The BioZorb® is a 3D implanted tumor bed marker created for patients with breast cancer to mark the breast cancer surgical excision site accurately. It consists of a spiral three-dimensional bioabsorbable framework embedded with six permanent titanium surgical clips. The BioZorb® offers 3-dimensional breast radiation treatment targeting and is available in various sizes from 2-5cm, including Lower Profile, and is intended to enhance results in breast-conserving surgery (BCS) when used in early breast cancer stages. Low Profile (LP) is an ideal option for smaller, flatter surgical cavities.
Dr. Gorman is one of the leading breast surgeons that has successfully used the BioZorb® implant in hundreds of Stereotactic Body Radiation Therapy (SBRT) breast cancer surgeries. She has seen firsthand how they improve outcomes with breast-conserving therapy post-surgically.
The BioZorb® implant has many benefits for patients, including excellent cosmetic outcomes, improved accuracy in radiation therapy, and minimal scarring after breast conservation therapy. Many breast cancer patients who have received breast-conserving surgery have experienced the benefits of the BioZorb® implant, though there have been a few reported side effects. This article will discuss some of the side effects reported by patients who have had the BioZorb® marker implanted and how the benefits still outweigh any potential risks.
BioZorb® Reported Side Effects
Some patients with BioZorb® implants have reported hard, uncomfortable lumps in the area of their implants.
Patients have reported skin deformation and scarring of the skin around the devices.
Patients have reported skin reddening, irritation, and itching in the vicinity of their BioZorb® implants.
Patients have reported that the devices have not been absorbed in the expected time frame but instead have stayed intact for over 2.5 years.
Some individuals also claim that the implant is so unpleasant that they want it removed or decide to undergo partial breast reconstruction or a mastectomy to remove the entire breast.
Some patients report that the BioZorb® implant causes the affected breast to become noticeably bigger than the unaffected breast.
Do the benefits of the BioZorb® implant outweigh the side effects?
About 60% of the more than 200,000 American women with early-stage breast cancer had a lumpectomy with whole breast irradiation. Since it can be challenging to identify the specific region of the breast where the tumor came from, radiation is often applied to the entire breast. BioZorb® was developed to improve the accuracy of such radiation therapies, and it has done just that.
Six titanium clips on the device show radiation oncologists precisely where to point the radiation beam. Radiation is thus applied to the tissue that needs it the most. The “lumpectomy bed” will then benefit from the boost of radiation. And even though sometimes the whole breast must still undergo radiation treatment, BioZorb® guarantees that the correct location gets the optimal boost dosage. With BioZorb®, Dr. Gorman also has been able to use partial breast radiation with SBRT (BioZorb® as the target). This shortens the course of radiation to five days and has improved cosmetic outcomes.
According to a study in the World Journal of Surgery, of 110 patients using the BioZorb® implant, the marker enabled more precise targeting for radiation planning and treatments in 95.7% of the cases.
Over the course of around two years, BioZorb® is naturally absorbed by the body, but the titanium clips are left in place. As a result, during routine mammography, it is easier for your doctor to precisely analyze the former tumor spot.
Breast surgeons are utilizing an extra advantage of BioZorb® implantation. After surgery, the BioZorb® prosthetic implant aids in preserving the breast’s natural form by supporting the breast tissue. As part of your lumpectomy, the 3-D spiral design of the marker is proving to help reshape the breast, which enhances the breast’s contour and, ultimately, its aesthetic appeal.
Dr. Gorman and BioZorb®
BioZorb® provides breast cancer surgeons with another cutting-edge method to enhance therapeutic and cosmetic results and improve overall patient outcomes. Dr. Gorman believes that for many patients, the benefits of the BioZorb® device outweigh any potential side effects. She continues to perform surgeries with the BioZorb® implant to help more women heal and recover.
If you have questions about the BioZorb® device or breast cancer treatment, please call our office to schedule an appointment. At your consultation, Dr. Gorman will be happy to personally answer all of your questions. Texas Breast Center is committed to providing its patients with a personal, individualized, and targeted approach to breast surgery and breast cancer treatment.
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.
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.
Dr. Valerie Gorman, MD, FACS, a breast surgeon specializing in surgical oncology and surgical diseases of the breast, was selected for faculty at the prestigious Women in Breast Surgery conference. The Tampa, Florida-based conference was sponsored by Hologic, a groundbreaking enterprise designed to support women’s health by providing effective, state-of-the-art technology to healthcare professionals. Hologic constructed this two-day conference around the personal and professional development of women breast cancer surgeons.
Four renowned female surgeons, including Dr. Gorman, led the courses, merging the medical field and the business world through incorporating topics such as improving workflow efficiency, leadership and a seat at the table, getting the word out to build your brand, and offering a negotiation workshop. Dr. Gorman and her peers, who came from all over the United States, provided new breast surgeons and breast fellows (the medical community’s term for surgery residents and breast fellowships) with leadership and marketing tactics. “It was an honor to be a part of this,” said Dr. Gorman, “and to provide the tips and tricks I wish I had known when I was starting in the field rather than learning these strategies the hard way. This is really exciting work for the breast surgeon community.”
Educating the medical community on breast cancer surgery practices
Breast cancer technology
Gorman’s practice, Texas Breast Center, is considered a center of excellence for training among medical personnel. The conference’s sponsor, Hologic, sends its representatives and other physicians to be trained by Dr. Gorman and her team on the technology of the BioZorb, a marker device used for stereotactic body radiation targeted therapy, and the wireless technology she employs. Dr. Gorman is grateful for the opportunity to train other physicians and industry persons on breast cancer treatment and care advancements. “Bringing them into the process of these surgical techniques and utilization of the BioZorb to gain a first-person understanding of the tools they are selling or using is essential to promoting healing and recovery for patients; education is key,” emphasizes Dr. Gorman. Her desire to raise awareness and educate others in the field led her to present at the Women in Surgery conference.
Strategies for breast surgeons
Dr. Gorman emphasizes the importance of empowering women, physicians and patients alike, through education. Her presentations at this conference aimed to help women claim their spot at the table among the leading breast cancer surgeons by providing insight into the business side of surgery, an aspect that is often neglected within the medical field. Additionally, effective business tactics would lead to larger public exposure of surgeons and, thus, more conversations surrounding breast cancer and breast care in general. Through a nationwide increase of young women entering the field with successful business strategies and tailored care for patients enduring breast cancer surgery, Dr. Gorman hopes this will lead to greater self-awareness and detection of early stage breast cancer among the public.
Why is breast cancer awareness critical?
Breast cancer is one of the most common cancers detected in females, ranking second only under skin cancer. This means that, statistically, most women will either be diagnosed or know someone who has been diagnosed with breast cancer. Awareness helps us begin to topple this statistic. It leads to more women participating in self-checks, earlier detection, and an understanding of the risk factors that may indicate breast cancer. Opening the door for these actions to become regular practices starts with preparing and enabling newer breast cancer surgeons with the information surrounding strong business tactics and state-of-the-art care for patients and their communities. The Hologic conference on Women in Breast Surgery sought to jumpstart these efforts, aligning with Dr. Gorman’s mission.
Dr. Valerie Gorman, MD, FACS, is committed to providing an advanced, personalized, and targeted approach to breast surgery and the treatment of breast cancer. As a board certified surgeon by the American Board of Surgery, she serves as the founder of Texas Breast Center and Chief of Surgery and Medical Director of Surgical Services at Baylor Scott & White Medical Center – Waxahachie. Intent on creating spaces of education for breast care, Dr. Gorman has also recently accepted the Clinical Assistant Professor of Medical Education position at the Texas A&M University College of Medicine.
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.
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.
Ross W. Transformation. In: Ross W, editor. Crusade: The Official History of the American Cancer Society. New York: Arbor House; 1987. p. 33.
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.
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.
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.
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!
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.
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.
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.
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 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 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:
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.
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.
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.
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:
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.
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.
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.
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.
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:
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.
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 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.
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.
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.
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.
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
RAD51C and RAD51D
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.
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.
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.
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.
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.
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.
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)
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 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 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, 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 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.
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.
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. 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.
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
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.
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.
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.
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.
The FDA, or U.S. Food and Drug Administration has recently approved two new medications for breast cancer treatments. The approval for these treatments was expedited due to the COVID-19 pandemic. One of these medications targets metastatic triple-negative breast cancer, while the other targets HER2-positive cancers.
Richard Pazdur, the director of the FDA’s Oncology Center for Excellence, stated, “As part of FDA’s ongoing and aggressive commitment to address the novel coronavirus pandemic, we continue to keep a strong focus on patients with cancer who constitute a vulnerable population at risk of contracting the disease. At this critical time, we continue to expedite oncology product development.”
