in America develop breast cancer at some point in life, with the likeliness increasing with age.) Knowing the statistics surrounding developing breast cancer, keeping watch over the risk factors, and seeking transparent, expert education on the latest prevention methods can help one improve their chances of keeping a late diagnosis at bay.

What are the achievements of the breast cancer movement?

Breast cancer research

An increase in awareness has led to a greater emphasis on research to cure breast cancer throughout recent history. Following individual concerns, support groups were created, leading to lobbyists and activists pushing for greater research and education on the disease. The Journal of Women’s Health provides one example of this through the seven-year project on environmental toxins and impact conducted by the Breast Cancer and Environment Research Centers (BCERC).4 This program was an influential precedent, as it was the first National Cancer Institute funded initiative to incorporate activists into the scientific research council. In this, those involved in pushing to raise awareness had a direct impact on the focus of the studies. This 2003-2010 project is simply one of many historical examples where voices in the community resulted in an incredible impact on cancer research. What proof that individuals’ involvement matters!

What is the aim of breast cancer awareness?

You Can Help Save Lives

Breast cancer is the second most common cancer in women. This means the odds of you or a loved one needing to be treated are high. Awareness aims to help eradicate this statistic, and you can play a tremendous role in this by educating yourself and your community on the risks. Being informed is crucial for many reasons, mainly because it teaches people about the necessary aspects of breast care. These are measures such as routinely scheduled mammograms, conducting self-examinations, maintaining a healthy weight, limiting alcohol consumption, pumping your own breast milk, extensively researching birth control pills and medicine, and staying active to the best of one’s abilities. Each of these factors can lead to a lower risk for women of developing breast cancer, or, if one is to get cancer despite a lowered risk, to an early diagnosis, which has proven to yield better outcomes.

Additionally, in creating ordinary spaces for conversations about the realities of breast cancer to occur, the perception of those whose lives have been affected by this disease will change for the better. Increasing knowledge in your community can breed hope and support for women with breast cancer. This acceptance can also lead to a society that encourages scheduling screening mammograms regularly, producing more cases of early detection, which can save lives.

Support for You

As research increases, so do the success rates of treatment. Even with improving science, we understand that a breast cancer diagnosis can still feel overwhelming. Texas Breast Center is committed to being with you every step of the way. The team aims to connect with you to provide hope through a personalized, targeted treatment plan and support that goes beyond your initial treatments. Valerie J. Gorman, MD, FACS, is a breast surgeon specializing in surgical oncology and surgical diseases of the breast. Under her care, you will find a broad spectrum of treatment options, such as hormone therapy, and a treatment program designed to benefit your exact case of breast cancer.

 

  1. Lerner B. Inventing a curable disease: breast cancer control after World War II. In: Lerner B, editor. The Breast Cancer Wars: Fear, Hope, and the Pursuit of a Cure in Twentieth-Century America. Oxford: Oxford University Press, Inc.; 2001. pp. 41–68.
  2. Ross W. Transformation. In: Ross W, editor. Crusade: The Official History of the American Cancer Society. New York: Arbor House; 1987. p. 33.
  3. https://www.elcompanies.com/en/our-commitments/the-breast-cancer-campaign
  4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3298674/

Black Women and Breast Cancer

Black History Month

Officially recognized in 1976, February is dedicated as Black History Month in the United States of America. Commemorating the victories and legacies of African Americans and recognizing the hardships they have faced throughout our history, it is a pinnacle time of awareness and memorialization in the lives of American citizens. In honor of this past month’s observations, we wanted to provide information on women’s health surrounding the realities of breast cancer for black women.

Black Women and Breast Cancer

According to the American Cancer Society, breast cancer is the most commonly diagnosed cancer for black women. Falling second to lung cancer, breast cancer is also a top cause of cancer-related mortality. It is crucial for black women to understand the likelihood of a diagnosis, the risks surrounding breast cancer, and ways to routinely check for potential breast tumors. There are many questions surrounding the truth on breast cancer statistics, particularly pertaining to black women. Educating people on the realities of breast cancer plays a key role in women knowing what to watch for regarding their breasts and in changing some of the socially constructed elements surrounding medical and breast care for black women.

What is breast cancer?

Essentially, breast cancer is the uncontrolled development of breast cells. This is why it is recommended that women examine their breasts regularly for evidence of changes to the breast such as puckering or discoloration, as they are often the first symptoms to appear.

What would lead to a breast cancer diagnosis?

Although there are many different varieties of cancer, tumor biology at its base level remains consistent, and they all have similar characteristics. The genes in the human body regulate and control cell proliferation. The job of genes, which are found in the nucleus of cells, is to ensure that as old cells die, they are replaced by new cells. Mutations can develop, causing this process to be disrupted. This change can significantly affect the regeneration process, removing control from the genes and allowing the cells to continue making new cells without restriction. The production of additional cells can lead to the formation of a tumor. The emergence of a malignant tumor (which is an aggressive form of cells and can spread to other areas of the body via the blood and lymph systems) is what typically generates a breast cancer diagnosis.

Breast Cancer Risk for Black Women

Age, ancestry, family history, and type of diagnosis affect the severity and likeliness of breast cancer.

Who has the highest risk of breast cancer?

Despite a lower incidence of breast cancer development, black women’s lives are approximately 40% more likely result in breast cancer death. Women of a younger age, meaning below the age of 45, also tend to have the highest risk. There is no simple answer to this disproportion, as these starkly contrasting numbers seem to arise from a combination of factors, including both sociological conditions and genetic factors.

Disparities of Breast Cancer and Race

In recent years, there have been increasing conversations surrounding the tragic breast cancer disparities of medical care and attention for people of color. These risks and realities prove particularly tangled and problematic in the world of health care and surgical access. While this is true, Dr. Gorman of Texas Breast Center is eager to dismantle this problem through targeted, attentive care for each person who comes under her expert care.

The prevalence of breast cancer is still far greater than we like to see, which is why Dr. Gorman and her team at Texas Breast Center fight endlessly to see these numbers decrease. Particularly among black women, the statistics of more aggressive forms of breast cancer diagnoses, such as triple-negative breast cancer, are astronomically higher.

What is triple-negative breast cancer?

Triple-negative breast cancer is a form of breast cancer that tests negative for all three receptors: estrogen, progesterone, and HER-2. This kind of breast cancer is one of the more aggressive and invasive breast cancer types, with high spread and growth rates. Both age and race play into the likeliness of this diagnosis, as it is most common in women under forty and in black women.

Not all black women are at the same risk of developing triple-negative breast cancer. Research shows that particularly those born in Western Africa and the United States are at an increased risk for triple negative breast cancer in comparison to those born in East Africa. This difference is especially notable when compared to white women or women of other races. According to the American Cancer Society, black women in the United States are actually twice as likely as white women to receive this diagnosis. This may be a reason for the lower rate of survival among black breast cancer patients. Educating oneself on the risks of breast cancer can help black women act in anticipation and preparation and increase the chances of survival through early detection.

Dr. Gorman at Texas Breast Center

While statistics surrounding breast cancer can seem overwhelming and may evoke fear, Dr. Valerie Gorman combats this with the truth that “treatment for breast cancer has improved significantly over the last few years, and success rates continue to rise.” Breast cancer outcomes and treatments have never seemed more optimistic.

Dr. Gorman and her team at Texas Breast Center, located in Waxahachie, are devoted to caring for every patient in a manner tailored to their unique case, conducting each interaction with expert care, attention, and skill. Providing honest, advanced information on the risk factors of breast cancer and the leading treatment options is a top priority of this Texas-based breast surgeon. She dedicates herself to the wellbeing of every single patient and, in doing so, aims to topple the disparities that black women diagnosed with breast cancer face and help reduce the rates of breast cancer mortality, one case at a time.

Staying informed

As a leading surgeon, Dr. Gorman advocates for preventative measures and staying on top of breast health. Regular self-breast checks, mammography screening, a regular clinical breast exam, assessing controllable risk factors, and remaining informed on the latest news surrounding breast care are all steps that can increase the chances of detecting breast cancer while it is still in the early stages.

If you have any questions surrounding breast cancer or breast cancer risk factors, don’t hesitate to contact Dr. Gorman and her team at Texas Breast Cancer.

 

https://www.cancer.org/research/cancer-facts-statistics/cancer-facts-figures-for-african-americans.html

https://acsjournals.onlinelibrary.wiley.com/doi/epdf/10.1002/cncr.32293?referrer_access_token=tNmZThNQBcGMkZz0Mw1KaU4keas67K9QMdWULTWMo8PjlxlDClmn9SMF_cvVV7b6CVxSyInTq9HeXJidKb9BxMA8NsR


How Breast Cancer is Diagnosed

No one is excited to get a mammogram or go through other breast cancer screening tests. However, keeping on top of breast health and regular screening can be life-saving. The sooner breast cancer is diagnosed, the better the outcome is more likely to be.

First Steps

Keeping on top of regular breast self-checks, yearly mammograms, and annual physicals can help increase the chances of finding breast cancer in the early stages. That is to say, mammograms and self-checks will not increase the chances of a diagnosis but of early detection of the disease should it occur. These are three possible first steps in a potential breast cancer diagnosis.

Self Breast Check

A self breast-check, also known as breast self-exams, is a method used to keep yourself informed and aware of your own breasts and breast tissue. They should be done monthly, if possible, and especially if you meet a high number of risk factors, and they do not take long. But if performed regularly, they can keep you very familiar with the feel and appearance of the breasts, meaning any change is sure to stand out.

The process is relatively simple:

  • Start by looking at your breasts, both looking down and checking them in a mirror. Check for any changes in color, size, or shape. Signs of cancer or other infection are swelling, redness, dimpling, puckering, or discoloration. Especially check the nipple for inversion, pain, or unexpected or bloody discharge.
  • Raise your arms and reexamine. Having your arms up may shift the positions of the breasts to reveal something you may have missed otherwise.
  • Use the pads of a few fingers to carefully feel over the entire breast. Use consistent, small, circular motions to move across, up, and down the whole breast, covering the collarbone to the top of the rib cage and cleavage to the armpit
  • . Use enough pressure to feel deep tissue but not enough to hurt yourself.
  • Lay down and repeat the process.

Keeping up with regular breast self-exams will make it easier to notice any changes. If you find anything of concern, speak with your physician to discuss options and further screening.

Clinical Breast Exam

A clinical breast exam is part of the standard physical. It is a breast exam performed by your doctor, in which they will physically examine and feel each breast to feel for any changes or lumps in the tissue. The clinical breast exam becomes particularly relevant if you are at high risk of breast cancer or have noticed changes in your breasts during a breast self-examination. Raise any concerns with your physician so they can help you and discuss any necessary next steps.

It is not as simple as finding a lump and having doctors diagnose breast cancer. Should something be found during these exams, your doctor will likely send you to get a mammogram or ultrasound.

Schedule your appointment for a clinical exam today!

Breast Imaging Tests

Mammograms

Another way to keep on top of your breast cancer risk and status is to receive regular mammograms. A screening mammogram, or mammography, is an X-ray of the breast using a low dose of radiation. Two plates will compress the breast at different angles to get multiple digital images, which a radiologist can examine for signs of breast disease or any other possible abnormality.

However, those who have particularly dense breast tissue or scar tissue in the breast are likely to have false positives in a mammogram. Breast cancer, dense tissue, and even cysts (fluid-filled sacs) appear white on x-rays, with limited ways to distinguish between them. For this reason, a potential positive from a diagnostic mammogram is not considered conclusively positive. Additional tests or a biopsy should be taken to confirm accuracy.

Ultrasound

A breast ultrasound uses sound waves to form a picture of the breast tissue. This is a good alternative to a mammogram if you’re pregnant and shouldn’t be exposed to x-rays. While ultrasounds are not generally used for cancer screening, they work well at differentiating a fluid-filled cyst from more solid masses. It can also give locations of tumors to help doctors, should they need to perform a biopsy or further investigation. Some surgical oncologists will use ultrasound during lumpectomies to establish the boundaries of the breast cancer before they begin removal.

MRI Scan

MRIs, or Magnetic Resonance Imaging tests, use magnetic fields to produce images of the breast’s interior. A contrast dye is injected before the screening, revealing where any blockages are. MRIs are not often used to diagnose breast cancer but instead used after an initial diagnosis to see how far cancer has spread. However, it can be used in combination with a mammogram to screen if:

  • there is a strong family history of breast cancer or ovarian cancer
  • the breasts are particularly dense (primarily ducts, fibrous tissue, and glands, with little fatty tissue), so any signs of breast cancer would be difficult to spot on a mammogram alone
  • the BRCA1 or BRCA2 gene mutation or other genetic mutations are present
  • radiation treatments have been applied to the chest before age 30

These traits can potentially lead to a high risk of breast cancer or, in the case of the dense tissue, an increased risk of missing early-stage breast cancer.

