Danielle: Good evening Jacksonville and happy Saturday, I’m Danielle lee in for Jay Gray. Welcome to the conversations and Doctor Kasraeian isn’t here today but we have a very special guest, Doctor. How are you today?
Doctor: I am perfect. How are you?
Danielle: I am good. No problem. So what is going on today?
Speaker 2: Well, first of all [inaudible 00:00:22] is the American College of Surgeons in Washington DC and asked me and offered me this opportunity to do this show today and of course this is October and breast cancer awareness month and you can see that the whole world has changed and turned to pink and everybody talks about breast cancer. So, I took advantage of this opportunity and we’re gonna talk about breast cancer.
Doctor: With me, I have a fantastic colleague and friend who is the assistant professor of medicine division of hematology and oncology at University of Florida at Gainesville, Doctor Karen Daily, who agreed to call in and help me out so that we would be able to talk about breast cancer and also answer to any questions that we may receive from the audience. So, Doctor Daily, are you there? Doctor Daily are you are there? Doctor Daily?
Dr. Karen Daily: Yes, can you hear me? I’m here.
Danielle: Oh, there she is.
Doctor: Okay, great. Well, I just want to thank you for taking this time and come on board with us so that we can talk about breast cancer. I would like to start with first of all truly congratulating all the breast cancer survivors and heath care providers, breast cancer care givers who have been fundamental forces and driving force behind progress that has been made in betterment of breast cancer care and also discovery of new information that they all are helpful in our ability to better diagnose and better treat our breast cancer patients. In that scenario, what I would like to do, is I would just like to spend a few minutes and talk to you about the status of breast cancer. Breast cancer is a disease that is not only associated with physical impairment but it is an actually causing a lot of psychosocial and psychosexual issues for women across the world. That has resulted in significant effort from scientist, clinicians, advocates, healthcare providers, healthcare leadership, across the world, to try to see whether they can find ways that they can better diagnose, better detect, and better take care of the patients with breast cancer.
So, there has been significant changes in the way that breast cancer is being viewed and treated these days and this is nationally significant progress and significant advances in what we have today. One of the areas that is incredibly important to really discuss, and that is where I have asked Doctor Daily to help us with, is really talk about, what are the breast cancer risk factors? Given the fac that the majority of breast cancers are what we call sporadic. They are not associated with any kind of risk factors for breast cancer. Those people that are regarded as high risk for breast cancer are those individuals that they need different attention and Doctor Daily is experienced and runs a high risk breast cancer clinic in Gainesville and she is the best person to really start the discussion with what are the breast cancer risk factors? Doctor Daily.
Doctor: Yes, thank you so much for this opportunity to share really important information with the community and our listeners. I think you touched on the first point I would want to make, which is most breast cancers are sporadic, meaning that they are not associated with a familial genetic condition and so that is always important to remember. Really just being a women and growing older are the most common risk factors. Those are both very common as it is a common disease and I think many patients without a family history are surprised at their diagnosis. So, I think that it’s worth revisiting that those are the most usual risk factors but in terms of being above average risk, having more risk than the usual US woman and breast cancer occurs in 12% of … Any individual woman has a 12% lifetime risk of getting breast cancer. So, again, it is very common. The most commonly diagnosed cancer in the US.
Some of the risk factors that increase risk, do involve family history. So, I’ll talk about that for just a moment. When you have a common cancer it’s quite likely that someone in your family will have been touched by breast cancer, which doesn’t necessarily dramatically increase risk. The kind of things that I would encourage our listeners to be aware of, the family history that they should know and discuss with their physicians would be, who in their family has been diagnosed because a first degree family member like a mother or sister or daughter, would imply a greater risk for the patient than say a second degree family member like an aunt or a grandmother or cousin, someone more removed.
The other thing that’s important to know is the age at which your family members were diagnosed. I mentioned that breast cancers more common with age, so the kind of cancers that impart a greater risk to family members are those diagnosed at a young age, which has been variably defined below 40, below 45, below 50, but knowing if your family member was diagnosed at 70, versus 40, would have a lot of implications for how your physicians would assess your risk and how they would treat you.
That’s the first thing I would touch on is family history but I would go on to a couple of other risk factors if I may. Probably the other thing to mention here is that not all risk is created equal. So, many women here in October with all of the awareness about various things that increase the awareness of breast cancer but not as much attention is spent on how potently, what magnitude of risk each factor contributes. There are very common things that are related to reproductive history. Things like an earlier age of starting menstruation. A later age of stopping menstruation. Having less pregnancies. Having pregnancies at later age. Having less breast feeding history. Many of those things contribute to a women’s estrogen exposure and can increase risk although they do not usually do that by even two fold or greater. It is an increase in risk but it’s not dramatic.
They’re important to consider but I would like to touch on really two more powerful risk factors just to bring some awareness to these entities. One is, and Doctor [inaudible 00:07:53], I hope you’ll comment on this later in the program because this would be something obviously in your expertise as a pathologist, some of the benin breast legions can increase a women’s risk of breast cancer easily four or five fold and some of those terminologies would be atypical hyperplasias, sometimes called atypical ductal or atypical lobular hyperplasia, or lobular in situ. So, some of those breast pathologies, things that a women might be told after a breast biopsy could lead to having an increased risk in the future.
Is that something that you would want to talk about anymore, Doctor [inaudible 00:08:41].
Doctor: Yes, absolutely. I mean you touched upon a very, very important part of this discussion for today and that is when we are really looking at morphologic risk factors, atypical [inaudible 00:08:55] hyperplasia, lobular hyperplasia, [inaudible 00:08:59], all of those components, we are referring to a category of pathologic entities that they have that capacity, particularly if they are associated with family history of breast cancer. They contribute to increased incidence of subsequent development of breast cancer and one of the most important thing that I would like to bring to the attention of our listeners is the diagnosis of these entities occasionally is challenging and there are times that there is a sort of a gray zone between atypical hyperplasia, which is a morphologic risk factors is a risk indicators verus low grade ductal carcinoma in situ that it is being viewed at the moment as a pre-cancerous legion and it requires cancer therapy.