The drug’s applications were granted by the FDA under the provision known as “accelerated approval” due to today’s current conditions. This means that the drugs may be distributed and administered under specific criteria. There will still be further data from further clinical trials required before full approval is granted.
The medications may be administered to patients only when certain conditions are met. For Todelvy, this means that it is “reasonably likely to predict a clinical benefit to patients” who have are in serious condition and have unmet medical needs. For Tukysa, the medication must be administered alongside chemotherapy, and there must be at least one prior attempt at treatment.
Trodelvy, also known as sacituzumab govitecan, is one of the medications to receive accelerated approval. Produced by Immunomedics, Trodelvy received approval based on results from a clinical trial (phase 1/2) of 108 patients. These patients had all received at least two treatments previously for their metastatic cancer.
It was given intravenously. It is formed of a combination of SN-38 (a metabolite of irinotecan, a chemo drug) and a monoclonal antibody that targets an antigen that induces cancer cell growth. The response rate in breast cancer patients in the trial was 33%, and 55.6% of those responders maintained their response at least six months.
Some common side effects of Trodelvy are nausea, fatigue, anemia, low white blood cell counts, as well as hair loss, rash, and abdominal pain. There are chances of more severe side effects to keep an eye out for, such as severe diarrhea and neutropenia–an abnormally low level of neutrophils.
Tukysa is the brand name of tucatinib, a tyrosine kinase inhibitor of HER2 proteins. When taken with capecitabine and trastuzumab in adult patients, it is intended for advanced metastatic, HER2-positive breast cancer, including brain metastases. The patients must have attempted at least one anti-HER2-based treatment geared towards metastasis.
This medication has been shown to inhibit the phosphorylation of both HER2 and HER3 in-vitro, or in lab studies. Further clinical trials will be performed.
Some common side effects of Tukysa are fatigue, liver problems, decreased appetite, hand-foot syndrome, and mouth sores, as well as others. The liver problems can become more severe, as can diarrhea, leading to other health problems.
Breast Cancer Treatment
Many adjustments have had to be made in day-to-day life with the introduction of the Novel Coronavirus. This includes the treatment of breast cancer, the testing of medication, and FDA processes of approval. These new medications have been pushed forward into the market more speedily than usual, but that does not mean they were pushed forward recklessly.
Each was pushed forward by the Food and Drug Administration with certain conditions to met before application. Each must also continue testing before the FDA approves it fully.
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.
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.
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.
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.
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 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.
The week of December 10, Dr. Valerie Gorman attended the annual San Antonio Breast Cancer Symposium to give a poster presentation for her research in 5-day SBRT radiation. This symposium is an opportunity for those involved in breast cancer research to share what they have learned.
The SABCS’ stated objective states that the conference “is designed to provide state-of-the-art information on the experimental biology, etiology, prevention, diagnosis, and therapy of breast cancer and premalignant breast disease, to an international audience of academic and private physicians and researchers.” Research is brought from all of these categories to be shared and help other practitioners improve their own research or treatments.
Dr. Gorman praises this conference for the multidisciplinary spread of study. As her breast cancer team is interdisciplinary, she can gather information that will interest every member of her team. She noted that there were presentations this year on “molecular studies on circulating tumor cells, more targeted therapies, and many other topics. Together with our oncology colleagues and team members, we’re able to use these to treat our patients in a collaborative, multidisciplinary fashion.”
For example, while Dr. Gorman does not specialize or perform chemotherapy treatment, she took note of several tailored researched studies into chemotherapy. There is new research being done on HER2 positive cancer, or breast cancer that tests positive for human epidermal growth factor receptor 2. HER2 protein excess is found in approximately 20% of breast cancers, caused by a gene mutation in the cancer cells. There is also chemotherapy targeting metastatic breast cancer, which is cancer that has spread beyond the point of origin–in this case, the breast and lymph nodes nearby. Patients with these cancers tend to have a lot of, and many kinds of chemo throughout their treatment. These new studies are helping us to learn how to “study the tumor and retailor the chemotherapy to the individual patient and their needs.”
The presentation that Dr. Gorman and her team were most interested in, however, came from the University of Florence in Italy. They presented on the ten-year results of breast cancer patients who had been treated with Accelerated Partial Breast Irradiation (APBI), a treatment Dr. Gorman has been using and perfecting for many years.
The use of radiation therapy on breast cancer is a common occurrence. This treatment directs high energy rays directly at the cancerous area to kill any cancerous cells left over after surgery. Traditionally, radiation therapy is implemented over 30 days. This regimen includes visits every weekday for six weeks and can potentially lead to burns on the surrounding tissue as well as changes in the patient’s appearance. However, APBI shortens the number of days needed for the treatment. Some protocols of APBI give radiotherapy twice a day for five days, while others–including Dr. Gorman’s practice–only give it once a day for five days. While the treatment itself takes little time in office, doctors know transport and waiting room time can take up valuable time from the patient’s personal and work life. By minimizing how many office visits are required, these doctors are giving their patients more of their life back.
The presentation that the University of Florence gave reveals new results from patients ten years after their surgeries and radiotherapy treatments. The results found that survival rates at the ten-year mark for those who received APBI–as with the five-year mark–matched the survival rate of those who received longer treatments. However, APBI has better cosmetic results and less burn damage.
Dr. Gorman is pleased to know that this treatment helps her patients, not only by treating their breast cancer but also by lessening the impact that breast cancer has on their personal life. With few in-office treatments, there is less time away from the office or the family. The APBI also produces more favorable cosmetic results, which can help with a healthier mindset as you approach healing.
Dr. Gorman and her team offer APBI when necessary to provide the breast results and the least interference in her patients’ lives. They also provides necessary breast cancer surgery to best help a given case. As the Chief of Surgery and Medical Director of Surgical Service of Baylor Scott and White Medical Center in Waxahachie, Dr. Valerie Gorman, MD, FACS is ready to answer your questions and design a personalized cancer treatment plan for you.
Dr. Valerie Gorman, MD, FACS, is a breast cancer surgeon, board-certified by the American Board of Surgery. She specializes in surgical diseases of the breast and surgical oncology, serving as the Chief of Surgery and Medical Director of Surgical Services at Baylor Scott & White Medical Center in Waxahachie, Texas.
As she helps her patients through the process of learning their best options for cancer treatment and the most effective type of surgery to help, her staff works with her. But she also knows that she is not the last step in the healing process. It is common for breast surgery for cancer to require reconstruction. So Dr. Gorman has an established partnership with Dr. Potter that has now lasted more than 15 years.
Dr. Jason Potter, MD, DDS, is a plastic surgeon who serves the greater Dallas area and has affiliations with multiple hospitals and hospital systems. He is double board-certified, with his advanced surgical training focusing on reconstructive plastic surgery. He serves the greater Dallas area.
Dr. Gorman and Dr. Potter’s partnership is based on mutual respect for both each other and the patient. The two sat down in a joint interview to explain how their collaboration worked and how it benefitted the patient.
To start, Dr. Gorman was asked why she chose to work with Dr. Potter. She answered,
“We both have the same standard for our patients. He doesn’t do the easy way; he does the right thing for the patient. He can offer every option to our patients, so he’s not just limited to one kind of breast reconstruction. I think other plastic surgeons recommend what they do. And he does it all, so it makes it easy to recommend the best thing for each patient.”
Dr. Potter explained his reconstruction options:
“The two main types of reconstruction are either implant-based reconstruction or tissue-based reconstruction. Patients are not always a candidate for both. Sometimes there are limitations put on us by the patient’s body habitus, such as how much tissue they have to donate for breast reconstruction or prior surgeries that prevent utilizing tissue from certain areas. So most of the time, implants will always be available, but if patients have had multiple infections or have a history of radiation, there are higher complication rates for implant surgery.
However, some people don’t want an implant. They’ve never had an implant, and they never will have an implant. They just don’t want one. Implants require maintenance. You have a new device in the breast that has to be maintained, has to be monitored, and has to be replaced approximately every ten years. Whereas, when you have an all-tissue breast reconstruction, the patient doesn’t necessarily need other surgeries once they’ve completed the process because maintenance isn’t required. It’s really sitting down with the patient, seeing what co-morbidities or preferences they might have or bring to the table, and then selecting the best option.”
Several factors have to be taken into account when figuring the best approach to breast reconstruction. Dr. Gorman usually starts the process when discussing the initial breast cancer treatment.