Metastatic Breast Cancer Detection

Specific imaging tests can detect metastasis once breast cancer has already been diagnosed. Biopsies can be performed by interventional radiologists, doctors whose primary focus is minimally invasive and targeted therapy.

Biopsy Sample

There are multiple kinds of biopsies, each serving their own purposes, though generally speaking, a biopsy is used to confirm or rule out a breast cancer diagnosis. Put simply, a biopsy takes a small amount of cells or tissue from an area of concern to examine under a microscope to establish whether these cells are cancerous or not. A pathologist–a doctor specialized in interpreting lab data and evaluating and diagnosing based on cells and tissues–will create a pathology report to explain what was found and discuss potential treatment options.

Fine Needle Aspiration Biopsy

The tissue or cell sample is removed using a thin needle.

Core Needle Biopsy

Like the fine needle aspiration method, the core needle biopsy uses a needle to remove the needed sample. However, the needle gets a core of tissue, so it collects a larger sample. This is generally the preferred technique for getting breast cancer diagnosed once an abnormality has been found in the breast, whether through physical examination or imaging tests. A pathologist will examine the sample to establish whether they are invasive cancer cells and identify any cancer biomarkers. Local anesthesia is commonly used to minimize discomfort during the procedure.

Image-Guided Biopsy

Image-guided biopsies are a form of core needle biopsy that map the area and guide the needle to the correct area of calcifications or mass through the use of imaging devices, such as ultrasound, mammography, or MRI. Usually, a marker is left behind–a small metal clip, usually titanium–to mark where the sample was taken.

Surgical Biopsy

Surgical biopsies are usually performed after a diagnosis has already been given, so they are rarely used as diagnostic tests. Most potential breast cancer patients will be given a form of needle biopsy to avoid unnecessary surgery. However, surgical biopsy does yield the largest amount of tissue.

Sentinel Lymph Node Biopsy

Breast cancer will sometimes spread into the local lymphatic system. The lymph nodes the breast cancer cells reach first are referred to as the sentinel lymph nodes and are usually the axillary lymph nodes (found under the arms). The sentinel lymph node biopsy removes 1-3 lymph nodes to avoid needing to remove more lymph nodes later.

Staging Breast Cancer

Once a breast cancer diagnosis has been established, your doctor will establish its severity in one of the breast cancer stages. The stage helps determine your prognosis and the best treatment options to take moving forward.

Some procedures that may be used to establish the breast cancer’s stage are:

  • Mammogram
  • Breast MRI
  • Blood tests
  • Bone scan
  • PET scan
  • CT scan

The stages ran from 0–meaning noninvasive and relatively contained–to IV–also called metastatic, meaning it has spread to other parts of the body.

Treatment Options

A patient’s treatment plan will be determined based on their breast cancer stage, health, and other factors. Dr. Gorman at the Texas Breast Center always ensures that each patient receives a personalized and targeted approach to breast cancer treatment to best meet their needs.


Breast Cancer Recurrence: New Data

In layman’s terms, breast cancer recurrence happens when cancer has come back after treatment. When a number of breast cancer cells evade initial treatment and later aggregate, they cause the cancer to return despite months or even years of remission. It is important to note that a minimum of a year must pass between the execution of cancer therapy and the appearance of growing cancer cells for the growth to be deemed a recurrence, rather than treatment failure or progression of cancer.

Every survivor of breast cancer faces a chance of recurrence, so it is essential to understand what to look for and how to take proactive measures. We have written a previous article that details risk factors of breast cancer recurrence and many of the prevention and treatment methods used to fight the growth of cancer cells. However, new data has arisen, giving us an even greater insight into the ins and outs of breast cancer recurrence.

New Data

Initially, recurrence was thought to happen within the first five years after treatment. Risk is greatest during these beginning years, but up-to-date studies reveal that the risk of recurrence lasts more than thirty years. Cancer cells can lay dormant, causing them to be undetectable for long periods, leading to a recent notable concern of the risks of late recurrence. The growing concern is attributed to a high cumulative incidence increase (which is an estimate of the risk that one may experience an event within a specific period). This means that more patients are at risk for late recurrence due to an increased number of long-term breast cancer survivors.

While this information seems alarming, and certain factors make recurrence more likely, thankfully, those who have a recurrence are not in the majority, and research has allowed us to identify the most prominent contributors to recurrences. The study also notes that because of the allotted time between the research participants’ first diagnoses and present day, as well as the study’s focus on late recurrence (requiring an extended follow-up), there have been significant changes and improvements in treatment procedures and technology since the participants’ initial treatment. Therefore, the study results are uncertain in association with today’s regimens. Because of this, such studies are paramount and must be completed repetitively to find continual up-to-date results.

Recurrent Breast Cancer

While the chances of a recurrence are not common, it is still valuable to consider the risk factors and to understand the realities of the different types of recurrences.

Types of Recurrence

If a recurrence does occur, a breast surgeon will categorize it by its appearance in proximity to the initial breast cancer. The three forms are:

Local recurrence

  • This refers to when the breast cancer returns to the same chest area as the original tumor.
  • Changes in appearance or feel (such as thickening of the skin or new lumps) are typical indicators of a local recurrence.

Regional recurrence

  • It is deemed regional recurrence if cancer cells show growth in nearby lymph nodes (found in the armpit or collarbone) to the initial cancer area.
  • Regional recurrence is differentiated from local recurrence solely because of the involvement of lymph nodes.
  • Symptoms of regional recurrence may involve newfound pain or lumps in the arm attached to the side of the body with the original breast cancer.

Distant recurrence

  • When cancer has traveled to different parts of the body (such as bone or organs), it is considered a distant recurrence.
  • Another name for this is metastatic breast cancer.
  • Bone pain, weakness, and extreme fatigue may point to metastatic breast cancer.
  • It is considered stage IV cancer, as the cancer has extended to other parts of the body.

Which breast cancer is most likely to recur?

The initial diagnosis is a significant indicator of the chance of recurrence. Recurrent breast cancer is most likely to appear in patients who had an original tumor with more than three positive lymph nodes.

What are the chances of recurrence of breast cancer?

The cumulative incidence of recurrence is between 8.5-16.6% for fifteen to thirty-two years after a primary diagnosis. Chances of late recurrence are typically higher for those whose initial breast cancer was found in the lymph nodes and resulted in tumors over 2o millimeters. The chances are higher for women who were 35 or younger during their primary diagnosis. According to the recent data, 2,595 of the 20,315 women involved in the research study were diagnosed with a recurrence more than ten years following their initial bout with breast cancer.

Is recurrent breast cancer worse?

Recurrent breast cancer may prove more challenging to manage, and the therapy used in your initial treatment may no longer be effective in your specific case. Metastatic cancer may also require more aggressive treatment, as the cancer has spread to more than just one part of your body. Recurrent breast cancer should not automatically be considered worse than the primary diagnosis, but it will often require different methods of treatment or therapy.

Treatment

Even simple cells can become tumors if not adequately treated. It is impossible to guarantee a 100% chance of freedom from cancer recurrence. Still, treatment may be able to halt the growth of undetected cells for many years, and there are methods of prevention that the doctor-patient duo can take to reduce your risk of recurrence.

While a breast cancer diagnosis can seem bleak, both Dr. Gorman and the researchers of this recent study recognize the significant evolution of modern-day regimens and their success rate. If your breast cancer comes back, treatment is available. Depending on the type of breast cancer, treatment may entail surgical treatment and radiation therapy. More aggressive treatment regimens and therapy approaches may be merited for those at a higher risk of late recurrence. Survivors are also encouraged to stay under extended surveillance by making regular check-ins with their doctors and surgeons.

Risk Factors and Therapy

The chances of recurrence are significantly lowered by the proactive utilization of hormone, chemo, or radiation therapy following the initial removal of cancer cells. You can play a role in lowering the recurrence risk factors by opting for therapy options (such as radiation treatment or endocrine therapy) recommended by your oncologist. Such regimens may attempt to prevent breast cancer recurrence or aid in reducing the potential of recurrence. Exercise and a healthy diet are also easy, proactive measures to implement for holistic well-being and to reduce the risks of recurrence.

Dr. Gorman and Texas Breast Center

Remember that recurrent breast cancer is not your fault. Though a breast cancer diagnosis can be alarming or dismaying, Dr. Gorman holds fast to the fact that “treatment for breast cancer has improved significantly over the last few years, and success rates continue to rise.” There is great hope. Dr. Gorman understands the significant emotional and physical impact a breast cancer diagnosis can play in one’s life. Her team at Texas Breast Center is dedicated to offering patients personalized, advanced care in the treatment of breast cancer recurrence and the prevention of recurrence, as well as support that lasts long after your treatment regimen.

Our previous article: https://www.texasbreastcenter.com/breast-cancer/breast-cancer-recurrence-what-and-why

New Data: https://www.medscape.com/viewarticle/963031?uac=390358FV&faf=1&sso=true&impID=3870849&src=mkm_ret_211213_mscpmrk_BC_Monthly

 


Breast Cancer in Men

Breast cancer is represented by the pink ribbon. Research is fundraised through walks decked out in pink, and breast cancer awareness gear can be found covered in slogans like “big or small, save them all” or better yet, “fight like a girl.” And while the runs, marches, and merchandise can go a long way in raising money, they can also go a long way in implying some wrong information. If nearly all breast cancer awareness is geared towards women, does that mean men cannot–or do not–get breast cancer? No. Men may be less likely to get breast cancer than women, but there is still a risk.

How can you tell if a guy has breast cancer?

Breast cancer in men displays similarly to how it does in women. The symptoms are the same, and some are even more easily found due to the smaller amount of breast tissue in most men. With less breast tissue, lumps are more easily noticed and therefore diagnosed.

The most common symptoms of male breast cancer are:

  • Scaling, flaking, or redness of the skin of the nipple; can show as puckering or dimpling as well, or can happen to the skin over the whole breast, not just the nipple.
  • A painless thickening, swelling, or lump in the breast.
  • Nipple discharge, retraction, or ulceration.
  • Pain or pulling in the nipple area.

If the cancer cells spread further than the initial breast tumor, there can be additional symptoms and side effects, such as:

  • breast pain
  • bone pain
  • swelling in the underarm lymph glands

If anyone, no matter the person’s gender, experiences these symptoms, they should speak to their doctor. The sooner any breast cancer cells can be found, the more likely any treatment options are to work, and the less rigorous treatment needs to be.

How common is breast cancer in men?

While it is commonly known that breast cancer will develop in approximately one in eight women over the course of their lifetimes, the statistics on male breast cancer are less well known. When you search google for ‘how common is breast cancer,’ every answer on the first page is about women. Most sites collecting data on cancer categorize breast cancer as ‘female breast’ cancer to clarify that their data does not include men, despite many other cancer types (stomach, colorectum, leukemia, etc.) gathering data for both men and women. While this makes it easy to do cancer research for women, it makes it difficult to find information for male cancer patients.

One source, however, found that one out of every one hundred breast cancer diagnoses is given to a man. So, while men are at less of a risk than women, there is still a chance of breast cells becoming cancerous.

The American Cancer Society did offer that approximately 2,550 new male breast cancer cases are diagnosed each year. With breast cancer being 100 times more common in women than men, and with a man’s risk of diagnosis averaging around one in 1,000, it is easy to see why it’s not as prominently discussed. However, the risk is still there, and men should know what to look for to minimize risk.

However, just as with women, some men have more risk factors than others. These risk factors do not guarantee that this person will get breast cancer, nor does avoiding the risk factors guarantee that the person will avoid a breast cancer diagnosis. However, if you have these factors in your history, or are aware of them, be mindful of the signs, symptoms, and possible screening guidelines for breast cancer.

What are the risk factors for men?

