Breast Cancer Q&A with Dr. Susan Westfall

Q: What are the signs and symptoms of breast cancer?

A: Early breast cancer usually does not cause pain and may cause no symptoms at all. Some breast cancers never cause symptoms or other indications of a problem. However, as the cancer grows, it can cause changes that women and men should watch for, such as:

• A lump or thickening (a mass, swelling, skin irritation or distortion) in or near the breast or in the underarm area
• A change in the size or shape of the breast
• A change in the color or feel of the skin of the breast, areola or nipple (dimpled, puckered or scaly)
• Nipple discharge, erosion, inversion or tenderness.

A woman (or man) should consult a physician when any of these changes are noticed.

Q: What are the risk factors for breast cancer?

A: Anyone may develop breast cancer. However, the following risk factors may increase the likelihood of developing the disease. Risk factors that cannot be changed include:

• Gender (breast cancer occurs nearly 100 times more often in women than in men)
• Age (a majority of cases occur after age 50)
• Personal history of breast cancer
• Previous chest irradiation
• Family history and genetic factors (having a close relative, such as a mother or sister, with breast cancer increases the risk; this includes changes in certain genes such as BRCA1, BRCA2 and others)
• Previous benign breast disease (some, but not all)
• Previous breast biopsy in which the tissue showed atypical hyperplasia
• Menstrual periods that began early in life
• Menopause that began later in life.

The most frequently cited lifestyle-related risk factors include:

• S moking
• Not having children, or having a first child after age 30
• Oral contraceptives
• Obesity and a high-fat diet
• Physical inactivity
• Alcohol use
• Long-term, post-menopausal use of combined estrogen and progestin (HRT)
• Weight gain and obesity after menopause
• Environmental risk factors ( exposure to pesticides or other chemicals is being examined as a possible risk factor).

Q: How is breast cancer diagnosed?

A: Screening for breast cancer before symptoms occur helps doctors detect the disease earlier, when it is most treatable. The American Cancer Society recommends the following guidelines for the early detection of breast cancer:

• Women age 40 and older should have a screening mammogram every year.
• Women in their 20s and 30s should have a clinical breast exam as part of a regular exam by a health professional, preferably every three years. After age 40, women should have a breast exam by a health professional every year.
• Breast self-exam is an option for women starting in their 20s. Women should report any breast changes to their physician right away.
• Women at high risk (greater than 20 percent lifetime risk) should talk with their doctor about adding MRI screening to their yearly mammogram. Women at moderately increased risk (15 to 20 percent lifetime risk) should do the same.

If your mammogram shows an abnormality (or you have a lump or other changes in the breast), additional tests may be performed. A diagnostic mammogram may be used to evaluate abnormalities detected on a screening mammogram. The St. John’s Mercy Breast Center provides state-of-the-art digital mammography to detect and diagnose breast cancer and other conditions. Our technologists are specially trained and certified in mammography, and our staff includes four dedicated breast radiologists who exclusively interpret breast images.

Breast ultrasounds and magnetic resonance imaging (MRI) also may be used to diagnose and classify conditions of the breast. A breast biopsy, a procedure in which samples of breast tissue are removed with a special biopsy needle or during surgery, may be needed to determine if cancer or other abnormal cells are present. The St. John’s Mercy Breast Center provides stereotactic and ultrasound-guided biopsy techniques, which offer enhanced precision and are less invasive than traditional surgical biopsy.

Q: What are the treatment options for breast cancer?

A: Your treatment plan will be determined by your physician based on your overall health, medical history, the extent of the disease and other factors. Treatment options may include surgery, radiation therapy, chemotherapy and hormone therapy.

Most women with breast cancer have some type of surgery. St. John’s Mercy’s medical staff includes board-certified surgeons who subspecialize in breast surgical procedures. Examples include:

• Breast-conserving surgery, including lumpectomy and partial (segmental) mastectomy
• Total (or simple) mastectomy
• Modified radical mastectomy
• Axillary (armpit) lymph node sampling and removal
• Breast reconstruction.

Speak with a physician, medical oncologist or breast surgeon for further information about treatment options for breast cancer.

Susan H. Westfall, M.D.
Surgeon
St. John’s Mercy Medical Center
621 S. New Ballas Road, Suite 7011B
St. Louis, MO 63141
(314) 251-6840