“Usually, the patient is in my office first, so I try to get a good understanding of them, and I try to learn a little about what the patient would like to do. I usually have an idea of when he would like to offer somebody one or the other, considering the patient’s preference, their medical situation, their questions, and what they already know. I then go from there. Some factors I look for are if they’re a smoker, or if I see they’ve had several abdominal surgeries. If they’ve had radiation before, I know we’re going to have to do a flap to try to protect that implant, those kinds of things. I leave it open for Dr. Potter to use his expertise and talk to them about the pros and cons of each option available.
Some people don’t want a massive surgery. The flap is a longer, second operation, so many people want to avoid that. But in the long run, 20 years from now, that 8 hours in the operating room, they’re not going to remember that part. So, we try to talk them through what they want and what we think they’re tending to prefer and talk about the pros and cons. If they’re a smoker, there may be certain options that have reduced risk. Then we send them to Dr. Potter, and he finishes the conversation, and they make the final decision. And our offices coordinate scheduling whatever procedure we’ve decided together with the patient.”
Dr. Potter added:
“It’s a nice team approach. From the day they go into Dr. Gorman’s office, they’re starting to get questions answered; they begin to have reconstruction questions answered. As soon as they find out they’re going to need a mastectomy, they want to know what that next step will be. Dr. Gorman is very good at starting that discussion with them. After surgery, both offices work with the patients when they have issues in the postoperative period, so it’s a nice comprehensive approach to patient care. I think the patients really like it.”
Once the patients have met their doctors, the process can begin.
“Breast reconstruction is a process, so it’s not usually one operation and done. It starts the day of the mastectomy with either placement of a tissue expander (which is a temporary implant) or initial reconstruction using the patient’s own tissue in certain situations. But operations are usually staged about three months apart. So, if surgery was all the patient needed, they may complete reconstruction in six months or so. If they need chemotherapy or if they need radiation, they may not complete the reconstruction process for nine to twelve months. It’s kind of hard to say exactly how quickly they can have their surgery, but they’re staged depending on the procedure and patient’s needs and other treatments.”
Dr. Gorman said about the stages:
“A lot of people come in and say, ‘I want it all done in one operation,’ which we can sometimes do. But we talk to the patient about how sometimes that’s not the best solution for them because they’re going to end up having another operation down the road anyway. So, whether it’s one stage or two-stage, we tend to go with two-stage for improved cosmetic outcomes. Once again, those are just the different options we offer.
Another variation of the reconstruction options mentioned above is whether the DIEP flaps procedure is being performed. Dr. Potter is well known for his ability to perform this operation.
“Not everyone does the flaps. That’s a big operation, and Dr. Potter does a significantly high volume of these. He’s the DIEP flaps guy. If you mention DIEP flaps to anybody, his name comes up. We offer that to our patients, which is awesome.”
Dr. Potter gave a little more detail into the DIEP procedure, saying:
“It’s a complex reconstructive procedure. Not every surgeon offers these techniques. Because of its complexity, patients are better served by an experienced team like ours. For the last 13 years, we’ve been providing that operation in Dallas. We have a very efficient team, which is important for patients so that they’re not under anesthesia too long. We’re also refining the technique and leading some of the advances. We are are now providing Resensate™ to candidate patients. Resensate is a technique to provide reinnervation to the breast.”
Reinnervation is the restoration of nerves to a place where there has been nerve damage, like a surgical site. This has been a concern of plastic surgeons for as long as this has been a profession. To explain the importance of Resensate and its work in reinnervation, as well as patient expectations, Dr. Gorman explained,
“The biggest thing when you’re educating patients about breast reconstruction after they get a mastectomy is that they’ll say, ‘oh well, my friend had implants, so this is kind of like that, at least I get a breast augmentation and implants like my friend did.’ And then you have to remind them, ‘your friend kept her breast, and yes, she has the same implants in there, but it’s very different.’ And the sensation is the most significant difference there probably. The way they feel and look are different, too, but the sensation is very different. And we have heard a wide variety of comments from patients who have had this procedure, from ‘they feel like they are floating in front of me,’ to ‘I have some intermittent feeling, it comes back over months,’ to somewhere in between. I think that’s the most significant difference, once they get over the initial surgery and diagnosis and treatment. Settling back into everyday life, it is a constant reminder. It is hard to forget what they’ve been through because it is so different. So gaining feeling back will be huge because it is one of the big reminders for them.”
Now that there is a general understanding of the types of breast reconstruction and the process of moving between the breast cancer surgeon to the plastic surgeon, Dr. Potter discussed some of the common questions he gets asked at appointments.
“There are lots of questions about tissue-based operations versus implant-based operations. There are lots of questions about the types of implants given, and the recent Allergen textured surface recall. And really, the most common question is ‘which operation is best for me? We try to take patients through that question because that discussion is never the same for any two patients. Recovery is always a concern. Most questions here deal with downtime, recovery, time off work, and number of surgeries.
Recovery varies with the operation and the patient. With the first operation–the mastectomy and the tissue expander–it can be anywhere from 2-4 weeks of downtime. Implant surgeries are usually less downtime for the first stage, and tissue surgeries can be up to 6-8 weeks, depending on what they choose.”
The recent concerns about textured implants have resulted in many questions regarding implant safety. He continued,
“Overall, implants are very safe. A recently identified process called Breast Implant-Associated Anaplastic Large Cell Lymphoma has brought renewed scrutiny to breast implants. Allergen was asked to voluntarily recall their textured surface implant line because 80% of the cases found worldwide were associated with that implant surface. But it’s an extremely rare process.
Despite its rare occurrence, many patients going through breast cancer treatment do not want to worry about other potential problems linked to the reconstruction. This is leading more patients to inquire about tissue-based options.”
In summary, whether receiving a tissue or implant breast reconstructive surgery, Drs. Potter and Gorman know to listen to you, to listen to each other, and work with the best materials to ensure the best outcome for you.
When asked for their final thoughts, Dr. Gorman had this to say,
“The team we’ve formed between our offices and the options we offer together are what I want to emphasize. Between the two of us, we can more thoroughly follow-up. If a patient goes to see him, he will ask me any questions that need asking. If they need to have drains removed but don’t want to drive all the way to him, they can stop in our office to get them taken out. We do a lot of that for the patient, which I think is pretty great for them. We navigate them through the post-breast reconstruction hassle. We can say ‘yes, we’ve talked to them, you’re good to go here or do this’ so they don’t have to go back and forth between us and say ‘well Dr. Gorman said this’ then they say ‘well Dr. Potter said to let you know that.’ This way, the patient doesn’t have to do all that on their own.”
Dr. Potter followed up in agreement.
“It is a very personal, very comprehensive approach. Patients are going to appreciate the individualized attention that they are going to get every step of the way. And the way our offices work together, it helps to coordinate and make sure the patient doesn’t have to determine which office to go to.”
Drs. Potter and Gorman work cohesively to ensure their patients are receiving the best care. By staying in contact, there is no risk of loss of information. By working with each other consistently, they learn how the other works and can better inform patients on what to expect. Dr. Potter’s expertise in types of breast reconstruction and Dr. Gorman’s cancer-oriented breast surgery go hand in hand to create a strong team approach for treatment, recovery, and your best outcome.
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.
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.
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.
Breast cancer and accompanying treatment can be a grueling experience, both physically and emotionally. And while relief can come with successful surgery, recovery can difficult. Here is some information about what to expect from recovery and a few tips to make it easier.
Your Hospital Stay
After surgery, you will stay in the hospital for the first steps of recovery. How much time you spend in the hospital differs depending on the type of surgery, whether it was outpatient or inpatient, whether reconstruction was performed, and other factors.
A lumpectomy is traditionally an outpatient procedure. It does not require an extended stay in the hospital—less than 23 hours—as the stay is merely to give the surgeon and nurses enough time to make sure there are no adverse aftereffects. Once they are satisfied, you may leave the hospital to better rest and fully recover.
A mastectomy, however, can require an extended stay. When lymph nodes are removed, and breast reconstruction is performed, you may have to stay in the hospital 1-2 days. Without the reconstruction, this may drop to overnight, though this is still considered an inpatient procedure. More complex reconstruction may require a longer stay. Always ask your doctor how long they expect you will have to stay before you can leave the hospital.
Anesthesia keeps a patient unconscious, painless, and calm during surgery and is carefully catered to each patient’s needs. Medications can be changed due to an individual’s allergies or previous experiences. Anesthesiologists will also adapt their medicines depending on the procedure. For example, general anesthesia is commonly used for these procedures.
General anesthesia can, in a small number of people, cause adverse reactions and symptoms. A sore throat can come from the tube placed in the throat to help with breathing during the procedure. Nausea, vomiting, delirium, itching, chills, and muscle aches are common side effects. Some may be caused by accompanying pain medication, but each sensation should pass rather quickly.