Some of the risk factors for male breast cancer include:

  • Family history of breast cancer–you have a higher chance of developing breast cancer if you have a close family member who has, or has had, breast cancer.
  • Age–most male breast cancer diagnoses happen after 50 and are most commonly between age 60-70. It is usually rare for a man to get breast cancer under the age of 35.
  • Radiation therapy treatment–having a history of radiation therapy to the chest can increase the risk of breast cancer.
  • Liver disease–liver cirrhosis and other liver diseases can reduce androgen (commonly referred to as male hormones) levels and increase estrogen (commonly referred to as female hormones) levels in men, increasing risk.
  • Testicle surgery or disease–surgical removal of a testicle (orchiectomy), testicular injuries, or testicle diseases or conditions such as mumps orchitis or undescended testicles can increase breast cancer risk.
  • Estrogen exposure–those who take, or have taken in the past, estrogen or estrogen-related drugs (used for hormone therapy for prostate cancer) can have a higher risk of breast cancer.
  • Obesity–obesity can be associated with higher estrogen levels, leading to an increased risk factor.
  • Enlarged breasts–having enlarged breast tissue, known as gynecomastia, can come from infection, drug or hormone treatments, as well as other causes. Having additional tissue can make it difficult to notice early signs of breast cancer.
  • Breast cancer genes–mutations to the BRCA1 and BRCA2 genes dramatically increase the risk of breast, ovarian, and other cancers. People of all genders should be aware of the potential danger of the mutation of these genes.
  • Klinefelter’s syndrome–Klinefelter’s syndrome is genetic and can be considered a form of being intersex. It occurs when a boy has more than one X chromosome, leading to lower androgen levels and higher estrogen levels. This increased amount of estrogen can increase the risk factor.

 

Can trans men get breast cancer?

Anyone can get breast cancer. However, transgender men and non-binary people occupy a unique space regarding risk factors and following the breast cancer story from start to finish. Many AFAB (assigned female at birth) men or non-binary people carry the same risk factors that cisgender (non-transgender) women have, especially if they have not taken steps such as gender-affirming surgery or hormone therapy.

Most data on the subject of transgender and non-binary people and their risk and experience with breast cancer comes from individual case studies and anecdotal experiences rather than extensive cancer research. One such study conducted in 2013 in the Netherlands examined nearly 800 AFAB trans men taking testosterone and discovered only one case of breast cancer. Overall, the study stated that “The rate of breast cancer among trans men in this study was estimated to be much lower than the rate of breast cancer among cisgender women and similar to the rate among cisgender men in the Dutch population” (1).

Do top surgery or binding affect breast cancer risk?

Binding, a practice not uncommon among trans men and non-binary people, compresses the breast tissue to make the chest seem flatter to help reflect the person’s gender identity more accurately and comfortably. Binding can sometimes cause adverse symptoms such as shortness of breath, pain, and skin infections, especially when done by more risky methods (tape, ace bandages, leaving binders on for too long). However, binding has not been linked to breast cancer.

Top surgery, a mastectomy performed to align the patient’s breasts and chest with their gender identity, is a different form of mastectomy from those performed for breast cancer purposes. Top surgery mastectomies remove fatty tissue but may leave behind some glandular (milk-producing) tissue and lymph vessels, where cancer may form. People who receive top surgery should still perform regular breast self-checks and discuss the risks of cancer with their doctor.

Can male breast cancer kill you?

There is a risk of death as with any cancer, depending on when the breast cancer cells are discovered. According to the American Cancer Society, the prognosis for breast cancer in men is similar to that in women. The odds of surviving five or more years after the initial diagnosis are, on average:

  • 96%–when cancer is still only affecting the breast tissue at diagnosis
  • 83%–when cancer has spread through the breast to nearby areas, such has the local lymph system (underarm, etc.)
  • 23%–when the disease has spread throughout the body

Just as is recommended to women, it is essential to be aware of any changes in the breast so that if cancer cells start to grow, treatment can begin as soon as possible.

What is the survival rate of male breast cancer?

As mentioned above, 2,550 new cases of breast cancer in men are diagnosed annually. Unfortunately, this same cancer also leads to around 480 deaths in men. While this is significantly lower than the close-to-40,000 women who die of breast cancer annually, it is still a statistic that can be lowered.

Most male breast cancers are diagnosed after patients discover a lump in their chest. However, many tend to leave this concern alone until other, more severe, symptoms arise, such as blood coming from the nipple. However, by this time, the cancer has likely spread further, making the necessary treatment harsher and the risks involved a little grimmer.

By informing male patients of the possible risk factors for breast cancer, they can be more aware should they notice something out of place in their chest. Self-breast checks can be just as necessary for men, transgender, and non-binary people as for cisgender women, and everyone should have the chance to be informed of their risk.

If you have questions about your risk factors, any changes in your breasts, or simply about breast cancer, speak with your doctor, or Dr. Gorman at the Texas Breast Center is happy to help answer any questions. Her goal is to keep all patients informed and prepared.

  1. Gooren LJ, van Trotsenburg MA, Giltay EJ, van Diest PJ. Breast cancer development in transsexual subjects receiving cross-sex hormone treatment. J Sex Med. 2013;10:3129-34.

Breast Cancer in Transgender People

Breast cancer is a vicious disease that is far more prevalent than we would like. One in eight women will receive a breast cancer diagnosis in their life, and one in one thousand men receive the same. However, more rarely discussed when mentioning these statistics is the risk of breast cancer for transgender people.

Transgender people–those who identify with a different gender than the one they were assigned at birth–may choose to receive treatments to align their bodies with the physical standard of their gender. This process, called transitioning, can include surgeries as well as gender-affirming hormone therapy. While some find these changes unnecessary, others rely on them to feel comfortable in their own bodies.

What gender is most likely to get breast cancer?

Most people could tell you that women are more likely to get breast cancer than men. And while this is correct, many don’t know the reasons why. Between the excess breast tissue and ‘female’ hormones, the female gender identity seems to come with risk. This includes both cisgender–those who are not transgender–and transgender women. However, everyone of any gender should invest in regular breast checks, looking for lumps or any other possible changes to their breasts.

Risk for Trans Women

An increased amount of estrogen and progesterone, commonly known as the female hormones, in the body for any reason will increase the breast cancer risk for anyone, regardless of gender. However, these two hormones can both be used in hormone treatment for trans women or non-binary people, giving their bodies access to more than they naturally produce. While this is perfect for helping transition (alter their physical characteristics to match their gender identity) it does introduce an increased risk where there wasn’t as high a risk before.

Risk for Trans Men

Transgender men, however, tend to lower breast cancer risk factors through both surgical means and cross-sex hormone treatment. Trans men and some non-binary people receive top surgery, a form of mastectomy that removes the breasts to give them flatter chests. While this procedure is different from a mastectomy performed to clear out breast cancer, a large amount of breast tissue is still removed. With less breast tissue, there is, simply put, less room to develop breast cancer. However, the lymph nodes and glandular tissue–two places breast cancer is likely to form–are usually still left in place. Also, consider that scars left behind can make breast imaging for breast cancer screening difficult.

Furthermore, breast cancer cases in trans men are relatively low because of their own hormone therapy. Trans men, and some non-binary people, go through testosterone therapy. Testosterone, commonly considered the male hormone, can bring trans men’s physical appearance closer to that of the general male population. And, while an unusually high amount of androgens–hormones relevant to sexual development, including testosterone–can lead to an increased breast cancer risk, testosterone treatment doesn’t tend to add enough of the hormone to the body to cause this kind of higher breast cancer risk.

Cisgender People

When discussing cisgender people, breast cancer development is far more likely to happen in women. However, even among cisgender women, some are more at risk than others, especially due to factors out of their control. For example, those who started menstruating early and became menopausal late have an increased risk. This increase is due to the excess amount of estrogen and progesterone these women were exposed to; as with trans women, the excessive amount increases the risk of breast cancer.

Cisgender men generally have the lowest risk of breast cancer. However, this does not mean they have no risk. Cis men absolutely should still be aware of the signs and symptoms of breast cancer, such as breast pain and nipple discharge, as well as the risk factors, such as family history and testicular surgery.

Is Trans hormone therapy dangerous?

As with any medical procedure or treatment, there are some risks to hormone treatment. Taking estrogen while smoking, for example, increases the risk of blood clots. One risk of taking testosterone is a high hematocrit count, or overly thick blood, leading to a possible stroke or heart attack. And while many trans men, trans women, and non-binary people may choose not to pursue hormone therapy due to these risks, one must also consider that those listed above are not the only people who utilize this treatment.

Many cisgender menopausal and postmenopausal women participate in hormone replacement therapy to treat their menopausal symptoms. The boost in estrogen that they no longer naturally produce minimizes their hot flashes and vaginal discomfort and has even been proved to reduce bone fracture and prevent bone loss.

Risks for this treatment are commonly listed as blood clots, stroke, heart disease, and, of course, breast cancer. So, while it is well known that hormone treatment alters the absolute risk of breast cancer, this is not strictly an issue for transgender people.

Who has the highest risk of breast cancer?

A Dutch study published online in 2019–”Breast cancer risk in transgender people receiving hormone treatment: nationwide cohort study in the Netherlands“–investigated the risk of breast cancer in transgender people receiving hormone treatment between 1972 and 2016 from a specialist clinic in Amsterdam (1). In this time, 2,260 trans women and 1,229 trans men were treated. In the population of transgender women–those assigned male at birth (amab) but identify with the female sex–15 cases of invasive breast cancer were diagnosed, approximately .7%. However, among cisgender women, the statistic is closer to 12.5% or one in eight women.

Of the transgender men–those who were assigned female at birth (afab) but have a male gender identity–examined in the study, only four cases of invasive breast cancer were diagnosed. This gives trans men a standard risk of approximately .3% if the study is trusted. Cisgender men receive breast cancer diagnoses in one in 1000 men, approximately .1%. However, the numbers and data pulled from the study are not the be all end all for transgender breast cancer risk statistics. More research needs to be done to have more confidence in the numbers.

However, using the data we have available from the study, those with the highest risk of breast cancer are the general female population, with cisgender women having the highest risk of all. Trans women follow after, then the general male population, with cisgender males having the lowest risk of breast cancer.

It is crucial for transgender people to understand the health risks that can come with transitioning. While many choose not to transition, many consider it of absolute importance to their health, both physical and mental. Further research needs to be done to better understand just what transitioning means to understand any potential side effects or health problems. Patients will need to know their new risks and new preventative measures to perform that they may not be familiar with, such as regular self-breast checks.

Dr. Gorman at the Texas Breast Center works to keep her patients informed of breast cancer risks, screening options, and treatment. Each patient she and her team see is treated with a personalized and targeted treatment plan.

 

  1. https://www.bmj.com/content/365/bmj.l1652

History of Breast Cancer

March is Women’s History Month. The history of women and the history of breast cancer go hand in hand. But how far back does the history of breast cancer go? How long have we known about it, and how long have we been able to treat it? This article will discuss treatments and diagnoses of breast cancer since antiquity.

Who first discovered breast cancer?

When did breast cancer start?

Breast cancer, and cancer as a whole, has likely been around as long as humanity has. Evidence of prostate cancer has been found on skeletons of both a Russian king (approximately 2,700 years old) and an Egyptian mummy (about 2,200 years old). But the earliest record we have of breast cancer can be found on the Edwin Smith Surgical Papyrus, an Egyptian papyrus dating back to 3000-2500 BC. While the papyrus does not offer much in the way of treatment options, it does give a way to identify an incurable disease as “cool to touch, bulging and spread all over the breast.”

Ancient Greece, around 460 BC, gave us the term carcinoma (karkinoma). Carcinoma is a cancer that starts in skin or organ tissue cells rather than in structures like blood vessels or bones. However, breast cancer treatment was still relatively unsuccessful as it was believed that disease was caused by imbalances of the four humours, phlegm, yellow bile, black bile, and blood. To treat illnesses, one had to remove or increase the humours within the body. Galen, a well-known Greek physician from around 168 BC, claimed that breast cancer was caused by too much black bile and began to treat the condition with surgery to remove the tumor, though he let the incisions bleed to continue removing excess bile.

While the surgery that Galen performed spread throughout Greece, the increase in religious philosophies and medical approaches prevented the practice from going much further. Early Christianity believed surgery to be more barbaric than their faith healing preference, a tradition that persisted through much of the world between 476 and 1500 AD. However, between the 10th and 15th centuries, Abu Al-Qasim Al-Zahrawl and Ibn Sina, a pair of Islamic physicians, revived the Greek practices, including surgery, and wrote many medical texts. Their ideas and practices spread throughout Europe.

