Asking the tough questions
Anonymous questions from the audience included some challenging and provocative ones, like what the motivation for finding a cure is when there is such a high profit in treatment; if “early detection,” is recommended; and why breast cancer is so often missed in younger patients because mammograms aren’t recommended by some authorities, and for certain women, until age 50. The Mayo Clinic currently recommends annual mammograms after age 40, and my own doctor, every two or three years after that age. This is a controversial and oft-debated topic, and clearly depends on the individual patient and their particular risk factors.
Another question posed by an audience member was if there is a relationship between attitude and outcome. There is. “If the patient comes into the treatment thinking this is the worst thing that ever happened to them,” said Dr. Torres, “then they don’t do well. There is plenty of evidence now that patients who exercise and eat well will tolerate the treatment much easier and better.”
“A good attitude means better compliance,” added Dr. Cutugno.
The atmosphere was mostly hopeful, with one grateful 44-year-old patient expressing gratitude to the panel for their efforts in her own treatment. “Thank you for helping us be survivors,” she said.
The physicians noted that the survival rate is way up. A couple of them said they felt lucky to live in a time when so many fewer of their patients die of breast and other cancers. So many more cases are treatable now.
Get that mammogram!
To backtrack a bit to diagnosis, the pathology report after a biopsy or mastectomy arrives in several parts, and all may not return from the lab at the same time. Some components may take weeks. But combined, the elements form a big picture. The pathology report tells doctor and patient both what is involved, with crucial information about the extent, type and severity of the cancer, plus a prognosis and the information needed for a treatment plan. The information includes the shape and size of any tumor or tumors, signs of it spreading to other areas, as well as helpful hormonal information.
Cancer, the abnormal growth of cells, behaves differently in each part of the body where it might begin. Has it spread from its original spot in a duct or lobule to other parts of the breast? Non-invasive can change to invasive if untreated.
If malignant rather than benign, the tumor can invade other body tissues, something that normal cells cannot do. It can even travel through the circulatory system via blood or lymph nodes to other parts of the body.
Symptoms of breast cancer can show up as a change in the shape, size or texture of the nipple or breast, dimpling of the skin, discharge from the nipple, or a lump in the breast or armpit, sometimes with uneven edges and not usually painful. In men (only 2,150 diagnoses per year) there can be pain and a lump or thickening. Tests include mammography, blood tests, biopsies of breast or lymph nodes, CT scans, MRIs and ultrasounds.
After heart disease, breast cancer is the second leading cause of death for women, according to the Centers for Disease Control and Prevention. It is the most commonly diagnosed cancer for women worldwide. One in eight women in the U.S. will receive a diagnosis of breast cancer, more than 220,000 a year. Though survival rates have been decreasing in the last couple of decades due to more effective detection and treatment methods, more than 40,000 of those will not survive it.
As October, Breast Cancer Awareness Month, comes to an end, if you are a female of a certain age get that mammogram! A painful one at age 35 made me put off the next one a dozen years, but the next one didn’t hurt a bit. Resources for more information include Benedictine’s Oncology Support House at (845) 339-2071, as well as www.breastcancer.org and www.nationalbreastcancer.org. The National Cancer Institute provides an online tool to help you figure out your risk of breast cancer. See www.cancer.gov/bcrisktool.