As with any surgery, some level of pain should be expected after breast surgery. Initially, this will come from the surgery itself, based around the incision sites and where the tissue was removed. If lymph nodes were removed, there would likely be more pain. As healing begins, the pain will settle more when you are still and be triggered more by a range of motion. As the breast, breast tissue, lymph nodes, and underlying muscles are so central to the body, almost any movement of the body can affect this area. Your surgeon will inject local anesthetic during surgery to reduce post-operation pain.
To help control pain levels, your surgeons will prescribe medication that will drop off into over-the-counter medicines that will drop off into no medication when you are ready. When the pain is still severe, you may be placed on something like tramadol for the early days. You will be weaned off of these drugs and onto over the counter pain medication within the first few days to prevent complications.
When tissue is removed from a surgical site, there is a risk of seroma. Seroma is a build-up of fluid to fill in a suddenly empty space in the body–a place where there once was tissue, and now there is not. Seroma can be uncomfortable or even painful, and can sometimes scar. To prevent this issue, the surgical team will place a drain in the breast that removes any fluid that attempts to fill the healing space after a mastectomy.
After the surgery, you will be given instructions on how to care for your drains. You will be told how to empty them, what to look for in them, and when they will be removed. They will likely look like a small tube leaving–and stitched to–the breast that travels to a hand-sized bulb. This bulb will be kept in a compressed position, setting up a vacuum to pull out any fluids that should be pulled out.
The bulbs have measurement labels on their exterior so that you can easily see how much fluid has drained. You will have to keep track of these measurements as you empty, clean, and recompress the drains throughout the day. These numbers help determine how long the drain will stay in place.
Living with drains can be inconvenient until you get used to them. You must always be aware of the tubes, so they don’t catch on something. Though the bulbs tend to come with loops you can strap around your surgical bra’s straps to keep them out of the way, the tubes are still something to keep in mind. There are also belts and shirts explicitly made to hold drains and their tubes.
Bathing is also tricky with drains. While you have to wait until your doctor has said you will be alright to bathe in the first time, you should not submerge your drains, so a bath is not a good idea (for your drains or your scars). Most doctors recommend gently patting yourself clean and dry with a sponge bath.
There are a few factors that you need to pay more attention to in your drains than others. You should alert your surgeon if you start to notice signs of infection, fluid leaking around the tubing, drainage increasing, decreasing, or thickening, the bulb losing suction, bright red drainage, or if the drain falls out.
What to Wear After Surgery
One reason surgery can be intimidating is that you don’t know how you’ll look when the scars have healed, and the swelling has gone down. Even with breast reconstruction, there may be changes to your appearance. Clothing can be a touchy subject. Not only will it fit you differently, but you will be sensitive for a time as your body heals.
Bras, in particular, will be difficult. Surgical bras are given and recommended in some situations, which offer some support while putting minimal pressure on incisions. They clasp in the front to avoid instigating the pain that comes from moving too much. A nurse can help adjust it easily while in the hospital, and it can be used to hand the drains to keep them out of the way of your arm.
In the first weeks after surgery, you’ll likely want to stick to bras or shirts like made in this way. Clasps, buttons, or ties in the fronts. Pants or skirts that can be easily stepped into. Nothing overly complicated or that has to be pulled over the head. This will pull on the arm and shoulder, and therefore the sensitive muscles beneath the breast. Advice commonly given by previous patients of breast cancer surgery recommend loose tops and shirts for a while. Give yourself time to adjust to your new appearance with some comfortable wear.
For the first year after surgery, bras should have no underwire. The seams should be soft, and the band should be wide to minimize any pressure on one particular place. Cups should be both full and separated. And you’ll likely want to be fitted by an expert for your new bra size. Make sure to find someone who has the training, perhaps at a lingerie shop or department store to ensure the best fit.
If you are using a breast prosthesis, you may want to find a bra with a bra pocket. These are small pockets sewn into the inside of the bra to hold a prosthetic in place. Mastectomy bras can be purchased with the pocket, or you can adapt a regular bra by sewing a pocket in yourself. Or, many find, a regular bra with a full cup that fits well enough will hold a prosthetic without a pocket. Of course, it all depends on your comfort level and what you like best.
Movement and Exercise
After breast cancer surgery–and other breast cancer treatment like radiotherapy–it can be essential to keep the affected muscles moving. Yes, they are sensitive and difficult to move. But that is precisely why you must exercise them. You don’t want them to weaken or stiffen further from disuse.
Exercise, in this case, does not mean a workout. Overworking your arms and shoulders in this condition would be easy and could be harmful. But simple exercises and movements to ensure that everything is staying in use will help in the long run. Within the first week of surgery–the first 3-7 days, if possible–you should start with the easiest movements. Use the arm on the side of the surgical site to comb your hair, practice deep breathing approximately six times a day, and raise the affected arm above the head (lay it on a pillow, so it is above) and clasp your hands open and closed 15-25 times. These are simple exercises you can do without straining too much or even getting out of bed.
Once you’ve healed more and your surgeon gives the okay, you may start other exercises. Again, these are not particularly strenuous. You are still recovering. Your muscles are not prepared to comfortably remain above your head long enough to pull a shirt on, let alone lift weights. These exercises are merely meant to keep the muscles in the area near the operation flexible. Side effects of any major surgery can be weakening of unused muscles and difficulty getting back to full strength. If you practice these minor arm exercises early, you can prevent these.
Some simple exercises can be done while sitting at your table. The Shoulder Blade Stretch is done while facing the table with your palms placed on its surface. Your back should be straight, the unaffected arm (the arm away from the surgical area) should be bent slightly. The affected arm (closest to the surgical area) should be straight. Without turning your body, slowly slide your affected arm forward until you can feel your shoulder blade moving. Relax, then slowly pull your arm back. Then you repeat 5-7 times.
If you prefer to lay down while you stretch, you can try Elbow Winging. This stretch helps the movement of the shoulders and the chest and is performed while lying on your back. It can do this stretch on a bed or the floor (whatever is most comfortable for you and your stage of healing). Once you are lying flat, bend your knees and place your feet flat on the floor. Place your hands behind your neck and clasp them together, bringing your elbows up, so they point up towards the ceiling. Carefully press your elbows out and down towards the floor. This will take a while. Your first attempt after your operation will likely not reach the floor. But as you heal, you will get closer and closer. Repeat this motion 5-7 times.
Be careful not to push yourself too soon after surgery. Wait until a surgeon has said it will be okay to exercise, so you don’t strain your wound. But remember that when you get the chance, moving is an integral part of healing.
Recovery is unique for each person. Some feel no aftereffects from anesthesia while others hate what it does to them. Some patients’ only clothing issues come from adjusting to the surgical bra they are given immediately after surgery, while others take longer to adjust to their new appearance. Recovery is not a straight path. It is a branching and varying road from breast cancer to health. But it’s not one traveled alone.
Not only will you have your support network of family members and friends, but your medical team is there to support you as well. The surgical team will work with you to find your best procedure, find your best medications based on experience and family history, and prepare you for recovery.
Dr. Valerie Gorman knows about the concerns and fears that come with a breast cancer diagnosis. But she and her team will work with you to create the best treatment plan for your needs and lifestyle and help you find the easiest recovery path.
Dr. Gorman’s team have walked alongside many people who have been diagnosed with breast cancer and understand your situation. It is our privilege to walk with you, answer your questions, and help you through this difficult process.
In a recent survey of patients diagnosed with early-stage breast cancer, 38% said they were worried about finances due to their treatment. 14% said that their breast cancer cost them at least 10% of their household income. 17% said that they had spent even more than that 10% on out-of-pocket medical expenses.
When doctors, surgeons, and radiation oncologists were asked about how their offices handle financial discussions with their patients, 50% of medical oncologists reported that someone in their practice “often or always discusses financial burden” with their patients. 43% of radiation oncologists said they did as well. Only 16% of surgeons reported the same.
Furthermore, no one seems to know, going in, just how far a diagnosis of breast cancer is going to set them back financially. It is difficult to find answers about the cost of treatment, whether for surgery, radiation, or other medications. We are taking this chance to clear the air between doctors and patients; we can give the answers that so many have been looking for and help to start the conversation so you can be prepared should this diagnosis ever come your way.
In 2010, breast cancer was the highest-costing cancer in the United States. Nationwide, it cost a total of $16.5 billion. By 2020, this is expected to increase to $20.5 billion. The American Cancer Society estimates that over $180 billion is spent on health care expenses and lost productivity every year due to cancer.
