Danielle Lee: Good evening, Jacksonville, and happy Saturday. I am Danielle Lee, and welcome to The Conversation. Usually it’s with Dr. Ali Kasraeian, but today we have Dr. Shahla Masood here, filling in for him. How are you today?
Dr. S. Masood: I am fantastic.
Danielle Lee: Perfect. We also have a guest here in the studio, and one on the line, so we have a very interesting show. We’re talking about breast health and breast cancer.
Dr. S. Masood: Absolutely.
Danielle Lee: Perfect. What’s going on?
Dr. S. Masood: First of all, I want to say hello to everyone and hope that you’re all having a good time on this rainy Saturday. I want to also thank Ali, that he has given me this opportunity to bring my guest in here and talk about my favorite subject, and that’s breast cancer and breast health. I wanted to all know that Ali is my son, so I have to tell that because I’m very proud of him. Having said that, I think what we are going to do today is try to give an overview of the most important aspect of breast health that one has to take under consideration. I’m very fortunate to have two wonderful colleagues and friend of mine with me today so that it will be a conversation about variety of different topics. One is Dr. Laura [Zoobury 00:01:16], who is assistant professor at the department of hematology oncology at the University of Florida, and we have Dr. Julie Bradley, who is associate professor at the department of radiation oncology at the University of Florida.
So, we all work together and it’s really fun to see how we can really do this show for this first time the way that we do that. We have a little public forum together and we take care of patients together, but this is a new experience for us. I wanted to just express my appreciation for them to have given us their Saturday and their private time so that they can come onboard and we all can talk about breast health. I am a pathologist, and as a pathologist, my job is to make diagnoses of abnormalities that our colleagues, the clinician or the patient herself, they identify. As that, I would like to just take a moment and talk about what are really the clinical signs of breast cancer. When a woman has to refer to a physician and when is the time that we need to pay attention to our breasts.
Fundamentally, breast cancer occurs often as a palpable mass. Often patients feel it when they’re showering, or their partner feels that, and in that scenario, I think again the best thing is to refer to a clinician and to a physician so that they can see what they need to do and will talk about that. Occasionally breast cancer occurs as a nipple discharge or abnormality on the skin of the breast. Very, very rarely pain may be the first presentation of the breast cancer. The most important thing to remember is that the majority of the lumps that people identify and feel fortunately, they’re benign. So, there is not really that much of reason for being worried and being afraid of referring to the physicians in the fear of hearing that you have breast cancer. The other way that breast cancer is identified these days is through a screening mammography. Truly, the public awareness and advances in breast imaging has brought a different dimension in the way that we diagnose breast cancer. And fortunately, with this, we have the capability of detecting small cancers.
When cancers are detected early, these are the cancers that can be managed beautifully with really not much of fear of any unfavorable outcome in the majority of the cases. And truly, breast cancer in this circumstance is really viewed as a chronic disease, rather than to a fatal disease that people really refer to when they talk about breast cancer. The entire concept of breast cancer has really changed. In that process, I think the most important concept is that women try to have that self-awareness of their breast and when there is a change, they refer to the physician. The other concept that is important to talk about that is often when patients develop breast cancer, they keep asking themselves, “What did I do? What did I do wrong?” Or, “Why has it happened to me?” And the concept is truly it is nobody’s fault. First of all, the majority of the breast cancers are what we call sporadic. It means that there is no risk factor as to say that with that. It just happens.
There are a very small number, 5% or 10% of breast cancers, are associated with some genetic abnormality. Those are the cases that naturally they come and they’re different circumstances. That is when the patients have family history of breast or ovarian cancer in first degree relatives, they have history of patients having breast cancer in early age. Families that they have bilateral breast cancers, male breast cancer, people that they’re coming from Ashkenazi Jewish family. These are all the people that they have biopsied areas of the breast that is associated or the diagnosis has been atypical hyperplasia, or atypia. In these circumstances, we call these individuals people that they have some risk factors. Naturally the risk factors is gonna be mild, moderate, or severe, but nevertheless these are the patients that they have to undergo a different concept of management, and we will talk about that.
I want to stop for a moment and ask Laura as there are patients that they come and they’re high risk, or they have atypical hyperplasia, and they’re coming to you as, “What do I need to do in order to make myself protected and protect myself from development of breast cancer?”
Dr. L. Zoobury: Thank you for having me, Dr. Masood and also thank you to WOKV for having me here. Hopefully we’ll be able to answer a lot of questions that do come up in patients’ minds and their families’ minds. For prevention of breast cancer, so patients with high risk, cystic disease that’s not yet malignant, many times we see these patients and the question to us is what is the risk and benefit of reducing their risk by medication. Many times, there’s different kinds of risk reduction strategies that can involve surgery or other things, but from our standpoint as medical oncologists, we do offer risk reduction with medication. The medication is basically targeted towards hormone receptors. So, it is something similar to what we use sometimes in invasive cancers, which is what we call the anti-endocrine therapy. We don’t offer it to everybody. It really depends on the risk and benefit of treatment, and whether or not the side effects of a given medicine are something that can be tolerated and whether the benefit outweighs the risk. And if that’s the case, then we do recommend treatment with those medicines.
Dr. S. Masood: Thank you very much. When do we advise the patients or we hype them to undergo DNA genetic testing?
Dr. L. Zoobury: Genetic testing definitely has a role. If there are patients who are either young, so 50 or less, if they have a strong family history. And family history doesn’t necessarily mean that somebody’s cousin had breast cancer or, because breast cancer, as we know, is very, very common. One in eight women will, over their lifetime, develop breast cancer. But if somebody has a family history that is concerning for a familial type of breast cancer, such as more than one first degree relative, so say somebody’s mother and maternal aunt both develop breast cancer at a young age, or if they also have a history of some other cancers, like ovarian cancer, that would make us think of a specific genetic conditions like the BRCA gene. In those kind of situations, we do recommend genetic testing. Same goes where there’s a family history of male breast cancer, or other things like that.
Dr. S. Masood: Thank you. I guess what we need to do and begin to further discuss this issue after a break.
Danielle Lee: Right. That’s right. As always you guys, the phone lines are open. You can always give us a call, 340-1045. This is a really interesting CRO. You don’t want to miss the next part of the segment here of The Conversation here on News 104.5, WOKV.