The 16th, 17th, and 18th centuries, known more commonly as the Renaissance period, saw a growth in surgical practice. Where once ‘surgeon’ was simply a title tagged onto the end of ‘barber’, and a procedure could be performed after a haircut, surgeons now had their own trade. John Hunter, a Scottish surgeon, proposes the first idea of breast cancer in stages. While not as clearly defined as those we have today, there were some stages where surgery was necessary, while others were not. This was also a time of no anesthesia, so these early lumpectomies and mastectomies had to be performed quickly and accurately.

As the 19th century rolled around, significant improvements were made to the safety of surgery. With the introduction of hygiene to medical practices (albeit slowly), disinfection and surgical garments became more common. Anesthesia was also developed, helping prevent patient shock and give the doctors more time to perform the breast cancer surgery. William Halsted, an American surgeon, developed the radical mastectomy procedure in 1894. This procedure removes the entire tumor in a single piece together with the breast, the axillary lymph nodes, lymphatic vessels, and pectoral muscles. This was the first time breast cancer was considered treatable and even curable. Two years later, Thomas Beatson, a British surgeon, announces that oophorectomies–operations to remove one or both ovaries– can reduce tumors in advance breast cancer.

Modern Breast Cancer Treatments

The 20th century brought vast change to breast cancer treatment. Tumors were shrunk using radiation. Chemotherapy was introduced in the 1940s, and Robert Egan introduced mammography as a breast cancer detection option in 1962. The first modern autologous breast reconstruction was performed in 1979, allowing for more natural feeling breasts. More medications, procedures, and treatments for breast cancer have been researched and implemented, as well as potential causes and risk factors. The BRCA1 and BRCA2 genes–commonly known as the breast cancer gene– were discovered in 1995. A few years later, new breast cancer subtypes–HER2 positive, triple-negative, progesterone receptor-positive, and estrogen receptor-positive–were classified in 2000.

Even today, new research is still being performed to improve upon the surgeries, treatments, and post-op for breast cancer patients to have the best possible results. Dr. Gorman was involved in a study using the Biozorb implantable marker that helps target radiation therapy as well as post-operation imaging. She also contributes to the study on Accelerated Partial Breast Irradiation, or APBI, a method that shortens the amount of time the patient needs to spend getting radiation therapy and uses a higher dose of radiation in a more targeted beam–assisted by the Biozorb marker. She also uses oncoplastic techniques which help with postoperative cosmesis.

Breast Cancer Treatment Today

With today’s understanding of the disease, treatment is far more effective than it has been in the past. One primary reason for this is the improved breast cancer screening guidelines and understanding of breast cancer risk factors such as family history or having the so-called ‘breast cancer genes’. Knowledge of these risk factors can help set up specific screening procedures for those with a higher risk of breast cancer while still having a standard screening arrangement for those with lower risk. Getting a regular mammogram and breast self exam are easy steps to keep an eye out for early potential signs and symptoms. The sooner breast cancer is caught, the easier it is to treat.

Once a breast cancer diagnosis is reached, a treatment plan is agreed upon; no patient’s treatment plan and recovery are exactly alike. Treatment plans can–but do not necessarily–include breast surgery, radiation therapy, chemotherapy, hormone therapy, targeted medical therapy, as well as cosmetic surgery to aid in the patient’s self-image after an oncological procedure. Each of these treatment options has benefits and downsides and side effects and is more useful in some situations than others. The different surgical approaches can be applied depending on the tumor’s size and how far the breast cancer cells have spread. There are options to save more of the breast tissue and chest muscles if the breast cancer is caught early enough.

Combination treatments–surgery accompanied by radiation therapy or chemotherapy alongside medical therapy, for example–can help by approaching the breast cancer from different angles, ensuring thorough results with no cancer cells left behind and decreasing recurrence. With a combined effort from a full oncological team, the survival and recovery rates have increased exponentially since the days of the Edwin Smith Surgical Papyrus.

Dr. Gorman and her team at the Texas Breast Center work together to treat breast cancer from all angles. Dr. Gorman focuses on treating from the surgical side and works closely with medical and radiation oncologists to form a personalized treatment plan best suited to each patient. She also looks to the future of treatment by keeping aware of current and ongoing breast cancer research to best treat her patients. If you have questions or are ready to find your next steps in treatment, reach out to the Texas Breast Center. The team is prepared to help.


Breast Cancer Screening

An essential part of breast cancer awareness and breast cancer prevention is breast cancer screening. Screening takes many forms, from the self-breast check to the breast MRI, but all play their part. These screening examinations provide an opportunity to catch signs and symptoms of breast cancer, as well as lumps, early so that treatment options can be less extreme. Here is some information on the basics of different tests, when and how they are taken, and the decision-making process behind them.

When should I start breast cancer screening?

While any person with breasts should start a regular breast self-exam as their breasts start to develop, clinical screening does not need to begin so early. Different organizations vary in their breast cancer screening recommendations, especially as it comes to when exactly you should begin your breast cancer screening. Your particular risk and family history can play a part in your timeline.

When should I get screened for breast cancer?

The general timeline recommends:

  • Ages 25-39: Self breast exam monthly; annual clinical breast exam; mammogram for high-risk patients (annually, starting 10 years before youngest family member diagnosed with breast cancer)
  • Ages 40-54: At age 40, patients with normal risk start annual screening mammogram.
  • Ages 55+: It is recommended that screening continues for as long as the patient is still living a healthy life and is expected to do so for at least ten more years. According to the U.S. Department of Health and Human Services, women between 40-74 with screened mammograms have a decreased chance of dying from breast cancer.

As with any medical concerns or tests, ask your doctor the best time to start your breast cancer screening and how often you should go.

What are the screening tests for breast cancer?

There are a handful of different kinds of breast cancer screening tests, each with its own purpose and use, as well as benefits and risks.

What are Clinical Breast Exams?

A clinical breast exam is an exam performed in a doctor’s office by a doctor or other health professional. They will use their hands to feel and check for any physical abnormalities, signs, or symptoms of breast cancer in the breast and surrounding areas. These include lumps, irritated or puckered skin, and swelling.

The doctor will also ask for any relevant information such pregnancy history or the date of the patient’s last period. These can affect a patient’s risk of developing breast cancer and the current state of their breast. It is always best to be familiar with your own breasts look and feel so you can note any changes to your doctor straight away.

Most often, when a woman finds a lump or other sign or symptom, it tends to be during dressing, bathing, or other regular activities. However, doing these regular physical and visual checks, especially self-checks, keeps you familiar with your breasts’ regular state, so you are more likely to notice a change.

What is a mammogram?

A mammogram is the most common method of breast cancer screening in women ages 25 and above. It is a low dose x-ray exam that provides internal images of the breast. Mammography is an integral part of early detection because it can find small changes within the breast before these changes can be felt or seen by the patient or their doctor. Ductal Carcinoma in Situ (DCIS) can also be found early in mammograms. DCIS is a collection of abnormal and/or pre-cancerous cells in the milk ducts of the breasts. The sooner breast cancer is found and treated, the better, as it is usually much easier to treat in early stages.

As with any medical test, there are some risks. Because it is an x-ray, there is radiation involved. However, it is such a low dose, and such a brief exposure, that no radiation is left in the body after the examination. These risks also include the chance of a false-positive in the test results. A false positive can be caused by particularly dense breast tissue, scar tissue, or other factors. However, most doctors will not give a positive diagnosis purely based on just the mammogram due to the risk of false positives. They will recommend another form of test to compare results. There is also a 10-15% risk of a false-negative test result from a mammogram.

Another form of this test is digital mammography, also known as 3D mammography or tomosynthesis, which is particularly helpful for women with dense breast tissue or other factors that might cause a false positive on a typical mammogram. This screening exam can improve the chances of finding small cancers while reducing the need for additional testing to confirm false positives. 3D mammography does give a clearer picture of the breast tissue.

Other Breast Cancer Screening Tests

A few other types of breast cancer screening tests are used less commonly, though each has its purpose. These screening tests are generally used for women or patients with many risk factors, such as a family history of breast cancer or a genetic predisposition for breast cancer, or potential positives in previous mammograms.

  • Breast MRI Screening–MRI, or Magnetic Resonance Imaging, uses radio waves and magnets to collect detailed images of the body. This is often used for high-risk patients and those with a genetic mutation that increases their risk of breast cancer. This may actually start prior to mammogram on these high-risk patients.
  • Breast Ultrasound–An ultrasound of the breast can be used when a woman cannot undergo an MRI or x-ray screening (for example, if they are pregnant). Ultrasounds are particularly useful on dense breast tissue, containing more glands or ducts than fat. The ultrasound can differentiate the dense tissue and breast cancers better than traditional mammography. If there is no contraindication, however, a patient also needs a mammogram.
  • Thermography– Thermography uses a heat-sensing camera to observe and record the temperature of the breast’s skin. Because some tumors cause temperature changes, the thermogram may detect the presence of these tumors. However, there have not yet been any randomized clinical trials of this test to determine its validity. This may be additional information for your physician but does not replace annual mammograms.

What is the most accurate test for breast cancer?

Each test used to screen for breast cancer, from the breast self-exam to the breast ultrasound, has benefits and risks. Mammography is the easiest screening test to access and has been found to to find DCIS and other breast cancer tumors reliably, and is best for average-risk women. However, 5-15% of mammograms need a follow-up by another test for clarification. Ultrasounds can add diagnostic information on a painting and can help give a clearer picture than a mammogram, especially for women with dense breasts. MRIs are also helpful diagnostic tools for women with dense breasts and can sometimes find cancers that were even missed by the ultrasound. MRI cannot be used by those who have metal implants or are allergic to the contrast.

Each of these types of cancer screening exams works uniquely to collect different results. Ask your doctor for their recommendation based on your personal risk factors and concerns.

Does screening for breast cancer really work?

No one breast cancer screening exam is going to find 100% of breast cancer. However, between regular screening and breast self-checks, the chance to find breast cancer while it is still in the early stages increases dramatically. The sooner breast cancer can be detected, the easier it is to treat, and therefore the easier treatment will be on the cancer patients.

Remember, you can speak to your doctor or health care provider about your risk factors and determine your best method and pacing for screening. Dr. Gorman and her team at the Texas Breast Center are always happy to speak with you about breast cancer and any next steps in treatment plans.


Breast Cancer Risk Factors

What is a Risk Factor?

A breast cancer diagnosis can seemingly come out of nowhere for many patients. However, many things that could have made this diagnosis (or any potential diagnosis) far more likely for some patients than others. These little details in lives are known as risk factors. Some factors are a part of your lifestyle and can be controlled in your day to day life. Others are beyond a given person’s control, like things built into the DNA. It’s important to note that none of these factors will cause breast cancer. Any one of these risk factors is not a cause for breast cancer. They will only bring about higher risk.

Risk Factors You Can Affect

  • Taking hormones–Some forms of hormone replacement therapy (HRT), including estrogen and progesterone, in menopause can increase the breast cancer risk.
  • Using oral contraceptives–Some birth control pills have been found to raise breast cancer risk.
  • Reproductive history–A few factors relating to childbirth can vary your risk level. Having your first pregnancy after the age of 30, not having children, never having a full-term pregnancy, or not breastfeeding can increasing your breast cancer risk.
  • Being physically active–Women who are more active will decrease their risk of getting breast cancer.
  • Being overweight after menopause–Older women with obesity have an increased risk as opposed to those at a healthier weight.
  • Alcohol–The more alcohol someone drinks, the higher the risk of breast cancer. For example, a woman who has 2-3 alcoholic drinks a day will have a 20% higher risk than a woman who does not drink.
  • Diet–There is some debate about what diets increase or decrease the risk of breast cancer. However, a healthy diet with plenty of fruits and vegetables and minimizing animal fats has many health benefits.
  • Smoking–Smoking can increase a person’s risk of breast cancer.
  • Night shift/light at night–Routinely working night shifts can bring about a higher risk of breast cancer, possibly due to light exposure at night.