Of course, each person’s case is unique. Their access to insurance must be taken into consideration. Different stages of cancer are harder to treat than others, which can affect overall treatment costs. Not to mention that disease takes root differently in each person, so it must be treated differently. And with no one-size-fits-all treatment, there is no one-size-fits-all price tag. All of these factors must be considered.
The stage at which a patient’s breast cancer is discovered significantly affects how difficult it is to treat. A study was done recently and published in The American Health and Drug Benefits1on the cost and frequency of some treatments based on the cancer stage and how long it had been since the diagnosis.
It was not much of a surprise to find that those patients with more advanced stages of breast cancer spent more on treatments. For those with stage 0 cancer, the average cost of treatment at twelve months after diagnosis was $60, 637. After twenty-four months, the price had jumped to $71, 909 per patient overall.
For those whose cancer had advanced to stages I-II, their medical costs were approximately $82,121 in the first twelve months of treatment. In the second twelve months, each patient still in the study brought the total average to $97, 066.
With breast cancer in stage III, the average cost in the first twelve months continued to rise to $129,387. After a full twenty-four months, the study reported that patients spent an average of $159,442.
At stage IV, the most difficult to treat, the average treatment costs were $134,682 at twelve months and $182,655 at twenty-four.
According to the study, patients were paying an average of $85,772 within the first twelve months of being diagnosed with breast cancer, despite their cancer stage. And within the first two years of their diagnosis, the study reported their treatment costs averaging $103,735.
Another major factor that will contribute to the overall cost of breast cancer treatment is the kind of treatment a patient is receiving. Which treatment you receive depends on the location, cancer stage, and extent to which the disease has spread. Sometimes the procedures are combined to get the best results and return you to health quicker and more effectively. The same study mentioned above also explored the average amount spent on categories of treatments, and how common these kinds of treatments were within the given periods.
Surgery is a standard treatment for a breast cancer diagnosis. If applicable, it is a way to remove cancer physically from where it has taken root. Altogether, surgical treatment accounts for an average of 20% of the cost of breast cancer care treatments within the first year after diagnosis, and 4% in the second year.
Inpatient breast cancer surgery accounts for 6% of the cost treatment in the first year, and 2% in the second year. In the first year of treatment, the cost of breast cancer surgery is, on average, $4,762, while in the second year after diagnosis, the cost is approximately $347.
Outpatient breast cancer surgery accounts for approximately 14% of the price of breast cancer treatment in the first twelve months, and 2% in the second. The cost of outpatient surgery in the first and second years were found to be, on average, $11,691 and $389 respectively.
Chemotherapy is another well-known treatment of cancer. It accounts for approximately 19% of breast cancer treatment in both the first and second year after diagnosis.
For general chemotherapy, the average cost (including all costs on the day of the treatment) in the first year is $15,113. As this accounts for 18% of the payment for treatment for breast cancer, this is particularly significant. In the second year post-diagnosis, the average cost for this treatment is $3,625. This makes up 16% of all breast cancer treatment costs.
Oral chemotherapy is far less conventional. It only accounts for approximately 1% of the costs of first-year treatment, and 3% in the second year. Patients are usually paying $432 in their first year and $636 in their second year for this treatment.
Radiation is used to kill the tumors by damaging cancer cells’ DNA. It is often used in combination with surgery. It makes up 18% of diagnosis treatment costs in the first year and 3% in the second year. In the first year, it costs an average of $15,455, while in the second year, patients pay $638.
Hand in hand with these major treatments come medications. Medications make up for 3% of the first year’s medical payments, and 7% of the second year. That equates to approximately $2,258 and $1,510 respectively.
There are, of course, other treatments. Smaller subcategories that don’t quite fit these above, including hormone therapy, additional inpatient or outpatient care, or professional or specialist care. They make up about 42% of potential treatment costs in the first year and 67% of costs in the second year. That equates to $35,762 in the first twelve months and $14,980 in the second.
Another factor that contributes to the overall cost of breast cancer treatment is health insurance. Healthcare, the amount of coverage you have, and the type of coverage you have, are all essential to discuss with your doctor, oncologist, and surgical team to make sure you understand where you stand.
Researchers in North Carolina found that patients who received a cancer diagnosis and did not have insurance or Medicare paid $6,711 for medication, while those with insurance paid $3,616 and those with Medicare paid $3,090 simply because they do not have the means to negotiate for a lower price.
Often, clinical appointments are more costly, as well. Where an insured patient might pay approximately $65-246, a patient without insurance coverage would pay around $129-391.
Ask Questions/Dr. Gorman
Getting a diagnosis of breast cancer is near impossible to imagine, and even harder to plan for. But if you ever find yourself in that place, you have a little more knowledge about what to expect. One should always be prepared for the unexpected, and it never hurts to have a little money saved up for emergencies. But breast cancer treatment costs will require more than just a bit of your savings. However, with communication with your team and laying out your healthcare terms and concerns as you discuss your health plan, everyone can be on the same page and do what they can to work within your needs.
Dr. Valerie Gorman knows about the financial burden that comes with breast cancer. She is dedicated to offering her patients a personalized approach to breast surgery and the treatment of breast cancer. She and her team will help to create a treatment plan that best meets your needs, and most fits your lifestyle. Because of the experience and breadth of our specialists, a multitude of treatment options exists which can be tailored to your situation.
There is no need to panic when you hear the word cancer. We have walked alongside many people who have been diagnosed and understand your fears and concerns. It is our privilege to walk with you and help you through this difficult process.
When someone is first diagnosed with breast cancer, their first concern is not often about their appearance. They might first consider prognosis. Can the surgeons get the cancer out? What are the treatment options? But if surgery is necessary, the cosmetic applications are a consideration. Your breast cancer team wants you to have the best results possible, including minimal scarring.
Breast Cancer Surgery
There is more than one way to remove tumors and cancerous cells surgically. Surgery options for the more extreme cases are the simple or total mastectomy, the radical mastectomy, and the double mastectomy. For the less severe cases are the lumpectomy or partial mastectomy, the nipple-sparing mastectomy, and the skin-sparing mastectomy. While these are still serious surgeries, these procedures can allow the patient to keep more of their natural breast shape with less dramatic scarring. While the type of procedure can certainly depend on how big the tumor or cancerous area is, treatment ultimately comes down to you, the patient, and your needs.
Breast Cancer Scars
The different variations of surgical procedures lead to different appearances, sizes, and locations for scars. With a total mastectomy, where all of the breast tissue, skin, and the nipple are removed, there will be a noticeable change in appearance. That area of the chest will be flat, and there will be a visibly large scar where the breast was.
With a skin-sparing mastectomy, the skin remains, but the nipple and breast tissue are removed. There is some room for reconstruction here under the skin, but there will still be a medium- to large-sized and prominent scar across the front of the breast.
A nipple-sparing mastectomy, however, leaves the skin and nipple and takes only the breast tissue and tumor. The scar traditionally branches off from the areola towards the armpit. It is still on the medium to large side of the scale and quite noticeable.
A lumpectomy only removes a portion of the breast tissue–that closes to the tumor–to ensure that none of the tumor is missed. This, too, can leave a large scar, which is quite visible depending on the location of the tumor and the surgeon’s approach.
All of these treatment options and their variations can be very effective with a skilled surgeon and oncology centers you are comfortable with. But they can leave a noticeable scar that many patients find a disheartening reminder:
72% of women did not realize how uncomfortable their breast cancer surgery scars would make them feel when undressed
72% of women are not displeased with the location of their scar
76% of women did not realize how uncomfortable their surgery scars would make them feel when someone else sees them undressed
82% of women have not worn a particular item of clothing because it reveals their breast cancer surgery scars
87% of women are self-conscious due to their scars
Hidden ScarTM Breast Cancer Surgery
In 2015, Invuity launched a new surgical approach to assist with just this issue. The Hidden ScarTM Breast Cancer surgery program was created to help surgeons and patients by offering less invasive methods of performing the surgery.
The Hidden Scar procedure allows for a smaller incision while still providing light in the surgical site, permitting the surgeons to treat the cancer and remove the tumor while still preserving as much of the breast’s natural shape as possible. More than that, this hidden scar process offers better cosmetic results by, as the name suggests, hiding the scars in the body’s natural folds.
Hidden Scar Mastectomy
For a nipple-sparing mastectomy, the Hidden Scar Breast Cancer Surgery scar will dramatically decrease. There can be no evidence of any cancer within the nipple for Hidden Scar Surgery, and this surgery is best suited to patients who have non-invasive cancer.
