Breast Cancer Awareness Month
Not so many years ago, a patient went to surgery not knowing whether she would wake up with her breast or if it would be removed. She would have biopsy under general anesthesia to remove a lump in the breast, determine if it was cancer, and then if it was cancer, almost always undergo a mastectomy. We have developed much better tools to make the diagnosis, and become much more sophisticated in tailoring treatment to each patient. We utilize simpler operations -- the result is fewer complications and better results.
Breast cancer is the most common cancer and the second leading cause of cancer death in women.
One in eight women will develop breast cancer in her lifetime and that risk can double if there is a strong family history. Early detection can improve outcomes. Breast cancer can be detected by self-breast examination, clinical breast examination (done by your physician), screening mammogram, or ultrasound. Every woman over age 40 should have a discussion with her physician about when it is appropriate for her to start screening and how often she should be screened.
If an abnormality is identified by physical examination or imaging, a biopsy of tissue should be taken to determine if the abnormality is cancer. Biopsy is often done in the office by a breast surgeon or radiologist using ultrasound and local anesthetic. Once a diagnosis of breast cancer is made, the patient will meet and discuss treatment options with a team of doctors that focus their practice on the treatment of breast cancer:
The Breast Surgeon is often the first specialist consulted. Today’s breast surgeon concentrates practice on breast surgery, often has developed advanced skills in both ultrasound breast evaluation and oncoplastic tissue rearrangement, and will be a mentor and navigator for the patient. The breast surgeon will discuss different options for surgery and the timing of surgery. In the past, all women with breast cancer had the same operation—a mastectomy. However, we now know that patients get the same results when only the lump of breast tissue with the cancer is removed (partial mastectomy or lumpectomy) leaving the breast intact, as long as the patient also receives breast radiation treatment.
New techniques in breast surgery emphasize incisions in areas of the breast that hide well, and the rearrangement of remaining breast tissue so the patient is left with a cosmetically acceptable scar and less deformity of the contour of the breast. Mastectomy is still an option for treatment in some patients and can be done in conjunction with reconstruction of the breast by a plastic surgeon using either implants, or the patient’s own tissue to reconstruct the breast contour.
The Radiation Oncologist provides radiation to the patient after breast conserving surgery, and sometimes after mastectomy. There are several different ways of giving radiation. The newest technique, which is still under clinical investigation, is intraoperative where the radiation is given to the patient in one dose while she is in the operating room and asleep during surgery. Then, there is accelerated partial breast irradiation using a catheter that is placed in the lumpectomy cavity in order to limit radiation to the rest of the surrounding tissues. This kind of radiation is usually given over five days. Whole breast radiation is the standard radiation given to patients over a five week period. The kind of radiation that is best suited for the patient will be determined after a discussion between the radiation oncologist, the breast surgeon, and the patient.
The Medical Oncologist is the “Cancer Doctor”. The oncologist specializes in chemotherapy and hormonal treatment. Often surgery is done first followed by these oncologic medications to keep the cancer away. Some breast cancers should be treated first with medication (chemotherapy or hormonal therapy) to shrink the cancer and allow for a better surgery. Breast cancer treatment is constantly improving as a result of research being done and newer advances looking at genes and special characteristics of the breast cancer.
Breast cancer treatment today is no longer “one size fits all” as it has been in the past. It is now tailored to each individual patient and their specific breast cancer type. As part of the breast cancer treatment team, we specialize in counseling patients every step of the way and keeping them informed of all their treatment options so that they are an integral part of the decision-making process.
Dr. Charleen Lee Kim is a board certified general surgeon who is a Diplomate of the American College of Surgeons and a member of the American Society of Breast Surgeons. She practices with West Coast Surgical Associates -- offices in Walnut Creek, San Ramon, and Concord. Call 925- 933-0984 to schedule an appointment. You can view her on www.wcsurgeons.com.