Risk Factors You Cannot Affect

  • Sex–A woman is far more likely to get breast cancer than a man due to the increased exposure to estrogen and progesterone. Because these are the hormones used in hormone replacement therapy for transgender women, this increased risk includes them. While men can certainly get breast cancer, the risk is not as high.
  • Race–White and black women are most likely to develop breast cancer. Black women tend to have the highest risk before 45 and are more likely to die from the disease.
  • Ashkenazi Jewish heritage–Jewish women also have a higher risk of breast cancer, likely due to a high occurrence of the BRCA1 and BRCA2 gene mutations in those of Ashkenazi Jewish descent.
  • Inherited genes–Several genes that can act as risk factors for breast cancer.
    • BRCA1 and BRCA2
    • ATM
    • BARD1
    • BRIP1
    • CDH1
    • CHEK2
    • NBN
    • NF1
    • PALB2
    • PTEN
    • RAD51C and RAD51D
    • STK11
    • TP53
  • Age–As you get older, your risk of breast cancer increases. Most diagnoses occur after the age of 50, and by the time a person is 60, the risk of breast cancer is 1 in 29.
    Breast History–If someone has previously been diagnosed with breast cancer or another breast disease like lobular carcinoma in situ or atypical hyperplasia, they have a much higher risk of breast cancer in the future.
  • Family History–Women who have a family history of breast cancer, especially when it is a first-degree relative (mother, sister, daughter) previously diagnosed. The risk of breast cancer also increases with multiple family members diagnosed, and a family history of ovarian cancer can also indicate an increased risk.
  • Radiation Exposure–Previous exposure to ionizing radiation in the chest area is a risk factor for breast cancer. Radiation is often used for treating Hodgkin’s disease. The risk is greater if the radiation was applied as a child.
  • Age at First Period–Starting menstruation early, before ages 11 or 12, can raise the breast cancer risk factor by bout 15-20% over those who started to get their periods at 15 or older. This is due to more prolonged exposure to estrogen and progesterone, which, as mentioned above, increases risk.
  • Age Starting Menopause–Women who start menopause after 55 have an increased risk of breast cancer by approximately 40% compared to those who start at age 45 or younger. Like with the earlier start of menstruation, this is due to more prolonged exposure to progesterone and estrogen.
  • Breast Density–Breast density comes from having more connective tissue than fatty tissue. This denser tissue can make it very difficult to read a mammogram accurately, sometimes increasing the risk of missing a potential diagnosis. Breast density can come from high estrogen levels, indicative of a risk factor rather than one on its own.
  • History of Diethylstilbestrol (DES)–DES was a drug given to some pregnant woman between the 1940s-1950s to prevent miscarriage. Those women and those whose mothers took it all have a high risk of breast cancer.
  • Birth Weight–Women born with a higher birth weight have an increased risk of breast cancer, particularly before menopause.
  • Blood Androgen–Androgens are hormones important to sexual development (including testosterone). An increased amount of androgens in a woman’s blood can increase her breast cancer risk.
  • Bone Density–High bone density can be a breast cancer risk factor. Someone with high bone density can have up to 60-80% higher risk than those with lower density.

Reducing Risk

  • Breast Cancer Screening–Go for regular breast screening to keep an eye on your breast health. For most, a mammogram is sufficient for checking breast health. A Breast MRI (Magnetic Resonance Imaging) may be better for those of higher risk. Speak with your doctor to establish the best course of action for the frequency and type of screening for you.
  •  Breast Self-Exam–Monthly, you should check your own breast health. While it won’t necessarily catch every sign of breast cancer, it can find many, and it is an excellent way to keep yourself familiar with your breasts. By checking your breasts’ appearance, feel, and textures regularly, you will be more likely to notice any changes should they come. If anything does change, bring it to the attention of your doctor.
  • Breast Feeding–Breastfeeding can help reduce the risk of breast cancer, particularly in those pre-menopause.
  • Lifestyle Changes–As mentioned above, some breast cancer risk factors that can be reduced through your own lifestyle choices. By doing what you can to handle these risk factors, such as alcohol intake and physical activity, one can reduce their risk of breast cancer by a great deal while also keeping themself healthy in general.

Speak With Your Doctor

If you are ever concerned about your risk of breast cancer, you can speak with your doctor. While some risk factors are easy to determine for yourself, some must be tested for–blood androgen levels, inherited genes, etc.–which your doctor can help you get access to and understand. Once you and your doctor are familiar with your breast cancer risk level, you can set up a plan for your next steps. These will include recommendations for breast cancer screening–how often and what type–as well as possible medical preventative steps if your risk of breast cancer is high enough.

Dr. Gorman at Texas Breast Cancer is always available to help with any questions about breast cancer risk, preventative steps, and the process should a breast cancer diagnosis be given. She is an advocate for the informed patient, always providing her patients and those who could potentially become patients with the information they need.

If you have any questions about breast cancer or breast cancer risk factors, please feel free to contact Dr. Gorman or her team at Texas Breast Cancer.

 


Breast Cancer Recurrence: What and Why?

When breast cancer comes backs, it is called recurrence. While those who have a recurrence are not in the majority, they are certainly not a rarity or an impossibility. Recurrences typically happen within the first five years after treatment but can occur at any time and have a few ways of returning. To help ease some of the worries of these first few cancer-free years, we want to give some clarity and explanation into what breast cancer recurrence is and what to look for.

Causes

Breast cancer recurrence occurs when cells from your original breast cancer manage to escape being treated and begin growing again. This process can sometimes take years. The cancer cells will lay dormant until something kick starts them into growing again.

Risks

Many of the recurrence risk factors are determined by the original tumor and cancer, though the patient determines some. These risk factors include:

  • A large tumor–A larger tumor increases the risk of cells being left behind.
  • Close or positive tumor margins–During surgery, when the surgeon removes the cancer, they will remove a small amount of healthy tissue around it. The tissue is then examined with a microscope. If it is clear of cancer, the margin is considered negative. However, if there are any cells left (considered a positive margin), risk or recurrence increases.
  • Lymph node infection–The risk of recurrence increases if cancer was found in lymph nodes at your original diagnosis.
  • No radiation treatment post-surgery–While most who undergo a lumpectomy choose to receive radiation therapy in the area of cancer afterward to reduce the risk of recurrence, some do not.
  • Inflammatory breast cancer–This type of breast cancer increases the risk of a local recurrence.
  • Specific cancer cell characteristics–Having triple-negative breast cancer or cancer resistant to hormone therapy can increase your risk.
  • No endocrine therapy–For certain types of breast cancer, not receiving endocrine therapy can raise the risk of recurrence in cancer patients.
  • Younger age–Those of a younger age during their initial breast cancer diagnosis, specifically under 35, have a higher risk of their cancer returning, despite generally older generally being a risk factor of cancer in general.
  • Obesity–Increased body mass index increases the risk of breast cancer coming back.

Prevention

There are methods and steps you can take to reduce your risk of recurrence of breast cancer, many in your initial treatment.

  • Chemotherapy–Those with an increased chance of recurrent breast cancer have been shown to have a decreased risk when treated with chemo.
  • Hormone therapy–If you have receptor-positive breast cancer, taking hormone therapy in your initial treatment can reduce your risk. This treatment method can sometimes continue for five or more years.
  • Targeted therapy–If your cancer produced additional HER2 proteins, targeted drug and treatment might reduce your risk.
  • Radiation therapy–A previous breast cancer patient with a large tumor, a breast-sparing operation, or inflammatory cancer would have reduced risk if treated with radiation treatment.
  • Bone-Building–Bone building medications can reduce the risk of recurrence taking place in bones, otherwise known as bone metastasis, for those with a high risk.
  • Healthy Diet–To decrease your risk of breast cancer recurrence, be sure to include plenty of fruits, vegetables, and whole grains in your diet, as well as limiting alcohol to one drink a day.
  • Exercising–Exercising regularly may help reduce your risk.

Kinds of Recurrence

Recurrent breast cancer can take one of three forms, defined by where it appears in reference to the primary cancer and treatment. The three types are local, regional, and distant recurrence.

Local

A local recurrence occurs when cancer cells grow in the same area as your previous cancer. If a lumpectomy was used for treatment (rather than a full mastectomy), cancer might start to regrow in the breast tissue that remains. If a complete mastectomy were performed, the tissue along the skin or chest wall would hold the recurring breast cancer.

Some signs that local recurrence is occurring are:

  • One or more painless lumps, nodules, or irregular areas of firmness under the skin
  • Newly thickened areas along mastectomy scars
  • Changes to the skin (inflammation, redness, changes in texture)
  • Nipple discharge

Many of the signs of a local recurrence are similar to those of initial breast cancer. After treatment, it does not hurt and may help to continue self-breast exams to keep an eye out for any changes, just in case.

Regional

Regional recurrence also happens rather close to the original site of infection. However, the difference between regional and local recurrence is a matter of lymph nodes. In regional recurrence, the local lymph nodes, such as those under the arm, will be infected with cancer.

Signs of regional recurrence cancer may include a lump or swelling in lymph nodes, so continue your self-checks in these areas:

  • Under the arm
  • Along the neck
  • Near and in the groove above the collarbone

This kind of recurrent breast cancer can almost be considered a subset of local recurrence and can many times be found by being familiar with your own body. Regular self-breast checks are just as necessary after breast cancer treatments as they are before.

Distant

Distant recurrence is when cancer recurred somewhere in the body away from the original site. This can include other organs such as the lungs or even bones. In this case, the patient is generally treated much in the same way as those diagnosed with stage IV breast cancer. However, treatment can vary from standard stage IV treatment based on the responses to previous treatments.

Treatment

Treatment, many times, is determined by the kind of breast cancer recurrence found. Local will be treated differently from regional will be treated differently from different.

Local Treatment

Local breast cancer recurrence is, if possible, treated with surgical treatment. If a lumpectomy and radiation were used previously, then a mastectomy would be the first choice treatment. If a mastectomy was performed prior, the tumor would be removed, and the patient will be treated with radiation therapy if not already received.

Either way, both of these plans are likely to be accompanied by chemotherapy, targeted therapy, hormone therapy, or some combination to ensure a full recovery.

Regional Treatment

Sometimes breast cancer will come back in the lymph nodes. This can be treated by removing the lymph nodes themselves, followed by radiation in the surrounding area, if not already received. Systemic (targeted, hormone, or chemotherapy) treatment after surgery may be discussed on a case-by-case basis to ensure that any remaining cancer cells are eliminated.

Distant Treatment

The primary treatment for distant recurrent breast cancer will be a form of system treatment (hormone, targeted, or chemotherapy) based on how your cancer has responded before. You and your doctor can create a treatment plan that serves you well, knowing what has worked with these breast cancer cells previously and what has not.

Dr. Gorman

Dr. Valerie Gorman and the Texas Breast Center are aware of the risks of recurrent breast cancer and the chances that your breast cancer may come back. This is why she and her team stay with you through your personalized treatment and long after to make sure you know that you always have a support system, whether you need it or not.

Dr. Gorman specializes in surgical oncology and surgical diseases of the breast. She serves as the Medical Director of Surgical Services at Baylor Scott & White Medical Center as well as the Chief of Surgery.


Breast Density FAQs

After a mammogram, some women find out they have dense breasts. They come to me with questions about what that means, how it affects their risk for breast cancer, and what they should do differently. Here’s how I answer the questions I hear most often.

 

What does it mean to have dense breasts?

It’s common for women to have dense breasts. Your breasts are made of fatty tissue, which is not dense, and supportive tissue, milk glands, and milk ducts, which is. The parts of your breast made up of dense tissue show up as white on a mammogram, so it can be harder to spot signs of breast cancer in those areas.

 

How do I know if I have dense breasts?

The radiologist who reviews your mammogram assigns a grade to your breast density based on how much of your breast tissue is dense. You might see something on your mammogram report called Breast Imaging Reporting and Data System (BI-RADS). There are four levels of breast density:

  • A is almost all fatty tissue, found in about 10 percent of women
  • B is more nondense than dense, found in about 40 percent of women
  • C is more dense than nondense, found in about 40 percent of women
  • D is almost all dense, found in about 10 percent of women

If you fall into the C or D categories, your mammogram report may indicate that you have dense breasts. If it doesn’t say, ask your doctor.

As you can see, about half of all women have dense breasts. You’re more likely to have dense breasts if you are younger, have less body fat, and/or take hormone therapy for menopause.

 

How does my breast density affect my risk for breast cancer?

Since it’s harder to spot breast cancer on dense breasts, you have a higher chance of cancer not being detected on a mammogram. Separately from that, women with dense breasts also have a higher risk of breast cancer.

 

What should I do differently if I have dense breasts?

You should talk to your doctor about your other risk factors for breast cancer and work together to come up with a breast cancer screening schedule that works for you. For my patients with dense breasts but no additional risk for breast cancer, I recommend an annual mammogram beginning at age 40. Depending on other risk factors for breast cancer, I might also recommend:

  • A breast MRI, which uses magnetic forces to image your breast
  • A 3D mammogram, which combines images of your breast taken from different angles
  • Breast ultrasound, which uses sound waves to investigate areas of your breast that might be concerning
  • Molecular breast imaging, which uses a radioactive tracer to look for cancerous areas

What is Breast Cancer?