The Hidden Scar mastectomy is performed by making an incision in the inframammary fold, or the natural fold under your breast. It will naturally be hidden by the fall your breast and its small size.
Hidden Scar Lumpectomy
A Hidden Scar Lumpectomy offers options for where the incision will go, depending on where the cancer is located in the breast.
The Axilla, or under the armpit. The scar is usually hidden in a natural fold.
Around the edges of the areola. Many patients prefer this option, as the scaring is minimal and hidden even when wearing a petite bikini top.
The Inframammary fold – like the mastectomy.
Dr. Gorman and Hidden Scar
Dr. Valerie Gorman and her team have experience with the Hidden Scar approach. They have performed Hidden Scar Breast Cancer Surgery and understand the differences and options that come from each approach to oncological surgery. Dr. Gorman knows that it is important to discuss all of your options when it comes to your health and will answer any questions you may have until you can come to a conclusion with which you are happy. Contact the Texas Breast Center in Waxahachie to make an appointment and have any questions answered.
The BioZorb marker is a medical device meant to be implanted in the surgical site. Thanks to its open structure, it can be stitched into place by breast surgeons to avoid movement and allow the surrounding tissue to grow around the device after the procedure. The marker has six titanium clips that are used for future clinical imaging.
What is BioZorb Made of?
The structure itself is made of a material that is bioabsorbable, or able to be absorbed by the body. Therefore, as the tissue grows and reforms, the BioZorb can be absorbed, leaving behind only the titanium clips as tissue markers for imaging if necessary. This process takes approximately a year.
How Does BioZorb Help?
Using a BioZorb implant in breast cancer treatment can be helpful surgically, cosmetically, and with radiation treatment. Surgically, the implant–or the titanium clips if the implant has already been absorbed–can provide a perfect reference point for any future imaging for where the previous breast surgery and radiation procedures took place.
It can also assist with the structure of healing, which lends itself to improved breast cosmesis. Often with tumor removal, the breast can appear concave where the tissue grew in to fill the void the tumor left. However, BioZorb offers structure for the surrounding tissue to grow around to prevent any potential divots. This can sometimes help with oncoplastic surgery or post-lumpectomy cosmetic surgery. As for radiation therapy, the implant can provide a target for the beam to minimize the radiation damaging any surrounding tissue unnecessarily.
What are some facts about BioZorb?
Your doctor is placing an implant into your breast during this surgery. The implant is firm, but not painful and can usually be felt in the breast for 12 to 18 months, even once the surgical scars have healed. It will eventually be absorbed by the body.
When should BioZorb be used?
It is not uncommon for a patient to react strongly when they hear a diagnosis of breast cancer. They may want to avoid any risk and go straight for the total mastectomy, removing the full breast and therefore the cancer.
However, with a breast cancer team working with you on your treatment, there is more room for a personalized approach. The cancer can be treated with surgery, radiation, or a combination of the two, and when it is caught at an early stage, a total mastectomy is not needed. A lumpectomy can remove a tumor while leaving most of the breast intact.
It is in these cases that BioZorb is useful. When a patient is able to receive breast-conserving surgery, the cancerous tissue is removed by the breast surgeon, and then the skin is closed. From there, radiation may be administered by a radiation oncologist to reduce the risk of recurrence without damaging the surrounding tissue. This can be difficult without something in the breast to mark where the surgery took place. Sometimes, the empty space of the surgical site where the tumor was will fill with a liquid, forming a seroma, and this can be an indication of where to radiate.
However, if BioZorb is placed in the breast during surgery, the metal marker clips work like a road sign pointing the way for the radiologist to follow. Even after the body absorbs the coils, the clips remain in case they are needed again for imaging purposes.
Dr. Gorman and BioZorb
Dr. Valerie Gorman uses BioZorb in applicable cases to help her patients recover with less pain, less cosmetic adjustment, and more accurate imaging. But she did not take this step lightly. Before jumping all in with BioZorb, she was involved with a study testing accelerated partial breast irradiation (APBI) using her preferred intensity modulated radiation therapy (IMRT). The IMRT was directed in each of the 57 cases by a BioZorb device to keep the radiation localized.
They found that, in the follow-up visits, the cosmetic results were excellent on all accounts. Only one patient experienced pain in the area, at it was easily treated. Patients were pleased with the results.
Dr. Gorman has worked with BioZorb before, and she and her team know the benefits it can bring. She will answer any questions you have. She always wants you to be comfortable and knowledgeable about your treatment, which is why she has done her own research into BioZorb. She wants you to receive the best treatment and best results long term.
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.
Hologic, Inc. (Nasdaq: HOLX) will showcase its growing breast surgery franchise, which includes products such as the new Trident® HD specimen radiography system, LOCalizer ™ wire-free guidance system and the BioZorb ® marker, in Booth #103 at the 20th Annual Meeting of The American Society of Breast Surgeons (ASBS) in Dallas from April 30 to May 5.
The pioneer behind the Genius™ 3D Mammography™ exam, Hologic has recently expanded its product portfolio significantly through insight-driven innovation and strategic acquisitions to address the entire clinical continuum of breast cancer diagnosis and care. From digital specimen radiography and stereotactic breast biopsy systems to breast biopsy markers and surgical guidance systems – Hologic’s comprehensive suite of products is designed to meet the unmet and changing needs of radiologists, pathologists and breast surgeons.
“ASBS marks an exciting milestone this year as we debut our newly expanded portfolio of breast-conserving surgery solutions,” said Pete Valenti, Hologic’s Division President, Breast and Skeletal Health Solutions. “We look forward to building upon our relationships with this community of leading breast surgeons and showcasing our growing suite of products designed to improve cancer detection, patient satisfaction and comfort, and facility workflow.”
A sampling of the products on display in the Hologic booth includes:
The Trident®HD specimen radiography system, a next-generation solution that delivers enhanced image quality, improved workflow, and instant sample verification during breast-conserving surgeries and stereotactic breast biopsies. 1 The system, which recently received FDA clearance in the U.S. and a CE Mark in Europe, uses amorphous selenium direct capture imaging – the same detector technology used in Hologic’s 3Dimensions™ mammography system – to generate crisp, clear, high-resolution images. The system also features a bigger detector that allows for complete imaging of larger breast surgical specimens, along with a wide range of surgical and biopsy samples. 2
The LOCalizer™wire-free guidance system, which is designed to enable precision and ease of use for breast surgery guidance. The LOCalizer tag is designed to replace traditional wire-guided methods, helping provide increased comfort and convenience for patients and their healthcare teams. Additionally, the Tag is designed to be implanted into the breast any time prior to the surgery, providing increased flexibility for patients and providers. A recent study has shown that the LOCalizer tag may be able to reduce positive margin rates with lumpectomy due to the unique feature of reading distance from the tag. 3
The BioZorb®3D bioabsorbable marker, an implantable three-dimensional marker that potentially enables a more targeted radiation therapy and helps clinicians overcome challenges in breast-conserving surgery or lumpectomy. When used to mark the surgical site, BioZorb has been shown to yield good to excellent cosmetic outcomes for at least two years post-surgery and result in minimal scarring on mammography after breast-conserving surgery. 4,5 Additionally, the marker has been shown to improve accuracy in setup and boost targeting as reported by 96 percent of radiation oncologists. 6
The TruNode®wireless gamma probe, a sterile, single-use device for common, radio-guided surgical procedures that senses hotspots using an innovative detector and heuristic audio feedback technology. The TruNode probe is designed to perform less invasively and may reduce infection risk from reprocessing due to its sterile, single-use performance.
Dr. Gorman’s Presentation on 5-day Radiation Therapy
Hologic will also host a breakfast symposium, BioZorb® and a New Way to 5-day radiation, featuring Cary Kaufman, MD, FACS and Valerie Gorman, MD, FACS on Saturday, May 4 from 6:30 – 7:45 am. Additional hands-on workshops hosted by Hologic will cover topics such as stereotactic breast biopsy, oncoplastic skills, and portable breast ultrasound.
The Genius ™ 3D Mammography ™ exam (also known as the Genius ™ exam) is only available on a Hologic® 3D Mammography™ system. It consists of a 2D and 3D ™ image set, where the 2D image can be either an acquired 2D image or a 2D image generated from the 3D ™ image set. There are more than 6,000 Hologic 3D Mammography ™ systems in use in the U.S. alone, so women have convenient access to the Genius exam. To learn more about the Genius exam, visit http://www.Genius3DNearMe.com.
About Hologic, Inc.
Hologic, Inc. is an innovative medical technology company primarily focused on improving women’s health and well-being through early detection and treatment. For more information on Hologic, visit www.hologic.com.
