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We have all heard the numbers lurking behind breast cancer: One in eight women will be diagnosed at some point in their lives. That statistic sounds scary, but the reality is that 87 to 88 percent of women actually will not get the disease.
Understandably, breast cancer is a very emotional and complicated concern for patients, said Dr. Phillip Bonanno, director of the Breast Institute at Northern Westchester Hospital. The landscape of breast cancer diagnosis and treatment has become even more confusing from a patients perspective now that genetic testing has entered the picture. Dr. Bonanno can help sort through them.
Here, Dr. Bonanno answers some common questions relating to breast cancer:
Who should I talk to about breast-health related questions? The first place to start is your primary care doctor or ob/gyn. (There is also information online at breastcancer.org.) If something abnormal appears on a mammogram or MRI result, then the patient will be referred to an oncologist or breast surgeon for further clarification. Were implementing a new model at our new facility in Yorktown of utilizing the expertise of nurse practitioners who specialize in breast health. Theyre very good at developing risk profiles and ordering proper diagnostic tests. If they find a red flag they refer the patient to a breast surgeon. This eliminates a lot of waiting and having to go from a doctor to a radiologist, then back to the doctor, and so forth. Im very eager to see this succeedI think the approach will really be useful for patients.
What role do genetics play in breast cancer? Of the many risk factors for breast cancer, genetics may be the most important. If someone has multiple close family memberssiblings, a parent, aunts or grandparentswith breast cancer, particularly under the age of 50, then that person is at higher risk for the disease. A practitioner would direct that patient to a genetic counselor to sort out the risk and gauge the need for genetic testing. Obviously, a woman should know her family history of cancer, especially breast and ovarian.
What kind of genetic testing would a patient undergo? BRCA I and BRCA II are the genes we look at. A mutation can indicate a greater chance of developing a breast tumor. But a positive test does not indicate that someone will definitely get cancer. This is a way of determining how closely a patient should be monitored. At that point, we look at other risk factors, such as a history of smoking, her age at menarche (before age 12 can indicate higher risk), and whether she breastfed (which can reduce risk). We also consider whether she is of Eastern European (Ashkenazi) Jewish descent and how easy or difficult it is to get a clear mammogram or MRI image of her breasts (this is dependent on the density of her breast tissue). These considerations can influence a womans next steps.
Are there other types of genetic testing? In the event of breast cancer, further genetic testing (oncotype) can help determine the course of treatmentand this testing has helped oncologists focus the therapy with a high rate of success. But as far as diagnosis, goes, the other genetic tests are still in the experimental stage, and many will probably go by the wayside.
What do you think of mastectomy in women at high risk but who dont have cancer? For some very high-risk women, this can help relieve anxiety. And breast reconstruction surgery has come a long way, which makes this option seem more acceptable to some. But its no guarantee against future cancer; it reduces risk, but the surgeon cant remove all the breast tissue. And there are risks involved with surgery as well, so this is not an option to take lightly.
A womans self-esteem is an integral part of the treatment and healing process. Taking into account how women want to look and feel at the end of successful treatment and designing the entire process around this objective is critical.
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