While most people are familiar with the idea and repercussions of breast cancer, not everyone may know what exactly breast cancer is or how it comes to be.

Kinds of Breast Cancer

Put simply, breast cancer is the continued growth of abnormal cells in the area of the breast. This area can include the ducts (that carry milk), lobules (that produce milk), and connective tissue (that holds everything together. Most breast cancers start in the lobules or ducts. And while this does mean cancers appear in the area that we traditionally think of as the breast, it includes the underarms as well.

But there is not one single type of breast cancer. And sometimes, the types overlap.

Invasive Ductal Carcinoma

With invasive ductal carcinoma, cancer cells start in ducts and spread out into the surrounding breast tissue. If it continues to spread to other parts of the body, it metastasizes.

Invasive Lobular Carcinoma

Invasive lobular carcinoma starts in the lobules and spreads to nearby breast tissue. This cancer can also metastasize.

Less Common Types

There are many other kinds of breast cancers, though most are less common. Medullary breast carcinoma starts similarly to invasive ductal, but grows slowly and only rarely spreads to the lymph nodes.

Mucinous or colloid carcinoma is a variation on invasive ductal carcinoma. However, the cancer cells float in mucin, an ingredient in the body’s natural mucus.

Paget’s Disease of the nipple originates with cancer cells collecting in and around the nipple, traditionally the ducts there. From there, it can spread to the areola and further.

Inflammatory breast cancer is also a variation on invasive ductal carcinoma. It is generally accompanied by symptoms of inflammation such as swelling, dimpling, and redness.

Triple-Negative breast cancer does not have the three common receptors found in breast cancers. These receptors are for estrogen, progesterone, and HER2 (human epidermal growth factor). Without the receptors, some methods of treatment are not available.

Ductal carcinoma in situ, or DCIS, is considered either the earliest stage of breast cancer or pre-cancer that is likely to lead to breast cancer. Cancerous cells are forming in the ductal lining, but they have not spread.

How Breast Cancer Spreads

Breast cancer cells start in ducts, lobules, and breast tissue. However, they can spread to the lymph nodes, raising the odds of metastasis–cancer cells spreading through the lymph system and the rest of the body. The more lymph nodes that have cancer cells, the more likely metastasis is. However, metastasis is not an inevitability. Some people with cancer cells in their lymph nodes do not have metastases. And, unfortunately, metastasis can occur despite there currently being no cancer cells in the lymph nodes.

What Are Breast Cancer Symptoms?

There are several possible changes to the breast that can be noticed in regular–monthly is recommended–self-breast checks. Keep an eye out for any changes to your regular breast shape, texture, or color. Some changes that may indicate the need to visit a doctor are:

  • A lump in the breast or armpit
  • Swelling or change in size to any part of the breast.
  • Discharge of any kind that is not milk coming from the nipple (including blood)
  • Puckering of the nipple/Inversion of the nipple
  • Flaky skin or redness around the nipple or the breast
  • Dimpling of the skin (like the skin of an orange) on the breast
  • Pain in any part of the breast

Any one of the symptoms on its own does not mean you have breast cancer. They could indicate an infection or changes due to hormonal shifts. However, if the signs continue or you are concerned, bring them to the attention of your doctor.

Risk Factors

There is no one sign that someone will or won’t get breast cancer, but there are some risk factors that can raise your chances. Some of these factors are genetic factors, while others come from a person’s lifestyle.

Some of the factors that cannot be reduced are:

  • Gender–being a woman increases your risk
  • Age–risk increase with age
  • Dense breasts–they are harder to see through on a mammogram, making early detection more difficult
  • Family history–the risk is increased if a close family relative (mother, sister, daughter) has had breast cancer
  • Personal history–previous breast conditions or breast cancer increase risk
  • Certain gene mutations–BRCA1 and BRCA2, as well as other mutations, can increase risk
  • Radiation exposure–while this may come from many sources, even medical treatment, it could potentially be a risk factor.
  • Starting your period young
  • Starting menopause older

Can Risk be Reduced?

Some potential risk factors come from lifestyle practices and can be adjusted for. Some of these factors are:

  • Alcohol–drinking in excess can increase risk
  • Obesity–obesity can increase your risk, particularly after menopause
  • Taking hormones–certain forms of hormone replacement therapy (progesterone and estrogen, primarily) can increase risk when taken for over five years after menopause. Some birth control pills can also increase breast cancer risk
  • Not having children or having them at an older age can increase risk.
  • Excercise–by not exercising, breast cancer risk can increase. Maintaining a healthy exercise schedule for yourself, you can lower your risk.

Prevention

The best way to prevent breast cancer in yourself is to maintain the risk factors that you can. Beyond that, keep yourself familiar with your breasts with a monthly breast self-check. More than anything, this keeps you familiar with the size, texture, and sensation of your breast so that you might be more likely to notice a change should one appear.

Also, speak with your doctor about breast cancer screening. They know the best time to start screening and will help you to the next steps if there are any concerns. Checking in on your breasts yourself, having your doctor check, and having regular screenings will help you be prepared and catch anything early should there be any signs of breast cancer to find.

Dr. Gorman

Valerie J. Gorman, MD, FACS, works to ensure that her patients are informed and receive a personalized approach to cancer treatment and breast cancer surgery. If you have questions about breast cancer or how it is treated, she or the team at Texas Breast Center in Waxahachie are happy to help answer your questions.

Dr. Gorman is board certified by the American Board of Surgery and serves as Medical Director of Surgical Services and Chief of Surgery at Baylor Scott & White Medical Center – Waxahachie.


New Study Associates Dairy Milk Intake With Increased Breast Cancer Risk

A recent study by the researchers at Loma Linda University Health has discovered a link between dairy milk and an increased risk of breast cancer. The study called Dairy, soy, and risk of breast cancer: those confounded milks was published to the International Journal of Epidemiology.

The study used a participation group of 52,795 North American women with a mean age of 57.1 years who were all free of breast cancer. The study then followed them for nearly eight years, taking into account their diets, demographics, family history, and other factors. A food frequency questionnaire, or FFQ, was used to estimate the women’s dietary intake. In contrast, a baseline questionnaire covered the other factors, including physical activity, hormonal and other medication use, alcohol consumption, reproductive and gynecological history, and breast cancer screening.

How much dairy milk?

At the end of the study period, the participation group yielded 1,057 new breast cancer cases. Using the FFQ, the study revealed that there is “fairly strong evidence that either dairy milk or some other factor closely related to drinking dairy milk is a cause of breast cancer in women,” according to Gary E. Fraser, MBChB, Ph.D., first author of the paper. He continued, “Consuming as little as 1/4 to 1/3 cup of dairy milk per day was associated with an increased risk of breast cancer of 30%. By drinking up to one cup per day, the associated risk went up to 50%, and for those drinking two to three cups per day, the risk increased further to 70% to 80%.”

While the particular fat content of the dairy milk–skim versus whole, etc.–had a minimal variation, when compared to minimal or no milk intake, high consumption of dairy milk and dairy calories were associated with a higher risk of breast cancer. Cheese and yogurt yielded no critical associations.

However, there was no clear association found between soy products and breast cancer. Fraser noted that “the data predicted a marked reduction in risk associated with substituting soy milk for dairy milk. This raises the possibility that dairy-alternate milks may be the optimal choice.”

One suggested reason for the link between dairy milk and breast cancer is the sex hormone content of dairy milk. Because cows are lactating when their milk is collected, approximately 75% of a dairy herd is usually pregnant. Breast cancer in women is hormone-responsive. Therefore, taking in this additional level of hormones could cause a higher blood level of it, and then insulin-like growth factor-1, which is thought to increase the risk of breast cancer, as well as other cancers.

Does Dairy Cause Cancer?

Does dairy cause cancer? There is certainly no proof of that being the case. But now there is some evidence of a link between dairy and breast cancer. “This work suggests the urgent need for further research,” Fraser said. “Dairy milk does have some positive nutritional qualities, but these need to be balanced against other possible, less helpful effects.

Risks

It is, however, worth remembering that just because an association was found does not imply causation. The numbers are just strong enough to keep researchers watching the intake of dairy, even when other factors were removed. And while Fraser stated that, “By drinking up to one cup per day, the associated risk went up to 50 percent, and for those drinking two to three cups per day, the risk increased further to 70 to 80 percent,” even that does not mean you are increasing your risk to 50% or 80% by drinking milk.

The 50% increased risk of breast cancer is a 50% increase to your current risk. If the average woman has a 1/8 chance of being diagnosed with breast cancer, that gives her approximately a 12% chance to increase the risk of breast cancer by 50% would only bring her risk up to a total of 18%. The 80% increased risk of drinking milk products 2-3 times a day would bring the total risk up to 21.6% risk of breast cancer. And while that certainly isn’t the happiest number to think about, it is certainly not as frightening as a jump to 80% risk would be.

Fraser and the rest of the researchers who worked on the study advise taking a look at current dietary guidelines, taking this increased risk of breast cancer with dairy intake into account.

If you have any questions about your risk, or possible next steps, Dr. Gorman and the Texas Breast Center are happy to help.


Texas Breast Center’s Covid-19 Safe Care

Dr. Gorman and the Texas Breast Center are still taking patients, but understand that there is hesitance in this time of COVID-19. To help ease fears and discomfort for patients, we have implemented certain safety measures, following Baylor Scott & White’s COVID-19 Safe Care Plan.

In-Office Policies

While some things have changed in the processes for patients and visitors to the Texas Breast Center, we are back to a full schedule. To maximize our patients’ safety, we are offering virtual care via video conferencing with your doctor for some appointments. There is also a drive-thru option for specimen collection. The waiting room is currently closed according to the Centers for Disease Control and Prevention guidelines, so when a patient arrives, they will wait in their car until an exam room is ready. When they are informed a room is ready, they will be escorted directly to their rooms. To encourage social distancing for both the patient and physician, only one visitor will be allowed to accompany the patient back. Everyone must wear a mask, including patients, visitors, and medical team members.

There will also be a screening process upon entry checking for any temperatures above 99.6 F as well as asking about potential COVID-19 symptoms such as cough, shortness of breath, sore throat, or others. If the patient answers yes to the questions or has a fever, they will be quickly moved to a separate, designated area, to prevent the spread of infection. If a visitor has a fever or answers, yes, health services will be offered. If the visitor does not need them at that time, we will request that they return home and contact their primary care doctor.

Policies and procedures are a little different when it comes to surgery rather than a general appointment or checkup at the facility.

Pre-Surgery Policies

While a surgeon’s preparatory efforts start happening well in advance of the surgery, usually a patient does not need to take any action until the day before. However, under the Safe Care guidelines, patients have a few tasks they must take care of in the week leading up to their surgery to assist in potential disease control.

Each patient is enrolled in a digital care journal five days in advance to help monitor them for fever or other symptoms of COVID-19. This online journal also offers resources to each patient who has questions. Then, 48 hours before the procedure, each patient will be tested, even if not symptomatic. Many people infected with COVID-19 are asymptomatic and can spread the virus without being aware of the risk. This is why both the testing and the personal journal are essential to your treatment. The results will determine how you and your medical team members proceed from there.

If your test comes back negative, you do not have the virus. You will not be called with the results if this is the case and can proceed with your surgery as expected. However, be aware that if the test is taken within the first 1-2 days after being infected, the results may show negative. So processes are in place at the hospital to keep patients safe, including masks worn by all hospital staff. If the COVID-19 test reveals a positive result, you have an active infection. In this case, you will be called by a healthcare team member to give you information on how to care for yourself and protect those around you. We will notify the local health department of your positive test–we are required to do so–so that you do not have to worry about it. Your surgeon and team will make a case-by-case determination on whether to postpone your procedure or continue as scheduled based on specific health needs and requirements.

When surgery takes place, all patients and visitors are screened upon entry to the building. On the day of the procedure, each patient is allowed one visitor, and then one for every 24 hours they remain admitted.

Personal Health and Safety

The Centers for Disease Control and Prevention has given us many guidelines and pointed us in a direction to follow to best care for our patients. In following these guidelines and setting up some ourselves to keep our patients safe, we have implemented new options and arrangements. As stated above, virtual care and telemedicine options are now available before and after procedures and surgeries whenever appropriate so that patients may stay home and away from hospitals.