Hologic, 3D, 3D Mammography, 3Dimensions, BioZorb, Genius, The Science of Sure, Trident and TruNode are trademarks and/or registered trademarks of Hologic, Inc., and/or its subsidiaries in the United States and/or other countries. Hologic is an exclusive distributor and licensee of the LOCalizer product and trademark, which is manufactured by Health Beacons.
This news release may contain forward-looking information that involves risks and uncertainties, including statements about the use of Hologic products. There can be no assurance these products will achieve the benefits described herein or that such benefits will be replicated in any particular manner with respect to an individual patient, as the actual effect of the use of the products can only be determined on a case-by-case basis. In addition, there can be no assurance that these products will be commercially successful or achieve any expected level of sales. Hologic expressly disclaims any obligation or undertaking to release publicly any updates or revisions to any such statements presented herein to reflect any change in expectations or any change in events, conditions or circumstances on which any such data or statements are based.
This information is not intended as a product solicitation or promotion where such activities are prohibited. For specific information on what products are available for sale in a particular country, please contact a local Hologic sales representative or write to [email protected]
SOURCE: Hologic, Inc., used by permission.
1 Wilson A. Trident 2.0 QUAL Qualitative Findings. Explore and identify the ideal breast biopsy verification system from the OR. Kadence International. July 2016.
2 Compared to original Trident system
3 N = 50 patient, single arm pilot study. DiNome M et al. Microchipping the breast: an effective new technology for localizing non-palpable breast lesions for surgery. Poster presentation, Society of Surgical Oncology annual meeting, Mar 27-30, 2019.
4 Kaufman, et al. Oncoplastic Surgery with the 3-D Tissue Implant Maintains Post-Lumpectomy Breast Contour. Poster presented at the American Society of Breast Surgeons 18th Annual Meeting, May 2-5, 2018.
5 Kaufman CS, et al. Registry Study of 337 Bio-Absorbable 3-D Implants Marking Lumpectomy Cavity Benefit Cosmesis While Targeting Radiation. Poster presented at the Society of Surgical Oncology Annual Cancer Conference March 15-17, 2017.
6 Harms S, et al. Mammographic imaging after partial breast reconstruction: Impact of a bioabsorbable breast implant. J Clin Oncol 33, 2015 (suppl 28S; abstr 111)
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Simple/Total Mastectomy–The entire breast is removed; lymph nodes and muscle are not removed.
Radical Mastectomy–The entire breast is removed, this time including the pectoral muscles and lymph nodes extending under the arm. This is rarely done today.
Modified Radical Mastectomy–Removes the entire breast including the lymph nodes;
Double Mastectomy–Both breasts are removed.
Lumpectomy/Partial Mastectomy–Part of the breast is removed, namely abnormal tissue or cancer, rather than the whole breast, just removing the lump.
Nipple-Sparing Mastectomy–The breast tissue is removed, but the nipple and skin are left unscathed.
Skin-Sparing Mastectomy–The skin is left intact while the breast tissue, areola, and nipple are removed.
Mastectomies are recommended for those who have large tumors or tumors that affect multiple areas of the breast. They can also be used as a preventative measure for those who carry the BRCA1 or BRCA2 gene or other genetic mutations that increase your risk of breast cancer. The skin- and nipple-sparing mastectomies are newer surgeries. These are optimal for minimal scarring and reconstruction.
What is recovery like for a mastectomy?
Your stay in the hospital after a mastectomy will vary depending on the kind of mastectomy you had, your reactions to the anesthesia, and whether or not you had reconstruction done at the time. However, it can be guaranteed that after surgery, you will be taken to a recovery room until the nurses are sure you are stable and (mostly) alert. At this point, you will be wheeled along to your hospital room where you will stay approximately 1-2 days.
Then, once you are home, you must keep the incisions clean. Your surgeon will give you instructions on how to do so, as well as how to care for your drainage tube, which you will only have with you until your follow up exam.
Your doctor should prescribe you medication for your pain, though the levels vary depending on the location, type of mastectomy, and amount of tissue taken. Follow your doctor’s instructions for approved medication intake.
It usually only takes a few weeks to be back to normal activities, though anything that uses your arms a lot or seems strenuous to your body should be approached cautiously for a while. If you’re ever unsure, you can always check with your doctor. It’s better to be safe than sorry. But soon enough you’ll be back on your feet and facing the world again.
What are mastectomy recovery tools?
While you are recovering, there will be many things you will have directly on your mind. There will be drains to empty and keep untangled, pain medications and antibiotics to keep track of, what will be waiting at home after your stay in the hospital, and your life at large to consider. But there are some tools to help you stay comfortable while you heal. And some people have been patients before you. They have tips to recommend based on their experience.
Some tools that many find helpful are drain belts or robes and mastectomy pillows. There are variations on both of these tools, but both offer support and work to simplify your recovery.
After the mastectomy, drains are left in the area to allow any access fluid to leave the body rather than pooling. The fluid follows a tube to a bulb that you empty regularly and record the amount in them. However, the tubes can quickly become an inconvenience with a risk of snagging. The easiest solution is to attach the drains to your clothes with the velcro attachment or clip them onto a lanyard. But other people have come up with more comfortable and convenient solutions. There are now drain belts, which are comfortable belts with holster-like pockets in which the bulbs can sit. There are drain robes that have pockets to keep the drains out of your way. And some companies produce adhesive pockets that will attach to whatever clothes you wear, making your pajamas into drain holders. Dr. Gorman’s surgical team will provide a bra for you post-operatively that includes rings to which you can attach your drains.
Mastectomy pillows are pillows that are shaped or placed in a way to help support you after your surgery. This can be anything from a regular pillow that is placed under your knees to raise your legs and increase blood flow to the armpit pillow–a rectangular pillow that lays over your chest with notches cut out for your arms. Some provide support for both breasts, while others go between the breast tissue of one breast and the other. Find the pillow that minimizes pain and discomfort and offers the support and comfort you will need. Volunteers in our community sew rectangular post-op pillows for Dr. Gorman’s patients. Each of Dr. Gorman’s patients receives one of these pillows in recovery immediately after surgery.
Previous breast cancer patients have made suggestions to make your recovery as easy as possible. First, stock up on food—at least two weeks’ worth–before your surgery. You will not want to go shopping while you are healing. And while you may not want to eat right away, you should try to find something light on the stomach so you can take it with your pain medication, such as yogurt or pudding.
When you take your first shower about two days after your surgery—or when Dr. Gorman clears you to do so—it’s generally best to do so sitting in a shower chair. You have been off of your feet and on medication since your mastectomy. It’s safest to sit while you clean yourself off.
Avoid housework. Think of this as an excuse to avoid your chores for as long as you can. You need to heal before you start expending that kind of effort. Similarly, don’t try to rush back to work. Many women recommend waiting at least three weeks before returning to your job. Returning too quickly could not only tire you out but could potentially cause complications. This advice is especially relevant to those who have reconstruction surgery, as well.
Dr. Gorman’s team provides a one-on-one education time for each patient that covers all of this information and more prior to a mastectomy.
What will my mastectomy scars look like?
The type or amount of scarring will differ based on the type of mastectomy you are having done. The total, radical, and modified radical mastectomies will leave a visibly large scar as a large amount of tissue/skin is removed. However, with partial/lumpectomies, skin-sparing, and nipple-sparing mastectomies, the scars are less noticeable. Skin-sparing mastectomies tend to leave behind a scar that is usually where the nipple was previously. The scar of the lumpectomy is small and linear and tends to be hidden away in the crease or around the nipple to avoid detection. Lastly, the nipple-sparing mastectomy generally leaves a scar under the breast, where it can be tucked away in the bra-line to avoid visibility.
The Texas Breast Center utilizes Hidden Scar™ Breast Cancer Surgery to help minimalize scarring in patients. Dr. Gorman works with each patient to make the right decision for them on the right kind of mastectomy, and from there to ensure the scarring will be minimal and where it will as minimally intrusive as possible.
How does breast reconstruction work?
Not everyone has breast reconstruction after a mastectomy. For example, those having lumpectomies do not necessarily need one, because a majority of the breast tissue is left alone in the breast. With a mastectomy, reconstruction is more likely as all the tissue was removed. However, it really is up to the patient. Talk to your surgeon about your preferences so that they can be informed when discussing your options with you
What are the risks of a mastectomy?
A mastectomy, like any other surgery, has its risks. There will be swelling in the area, as well as bruising for a while after the surgery. The breast will be sore and scar tissue will form and likely harden. Some patients experience phantom pain in removed breasts. More seriously, however, the incisions could bleed or become infected, or, more rarely, skin necrosis. There is a risk of lymphedema or swelling in the arm where lymph nodes were removed. Seromas (fluid filling the now-empty breast) can form. And not the least of the risks can be a change in self-confidence.
