Breast cancer questions answered
More questions and answers
Q: I can't afford a mammogram every year. Is every two years enough?
Dr. Logan-Young: Once women are in their forties they should have a mammogram every year. Some states have agencies that subsidize the cost. Call the American Cancer Society at (800)227-2345 to find one near you. In younger women, between age forty and fifty, annual mammograms are important because lumps are harder to detect in younger, denser breasts. One-third of breast cancers happen before age fifty. I recommend starting at age thirty-five if you have a mother or sister who had breast cancer. If it's an aunt, start at forty with all other women. You can't use distant relatives as a guideline because if you add together all of your relatives it often adds to about ten, and one in ten incidence is average.
Q: Does it matter who does my mammogram?
Dr. Logan-Young: Yes. You should not get your mammogram at a place that's not accredited by the American College of Radiology. Most centers are accredited, but sometimes the new ones aren't so it doesn't hurt to ask.
Q: How often does a mammogram find a lump?
Dr. Logan-Young: The average number of cancers is about one in two hundred mammograms. One out of every 30 mammograms that we do will find something new that requires further evaluation. Often those are cysts and other benign conditions.
Q: What can I say to a friend who just got diagnosed with breast cancer?
Dr. Logan-Young: Be glad that you got it now instead of twenty years ago, when it was much more difficult. Her chances of surviving are much greater now. They're catching the cancers when they're much smaller, and the treatment is much more sophisticated. The chemo is safer -- the same results with not as many side effects. And breast reconstruction is better.
Q: What should I do if my radiologist and surgeon disagree on the best method of treatment?
Dr. Logan-Young: Lumpectomy is much more common now, which makes recovery faster. If they disagree, get a third opinion. But that's unusual. A long time ago disagreement was common, but now that treatments are better, there's more agreement.
Q: I just can't see doing those self-exams. I can't imagine I'd find anything anyway. How many folks who "find lumps" actually find them themselves?
Dr. Logan-Young: BSEs are very easy, but many people don't want to do it because they find lumps. But what they don't know is that their own breast tissue can be lumpy. Breast tissue is normally lumpy, as long as the lumps match in both breasts that's normal. If you find something that's just in one breast, get it checked out. But keep in mind that if one breast is bigger than the other, all the matching lumps will be bigger on that side. The week just before your period starts is when your breasts are most lumpy, so don't examine them then. The best time is the week at the end of your period.
Q: My grandmother and two aunts died from breast cancer. My mother had preventive mastectomies, but I'm only 26, I don't know if I should get one done too, or if I should just take my chances?
Dr. Logan-Young: Since your mother doesn't know if she would have gotten cancer, you don't know if you're at increased risk. The grandmother and the aunts are not enough information to tell if you're at increased risk. The only way to tell is to get checked for the breast cancer gene. But even if you don't have a mutation in the breast cancer gene, that doesn't mean you're safe. It's up to you whether you feel at increased risk enough to have a mastectomy, but clearly you should be diligent about BSE. And, of course, you should have a clinical exam twice a year. When you get older, be sure to get mammograms.
Q: Is it worth traveling to a top hospital for a lumpectomy -- like Memorial Sloan-Kettering?
Dr. Logan-Young: Most areas have outreach programs with excellent referrals. The doctors communicate from remote areas to the major centers. They actually electronically send mammogram films from some centers to the major centers in order to get second opinions and other advice. That's brand-new and it's not yet routine, but other centers can mail the film. You can have an answer in a couple of days without having to travel.
Q: What is the percentage of women who are diagnosed with breast cancer in their twenties?
Dr. Logan-Young: No more than 1 percent of women who get breast cancer get it in their twenties. Put another way, one out every million women in their twenties will get breast cancer. The one in eight statistic is over your entire life, up to age ninety. The risk increases as you get older, but it's very rare for women in their twenties.
Q: What are some of the options women face when they have a malignant tumor? Do they always have mastectomies?
Dr. Logan-Young: Half of the women in our office have mastectomies; the other half have lumpectomies with radiation. The younger the woman is the more likely it will be recommended that she also have chemotherapy. Studies have shown that lumpectomies are as effective as mastectomies with small tumors. Recurrence after lumpectomy is 6 percent; recurrence after mastectomy is also 6 percent. But lumpectomies are only done if the tumor is small enough. Lumpectomies are still major surgery because they have to do a second incision under the arm to take out lymph nodes. But they won't need reconstruction. When a patient has a mastectomy, sometimes they do reconstruction at the same time. Then they wake up after the surgery without a missing breast.
Q: How can I find a good oncologist or surgeon?
Dr. Logan-Young: Most cancer centers or medical schools can tell you who is good. Or call your local chapter of the American Cancer Society. (800)227-2345
Q: Is it common to interview the people you'll deal with for your surgery?
Dr. Logan-Young: Yes, go talk to one surgeon and if you're not happy with that person's approach go back to your family doctor and ask for another referral. You want someone to work well with your family doctor.
Q: What are some of the recent advancements we should know about in this area before we go in and talk with the doctor?
Dr. Logan-Young: The differences between lumpectomies and mastectomies is the biggest issue. If you feel that a surgeon is recommending unnecessary mastectomy, you might want to do a little more research. Some women are so afraid of cancer that they would rather have a mastectomy. If a surgeon is recommending a lumpectomy your chances of surviving are excellent with that treatment.
Q: I'm 46 years old and I just moved to a new city. I've always just had my internist be my gynecologist too, but should I get a specialist since breast cancer runs in my family (mother and aunt)?
Dr. Logan-Young: I don't think you need a specialist as long as you don't have breast cancer. But be careful to do breast self-exams and alternate visits to internists and gynecologists and mammograms so someone is doing an exam every four months. You should be sure to get a mammogram every year. For the average woman, we're beginning to see evidence that there is a decreased death rate for women who get annual mammograms in their forties. But for women with a mother or sister with breast cancer, there's no argument that annual mammograms in your forties are valuable. The argument that some people raise about not doing mammograms for every woman every year in their forties is that they claim the money would be better spent on other care. If you're one of the women who gets early detection from one of those mammograms, than that money was well spent.
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