Along these lines, Virtual Waiting Rooms have been implemented. These are patient portals used to communicate updates about care, scheduling, etc. between the hospitals, doctors’ offices, and surgery centers. These ‘waiting rooms’ can be used to set up messaging via text or phone calls as well so that there is the absolute minimum time spent in common areas.

Everyone within the buildings, including staff, patients, and visitors, must be masked and participate in social distancing to assist each other in minimizing the spread of COVID-19. We have also implemented touch-free protocols, involving paperless registration, and enhanced cleaning protocols, including UV-light disinfection.

Dr. Gorman

Dr. Gorman understands that for our breast cancer patients, the COVID-19 pandemic is only increasing the stress and anxiety in an already challenging and uncertain time. However, with the Safe Care plan, we are doing everything we can to help our patients navigate and continue on their journey to recovery.


Breast Self Exam: What to Look For

Last month was breast cancer awareness month, a time to highlight the importance of cancer screening and breast health. The Center for Disease Control has named breast cancer as the most common cancer for women in the United States. Approximately 12% (that is, 1 in every eight women) will be diagnosed with invasive breast cancer over her lifetime.

These statistics shift depending on other factors like age, race, and certain genetic factors. For example, African-American women are far more likely to be diagnosed with triple-negative breast cancer than women of other races, and to die of breast cancer of any kind. Asian, Native American, and Hispanic women tend to have lower risks of developing breast cancer, though they should still be aware of the signs and symptoms.

Why is Breast Cancer Screening Important?

In September of 2019, the American Cancer Society announced a new stance on breast self-exams. They stated that self-checks do not tend to reveal any early signs of cancer when women are also getting their scheduled breast cancer screening mammograms and regular checks by their health professionals. That’s not to say that people do not come to their doctors after spotting changes in their breasts. However, these changes are often noticed during dressing or bathing.

Despite this announcement, breast checks can still provide valuable insight. It is easiest to spot changes in your breast if you are familiar with it in the first place. If you are doing a regular breast self-exam, you will be ready to catch anything out of the ordinary–whether that be during your exam or while getting dressed.

How to do a Breast Self-Exam

There are two basic steps to a breast check. You’ll want to examine the breasts by looking and by feeling. Both of these steps can be further broken down from there. Try to do all parts of the exam on the same day and around the same time in your cycle every time: a week after your period ends is a standard time to do it. If you don’t get a period, set a date every month to do your breast self-exam.

Look

For the looking portion of the check, you will want to stand in front of a mirror. You will be standing in a few different poses and looking at a few different angles–front, right, and left.

In each of your poses, you will want to look at a few factors. Make a note of the shape of your breasts, especially in comparison to one another. It is far from unusual for one to be larger than the other, but sudden or drastic changes in size should not happen. Keep an eye out for a change in the usual vein patterns in your breasts. If the veins have increased or expanded significantly, you may want to speak with your doctor. Symptoms display in your nipples if they are consistently itchy, red, swollen, scaly, inverted, or are producing discharge. Finally, check the skin on your breasts for dimpling, redness, rash, puckering, or anything that could be considered like an orange peel. These could all be signs of something happening beneath the surface.

The best way to look for all of these symptoms is to examine your breasts from all angles. First, face the mirror with your arms down at your sides. Turn to the left and the right to check both sides of each breast. Next, place your hands on your hips with your elbows out to your sides, keeping your shoulders up and back. Repeat the pattern of front, left, and right. This same pose can be done hunched forward. This adjustment allows the breasts to hang so that you can see the underside.

Now, raise your arms straight above your head. You can clasp them together or leave them in a superman pose, but try to remember what you have done in previous breast exams so that you know what to expect. Once you have made a thorough observation, lean forward at the hips so that your breast hang forward again, keeping your arms above your head.

Make a note of anything you find that is different from normal and keep an eye on it. Many symptoms we attribute to breast cancer can also be symptoms of things like PMS, a swollen lymph node due to another infection, or many other factors, though, so observe first. However, if you have strong concerns, don’t hesitate to call your health professional for answers.

Feel

To start the feeling check, you will want a comfortable and flat place to lie down. You will lay flat on your back with your right arm up behind your head (if you are starting with your right breast). The goal is to get your breasts as flat as possible.

Once you are in a comfortable position, you will want to start feeling along the outer edge of your breast, near your armpit. You will want to use the pads of your fingers rather than your fingertips and move in small, smooth circles. Perform each circle at more than one pressure–light, medium, and firm–between the size of a dime and a quarter. By varying the amount of pressure, you can check more of the breast tissue. Move in a slow, up and down pattern across until you have covered the entire breast. Another option is to start at the nipple and perform your press checks in a spiral outwards. So long as you have a pattern to ensure you cover the entire breast and become familiar with it, this should be sufficient. Try to follow the same pattern every time you do your breast self-exam.

Once you have finished your exam lying down, it is best to give your breasts an exam while standing or sitting up as well. You will use the same pattern you have established for yourself, using firm, medium, and light pressure and the pads of your fingers to feel for anything unusual in the breast tissue you might have missed while lying down.

When is a Breast Lump Cancer?

It’s not entirely uncommon to find some kind of lump or bump when doing your breast self-exam. Hormones, infections, and other causes can cause temporary lumps that you may detect during your monthly checks. There are common attributes that a cancerous lump will have, though none are a guarantee. If you are concerned about anything you find, have your doctor examine it as well.

Your fingers can detect the most common criteria for a cancerous lump during your breast self-exam. The lump will be a firm, painless mass. The edges are sometimes irregular. If you have a lump that is getting larger over time, that may also be a cause for concern.

Of course, each case is unique. Some cancerous lumps may be painful or soft, and some may feel perfectly round. They can be more challenging to detect in people with more dense breast tissue or scar tissue on their breast–for example, those who have had previous breast surgery. These denser tissues can also make it somewhat more difficult for mammograms to detect cancer. People with dense breast tissue or scar tissue should be particularly familiar with their breasts so that they can detect changes early.

What Causes Breast Cancer?

While there is no one singular cause of breast cancer, there are several risk factors that could increase the likelihood of a diagnosis. Some are environmental factors that may be controlled, while others are physical characteristics or part of your history.

Gender, race, age, and genetics are all potential risk factors. Women are more likely to develop breast cancer, and this risk increases once they reach the age of 55. Some genes, like the BRCA1 and the BRCA2 genes, can be passed through generations and are considered a potential cause. If a first-degree relative (a daughter, sister, or mother) has or had breast cancer, your risk doubles. Because of the importance of hormones as a risk factor, your menstrual history may also be a factor. Those who started their period early–before the age of twelve–may have an increased risk.

Some risk factors are situational or environmental. Tobacco and alcohol use can increase your risk, especially in younger patients, as can being overweight or obese. Some previous benign or noncancerous breast conditions may influence your risk later on. Hormone use, such as hormone replacement therapy, both current and in the past, can increase your risk. One risk factor that is easier to lower is living a sedentary. Exercising regularly will decrease your risk of developing breast cancer.

Breast Self-Exam Results

The primary purpose of a breast self-exam is to help you to familiarize yourself with your breasts. If you know what the skin, muscle, and tissue feel like on a typical day, then you will be better prepared to notice anything abnormal should something come up.

These tests are not a reason to avoid getting a mammogram or having a physician examine you, especially if you are among those with risk factors. If you do come across something in one of your breast self-exams that has you concerned, bring it up with your doctor, or with Dr. Gorman at the Texas Breast Center. As a surgeon specializing in surgical oncology and surgical diseases in the breast, she can help you understand whether your lump, change in skin texture, or any change is a cause for concern. And, if it is, she and her team will help you set up a treatment plan.

Valerie J. Gorman, MD, FACS, is board certified by the American Board of Surgery and serves as Chief of Surgery and Medical Director of Surgical Services at Baylor Scott & White Medical Center – Waxahachie. Her goal is to ensure that all of her patients have an informed, personalized approach to breast surgery and cancer treatment.


An Overview of Invasive Ductal Carcinoma

What is Invasive Ductal Carcinoma?

If you have received a cancer diagnosis of invasive ductal carcinoma, you may not understand what that means. You may, like any of us would be, be scared. As one of the most common types of breast cancer, invasive ductal carcinoma–IDC–accounts for about 80% of all breast cancers. Also called infiltrating ductal carcinoma, cancer infiltrates and invades the breast tissue after bursting free of the milk ducts. A carcinoma is a cancer that begins in organ-lining tissue or skin. Therefore, the name–invasive ductal carcinoma–is no more than a definition of the thing it names.

What Causes Invasive Ductal Carcinoma?

Cancer can form anywhere when cells in a given area start to multiply after a change of shape or makeup. They multiply rapidly and don’t die when they should. In this case, the cells are increasing inside the milk ducts. There are several risk factors that could contribute to these changes in the cells (though sometimes the changes happen in people who do not have these risk factors and others have the risk factors and never get IDC). Some of the factors are being female, smoking, alcohol intake, previous radiation therapy, poor nutrition, family history of breast cancers, or potentially having mutations to some genes. The most commonly known breast cancer genes are BRCA1 and BRCA2 gene, which have been linked to IDC in some cases.

Is Invasive Ductal Carcinoma Dangerous?

In the early stages, IDC can be difficult to notice, as it causes few symptoms, which can make it dangerous. However, if you are doing regular self-breast checks and screening mammograms, it is likely to be caught sooner rather than later. Some signs of breast cancer to keep an eye out for during your breast checks are breast pain, nipple pain, inverted nipple, swelling of the breast (all or just a part), dimpling, irritation, redness, scaliness, or thickening of the nipple/breast skin or breast tissue, a lump in the underarm, or discharge from the nipple that is not milk.

What are the stages of Invasive Ductal Carcinoma?

Like many cancers, invasive ductal carcinoma is broken down into five stages, and each stage is measured in terms of the size of the tumor, how the lymph nodes are affected, and metastasis–where the cancer has moved throughout the body. All of these points are considered and taken into account, along with genetics, surgical results, and other considerations to assist in giving the patient their prognosis. The first stage is called stage 0, or ductal carcinoma in situ (DCIS), then Stage I is at when the cancer is starting to leave the milk ducts, and stage IV is when the cancer has spread outside the breast or auxiliary lymph nodes. For IDC specifically, this means:

Stage 0 — The disease is primarily in the ducts, though it may have spread to the lobules of the breast but no further. It is considered noninvasive at this point.

In the early part of Stage I (Stage IA), the tumor is small but has become invasive, though it still has not reached the lymph nodes. The cancerous area is between .2 mm and 20 mm.

Stage II can vary from person to person. Early Stage II  (Stage IIA) can either have no tumor, but the cancer has spread to up to three lymph nodes under the arm, a 20 mm or small tumor AND have spread to the lymph nodes or have a tumor that is between 20-50 mm without any spread to the lymph nodes. Later Stage II (Stage IIB), either has a tumor between 20-50 mm and has spread to the under-the-arm lymph nodes, or it must be over 50 mm without spreading to the nodes.

Fittingly, there are three phases to Stage III. In the first (Stage IIIA), the cancer (any size) has spread to 4-9 lymph nodes–under the arm or mammary. However, it has not spread anywhere else. If this is not the case, it could be a cancerous area of over 50 mm that has spread to 1-3 axillary lymph nodes. For the second phase of Stage III (Stage IIIB), the cancer may have been diagnosed as Inflammatory Breast Cancer due to its spread to the chest wall, swelling, and ulceration of the breast. Sometimes it will have spread to 9 or more lymph nodes–again, mammary or axillary–but most likely nowhere else. In Stage IIIC, any tumor will have spread to 10 or more lymph nodes. These could be mammary lymph nodes, axillary lymph nodes, or the lymph nodes under the collarbone. However, the cancer still has not spread throughout the body.

Stage IV is also known as Metastatic cancer. Metastasis is when the cancer has spread to other parts of the body such as distant lymph nodes, bones, other organs, or the chest wall. The tumor can be any size. Cancer is first diagnosed as metastatic about 5-6% of the time and is most commonly found after previous diagnoses of early breast cancer.

Survival Rate of Invasive Ductal Carcinoma

As of 2017, the survival rates for people treated for breast cancers have been increasingly favorable. For those in stages zero and one, the survival rate–measured as the five-year survival rate–is nearly one hundred percent. For those with stage two breast cancer, the survival rate is 93 percent, an increase from the 86 percent survival rate of 2014. For stage three, the five-year survival rate is 72 percent, a dramatic increase from 2014’s 57 percent. Finally, stage four is currently holding at a 22 percent survival rate, a jump from 2014’s 20 percent.