Dr. Gorman is aware of these risks and is there to help prevent them. If they can’t be avoided, she will support you through them and work with you on a plan to improve, step by step.
Should I have radiation or chemo with my mastectomy?
Chemotherapy is not used in all cases of breast cancer. And, if it is used, it is not always used in the same way. There are two primary ways it is used concerning surgery.
Some kinds of chemotherapy–neoadjuvant chemotherapy–is used before surgery as an attempt to shrink the tumor to a more manageable size that requires less extensive surgery. Adjuvant chemotherapy is given after surgery to kill any possible remaining circulating cells that may have been left behind to prevent more tumor growth.
Radiation is often recommended after a mastectomy as a tool to prevent the recurrence of cancerous growth. Traditionally, radiation is administered for five to six weeks, up to five days a week. However, Dr. Gorman has experience with a method that only takes five days, with less waiting period between surgery and the radiation beginning for post-lumpectomy patients.
Can men get a mastectomy?
Breast cancer in men may be rare, but it is still very possible. Only 1% of breast cancer diagnoses are in men, but that still accounts for 1 in every 1,000 men. Invasive Ductal Carcinoma is the most common form of breast cancer found in men. Like in women, black men have a higher risk of getting breast cancer than those of other races. Take precautions and familiarize yourself with the breast area by firmly feeling over the breast tissue in the area for anything unusual.
If a man receives a diagnosis for breast cancer, there is a high chance surgery will be involved in treatment. The operation could be used to establish how far into the lymph nodes the cancer has spread (a sentinel lymph node biopsy, for example), to relieve symptoms of advanced cancer, or to remove as much of the tumor itself as possible (a mastectomy).
All of these and a few more can be performed on a man to help treat him for breast cancer. It is not just women who get this disease, and today’s treatments reflect that.
How do I take blood pressure after a mastectomy?
There is some question about where to have blood pressure taken and blood drawn from post-mastectomy; more specifically, patients ask whether it is safe to do these things on the same side of the body as the mastectomy. While you can have your blood pressure tested from either arm without causing any trouble to your healing process, there could be a (minimal) risk when it comes to drawing blood after breast cancer surgery.
After certain types of mastectomies–radical mastectomy, modified radical mastectomy, sentinel lymph biopsy, or any procedure when the lymph nodes are removed–there is a risk of lymphedema. Lymphedema is a swelling of the arm and usually stems from an infection of the arm. Because having blood drawn in a medical facility is done in a clinical environment with sterile equipment, the already small risk of infection becomes minimal. However, it is still recommended to take the ‘better safe than sorry’ route and instead have your blood drawn from the arm opposite your operation.
The same goes for vaccines and other injections. While the medication won’t cause any complications, it’s best to reduce the chances of introducing possible infections to the area soon after your breast surgery or years later.
What do I ask my surgeon?
You should always prepare a few questions when going into a procedure like this. Likely, a number of them will get answered simply through the surgeon’s explanation of the process, but it never hurts to be prepared. Here a few to get you started:
What are the risks of my type of mastectomy?
Will I need reconstruction? Can it be done in the same procedure?
How can I prepare my home for my recovery before the procedure?
How can I emotionally prepare for this?
What medicines/foods should I or shouldn’t I take on the day of the procedure?
Who will perform my breast reconstruction surgery?
How much breast tissue will be removed in my mastectomy?
Will I need radiation therapy?
How long will I stay in the hospital?
Will I need to return for additional surgery?
And remember, there really are no stupid questions. None. This is your surgery, you deserve to know about it, and Dr. Gorman is here to help you understand. Ask away and she will do her best to answer. She will help with your before questions, your after questions, and your it’s-been-a-while-but-this-just-occurred-to-me questions. Being informed is something she wants for all of her patients, and something she will do her best to ensure as she walks with you every step of the way.
Who performs a mastectomy?
A breast cancer surgeon will perform your mastectomy, and a plastic surgeon will perform your breast reconstruction should you have that done. When choosing your surgeon, Johns Hopkins recommends a surgeon who:
Specializes in breast cancer
Is recognized as a breast surgical oncologist
Performs many breast cancer surgeries each year
Looking at these qualifications, Dr. Valerie Gorman at the Texas Breast Center can be your breast cancer surgeon, and of course, is always ready to help. Her specialty is breast cancer surgery and its related topics. Her residency was in general surgery, though with a focus on detecting and treating breast cancer. She is also currently serving as the Chief of Surgery and Medical Director of Surgical Services at Baylor Scott & White Medical Center, as well as board-certified by the American Board of Surgery.
At the Texas Breast Center, mastectomies and other breast cancer surgeries are what Dr. Gorman is known for, and she performs them year-round.
The FDA released a warning about using robots in surgeries. Since then, the da Vinci surgical robot has been brought to the forefront by many news networks. Over its history, it has had many successes, but more notable are its failings. While it has only been in use for twenty years, the da Vinci has had over twenty thousand adverse events filed with the FDA. Of these twenty thousand, seventeen thousand were classified as device malfunctions such as pieces falling off into the patients’ bodies or the arms freezing or going in the wrong direction. At least 274 of the events have been categorized as deaths.
And while many of these issues have been solved in any of the 175 recalls the da Vinci has been through in the past decade (in the past two years alone these have consisted of everything from general software updates as well as failing surgical arms), there are 3,000 of these robots in use in surgery today.
Some Benefits of Surgery via Robotic Aids
However, when used properly, using robotics in surgery can bring benefits to the operating table. They allow for more precision, minimizing scarring, blood loss, and pain, and can minimize the risk of infection. Because of all this, it even lessens recovery time, which is why many people would opt for robotic surgery in the first place, especially as the technical glitches are being weeded out.
Long-Term Survival Concerns for Breast Cancer Patients Having Robotic Surgery
This new FDA warning, however, might put a damper on those benefits. Even if the surgery goes off without a hitch and you recover faster than average because you used a robot surgeon, you now have a new worry. In a study done primarily on cancer surgeries (especially cervical and breast surgeries such as mastectomies),
it has been discovered that there may be long term survival effects from using a robotic surgeon.
The warning cited a clinical trial run by The New England Journal of Medicine comparing the patients with early-stage cervical cancer by the type of surgery they had performed and their results four and a half years later. They were randomly assigned open surgery (using a large incision), minimally invasive surgery using a laparoscope (small incision using a small camera to assist the surgeon), or minimally invasive using a robotic surgeon (that is, a surgeon operating via a robot). Approximately half the patients were operated on via open surgery, and half were via minimally invasive, and of the minimally invasive, 15.6% were robot-assisted.
When the four and a half years were up, 96.5% of those who received open surgery were alive and cancer-free, while only 86% of those who underwent minimally invasive surgery were in the same condition. That’s over ten percent more. The FDA cited this study as evidence against robotic surgeons. Alongside that, assistant director for the health of women in the FDA’s Center for Devices and Radiological Health, Dr. Terri Cornelison stated the FDA is aware that “surgeons have been using the device for uses not granted marketing authorization by the FDA,” putting the patient, you, at risk.
In August of 2021, the FDA released a new safety communication about robotically assisted mastectomies, reminding physicians and patients alike that conclusive results on the safety and effectiveness of robot use in surgery has not been established beyond short-term follow-up.
A Hands-On Approach
Dr. Valerie Gorman has always believed in a hands-on approach with her patients. She chooses not to perform robotic surgeries. Dr. Gorman takes the time from your first step into her office to your last checkup (which is when you decide it is) to answer your questions, so you always know the risks. She knows her tools and what now to bring into the operating room with her. Moreover, she will make sure you are comfortable with her space too.
If you have had a mastectomy done using a robot assist and have concerns, contact your surgeon, or Dr. Gorman would be happy to take a look for you and answer your questions.
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.
Body 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:
Hair loss as a result of chemotherapy or radiation therapy;
Surgical modification of body parts;
Skin changes such as redness, itching, more sensitivity, or pain in the area that was treated;
Loss of muscle mass or muscle weakness;
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.
By Valerie Gorman, MD, FACS, Breast Surgeon at Texas Surgical Specialists
If you receive a diagnosis of breast cancer, it can be overwhelming. You’ll have to sort through a lot of information quickly and make decisions about what treatment is best for you.
For many of my patients with early stage breast cancer, lumpectomy – removing the tumor surgically – is the recommended treatment option. But you have to have radiation after a lumpectomy. That’s part of the package.