Is Invasive Ductal Carcinoma Curable?

Just as every patient’s experience with cancer is unique, so is their treatment. There may be a form of drug therapy, such as chemotherapy, a hormone therapy, HER2 targeted drug, or some combination. There could be surgery such as a breast-conserving surgery (lumpectomies, partial mastectomies) or a mastectomy, which can involve breast reconstruction. The patient may need radiation therapy to prevent a recurrence of the cancer. Your treatment route is determined by many factors. Family history can come into play, as can the size of the cancer, the type of tumor, maybe genetics, and how far this invasive breast cancer has spread. However, just as important is you and where you stand in all the chaos. Make sure you understand what your treatments are. Ask your doctors questions. They are there to assist you through your process and make sure you are receiving the right treatment.

Dr. Valerie Gorman

Dr. Gorman and everyone with her at the Texas Breast Center are there to help you with your questions about invasive ductal carcinoma and its treatment. She will walk with you through the whole process, and she knows how important it is for you to be informed. She and her team will cater your treatment to your needs and walk with you on your journey through this process.


Mastitis and Inflammatory Breast Cancer: Things You Should Know

What is Mastitis?

Mastitis (commonly known as ‘Lactation or Puerperal Mastitis,’ terms related to post childbirth) is an infection that occurs in the breast tissue. This condition is often caused by tears around the nipple, obstructed milk ducts, or improperly drained milk; this is a common occurrence with breastfeeding mothers and new mothers who have had a baby within the last 6 to 12 months, but can also occur at other times in life. When cases of bacteria appear within the breast due to a tear or obstruction, the body combats the infection with white blood cells. This results in symptoms include swelling, pain, redness, a fever accompanied with chills, and warmth of skin in (typically) one breast. Rest assured, Lactating Mastitis is unrelated to breast cancer and will not increase your risk for breast cancer.

In the case of rare conditions such as Non-Lactational Mastitis, which is a occurs in women with diabetes, women with depressed immune systems, and women who have lumpectomies following radiation therapy. New symptoms similar to Lactation Mastitis and women experiencing Non-Lactational Mastitis should consult their medical professional to discuss their overall health and how to support their breast health better.

Are the symptoms of Mastitis and breast cancer similar?

Yes, in the case of Inflammatory Breast Cancer, often the symptoms present in a similar way as does Mastitis. It is crucial to see your doctor to examine the area to positively identify cases of Mastitis. If you are experiencing symptoms such as itching, a rash, an inward nipple, swelling, rapid increase in breast size, nipple discharge, discoloration of a breast that starts off pink progressively turns purple, and ridged, thick skin (comparable to an orange peel), you may have Inflammatory Breast Cancer (IBC). Due to the common symptoms caused by Mastitis and Inflammatory Breast Cancer, it is crucial to pay attention to the affected area and consult a medical professional. Inflammatory Breast Cancer does not show symptoms like the standard breast cancer disease because Inflammatory Breast Cancer does not cause a breast lump and may not show up in a mammogram, making it more difficult to diagnose the disease. Infection or injury to breasts do not cause breast cancer because breast cancer is caused by cancer cells blocking lymph vessels within the body. Although less common than non-inflammatory breast cancer, Inflammatory Breast Cancer is aggressive and needs immediate treatment. Generally, within 1-3 months symptoms appear and rapidly spread to nearby lymph nodes. Inflammatory Breast Cancer is often treatable. Patients who seek earlier treatment have higher success rates after Inflammatory Breast Cancer is diagnosed.

What Should I Do If I Have Mastitis?

If you have conditions of Mastitis, it is best to see your medical professional to begin early diagnosis and treatment. Anticipate tests such as a mammogram or biopsy of breast tissue to determine Mastitis or breast cancer. If tests results show Mastitis, antibiotics are administered to eliminate the infection from the breast tissue, and women usually feel relief in 48 to 72 hours. If there are complications, such as a breast abscess, expect to have the fluid drained from the breast either through surgery or a needle aspiration. Despite the ease of clearing Mastitis through prescribed antibiotics, ignoring symptoms can be serious as infection could affect the bloodstream.

Although it might be uncomfortable, it is okay to continue nursing while experiencing Mastitis. Mastitis will not affect the health of the baby or milk produced from breasts. To prevent Mastitis while breastfeeding, try to receive proper amounts of sleep and eating balanced meals to maintain a healthy body to fight infections. Make sure to breastfeed often as well emptying the breast of milk after nursing by using a breast pump, or by massaging breasts to remove any excess milk to keep the milk ducts open and free from obstructions. Note to also alternate breasts in which the baby latches onto for feeding, and support the baby to latch onto the nipple properly. Mastitis can occur when the mother suddenly stops breastfeeding the baby, as her breasts continue to produce milk causing the milk in the breasts to become stagnant and a hub for bacteria. Try weaning the baby off of breastfeeding over a period of time instead of suddenly stopping. This allows for the breasts to slow milk production. Another method of prevention is to take care of the nipple skin to avoid irritation or cracking by using a 100% pure lanolin ointment. This is safe for breastfeeding and is hypoallergenic.

What Should I Do If I Have Inflammatory Breast Cancer?

Dr. Gorman will review your diagnosis carefully and recommend treatment options. Often, treatment begins with chemotherapy. Breast surgery may then be needed to remove the breast (mastectomy), or part of the breast (lumpectomy) and to possibly remove lymph nodes that have been affected by Inflammatory Breast Cancer. Surgery can also support cosmetic enhancements to the breasts when the cancer is removed.

Dr. Gorman will then discuss whether radiation is needed, clearly communicating its risks and added benefits.

If you are concerned that you may have cancer and not mastitis, do not hesitate to contact us. We want you to be proactive in seeking answers. Valerie Gorman, MD is a breast surgeon who specializes in personalized treatments for breast cancer. Should you have breast cancer, you are in good hands at Texas Breast Center. Dr. Gorman will walk alongside the patient, from the first mammograms, through surgery and any additional treatments, to follow visits in the future, all for your peace of mind. Her efforts to ensure you have a caring medical professional at every stage of cancer treatment allows for patients and families feel assured that she genuinely cares about their recovery. Dr. Gorman always attempts to accelerate the process with her hands-on approach and clear communication, so there is not the anxious waiting that patients often experience at other breast cancer centers.


How Can I Improve My Self-Image After Breast Cancer?

body image after breast cancer pinkBody image issues are real concerns for women cancer patients that can impact self-esteem and mental health. You may view your body and yourself differently after breast cancer. Give yourself time to adjust. It takes time to adapt, so remember to treat yourself with compassion and kindness. Talking with others who have been in similar situations either in one on one conversations or support groups may help. This can be instrumental in providing understanding and hope. Keep your network of family and friends close and let them give you comfort. It’s okay to ask for and accept help.

If you struggled with your body image before the cancer diagnosis, then you may have an even harder time coping with changes in your appearance after. The reaction of people close to you and others can affect the way a person adjusts to the changes, as well. Counseling can be helpful if body image is a significant issue for you, particularly if it negatively impacts your return to work and/or other normal activities before cancer.

Along with the emotional stress that cancer and its treatment can cause, it may also change how you look. Many women with breast cancer feel self-conscious about changes to their bodies. Some physical changes may only last a short time while others are permanent.

Possible Changes in Physical Appearance Due to Breast Cancer Include:

  • Scars from surgery (Scarring After Breast Cancer Surgery);
  • Hair loss as a result of chemotherapy or radiation therapy;
  • Surgical modification of body parts;
  • Weight gain/loss;
  • Skin changes such as redness, itching, more sensitivity, or pain in the area that was treated;
  • Loss of muscle mass or muscle weakness;
  • Lymphedema; and
  • Changes in sexual functioning.

Hair Loss and Breast Cancer

One of the possible changes listed above is hair loss from radiation therapy or chemotherapy treatments. Hair loss can be especially stressful. Ask Dr. Gorman about possible ways to retain your hair with the use of cooling caps or scalp cooling systems. If hair loss is going to happen, it most often starts within two weeks of treatment and gets worse one to two months after starting therapy. Your scalp may feel very sensitive to washing, combing, or brushing. It’s important to note that hair often begins to grow back even before treatment ends.

You’ve got choices even if you do lose all of your hair. There are many cover-ups to choose from, or you can go bald. However, many women want to find some way to conceal their bald head and keep warm. Then it’s a matter of what you’re most comfortable with whether it’s a wig, a scarf, or a hat. Be creative.

Lymphedema As Result of Cancer Treatment

Another physical change that you may not be familiar with is lymphedema, and it refers to swelling that generally occurs in one of your arms or legs and sometimes both. It’s most commonly caused by the removal of or damage to your lymph nodes as part of your cancer treatment. This happens because there is a blockage in your lymphatic system, which is part of your immune system. This blockage prevents lymph fluid from draining, and the fluid buildup leads to swelling.

Lymphedema Signs and Symptoms:

  • Swelling occurring in part or all of your arm or leg, including fingers and toes;
  • A feeling of heaviness or tightness;
  • Restricted range of motion;
  • Aching or discomfort;
  • Recurring infections; and
  • Hardening and thickening of the skin (fibrosis).

While there is presently no cure for lymphedema, it can be managed with early diagnosis and diligent care of your affected limb.

Changes in Your Sex Life Due to Breast Cancer

Talking about your sex life and relationships can be extremely uncomfortable especially after dealing with changes from your illness. You’re not sure exactly what’s wrong or how to treat it, but you know things are different. Many women report having less sex after their illness and here are a few reasons why:

  • A common issue that many women bring up is not feeling “sexy” anymore. This is so understandable because breast cancer is such a physically and emotionally taxing experience that changes so many aspects of a woman’s life.
  • Having breast cancer slows down your body and can result in taking longer to do lots of things, including getting interested in and starting and finishing sexual intercourse.
  • For the woman that has been thrown into sudden-onset menopause, sex can be not just uncomfortable, but even painful. So, not surprising that you may have less sex, for now. Many women report having had little or no sex from the time of diagnosis through treatment.

How breast cancer affects your sexuality is different for every woman. You may find the support you need from your healthcare team, partner, family, friends or other survivors. A support group or close friend may be the key to you reconnecting with your own sexuality. Many online groups host discussion boards where you can “talk” about concerns with someone who has been there.

Finding Help and Support During and After a Breast Cancer Diagnosis

Learning to be comfortable with your body and self-image during and after breast cancer treatment is different for every woman. The right information and support can help you manage these changes over time. It’s essential for you to know that regardless of your experience with breast cancer, there is advice and support to help you cope. Talking with Dr. Gorman and your healthcare team at Texas Breast Center is a great place to start.

Resources:

If you’re interested in visiting a Breast Cancer Support Group, contact Texas Breast Center for more information.


What To Say To Someone With Breast Cancer

what to say to someone with breast cancerWhen someone gets diagnosed with breast cancer, the world can seem a very lonely place; there is no right or wrong way to react, everyone is an individual and will cope with challenges differently. An issue that many patients have talked about is the reactions of their friends and family, once they do summon up the courage to break the news.

Very few partners, family members or friends are likely to be trained counselors, and even if they were, it is much more difficult saying the right thing to someone who means the world to you personally. Most people it seems, feel obligated to say something, and it is a fair assumption, that a pregnant pause or an extended period of silence is not what your friend or relative is looking for, but the question is what is the right thing to say in this situation? After all none of us are trained in these matters, and we all want to help, so let’s examine some potential ideas so that if you ever find yourself in this situation, you won’t be left speechless.

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What Is Invasive Lobular Breast Cancer?

what is invasive lobular breast cancerBreast Cancer consists of many different types, so if you have been diagnosed with Breast Cancer, then it is important that you understand which specific kind of Breast Cancer you have. The treatment, prognosis, and outlook vary depending on the different type.

Invasive Lobular Breast Cancer takes its name from the origin of this type of breast cancer. It begins and develops within the milk-producing glands of the breast. These are known as the lobules, which is where the name of this particular cancer originates. The Invasive part of the name differentiates between cancer and pre-cancer.

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Birth Control and Breast Cancer: What’s the Connection?

contraception and breast cancerLate in 2017, the media picked up on a study published in the New England Journal of Medicine that linked hormonal contraceptives, like the pill and some intrauterine devices (IUDs), with a higher risk of breast cancer.

After hearing this news, you might be concerned about whether your family planning choices might increase your cancer risk. Here’s what I explain to my patients.

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