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What You Should Know About Breast Cancer

A Q&A with Dr. Johnetta Blakely (Internal Medicine and Medical Oncology) of the West Clinic.

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Flyer: What is breast cancer?

Dr. Blakely: It's a disease where there are cancerous cells from the breast tissue itself. Most of the time this occurs in women; however, men can also have breast cancer.

What are the signs of breast cancer?

Many times there are no signs at all, and there are abnormalities found during routine mammogram testing.

Signs include:

• a mass or "knot" in the breast

• dimpling of the skin

• inverted nipple that is new

• bloody or other discharge from the nipple

• thickening of the skin

• redness of the skin

• changes in the size of the breast.

What causes breast cancer?

There are no known direct causes of breast cancer; however, there are several known risk factors which include:

• Family history — usually considered to be a first-degree relative (i.e., mother, sister, daughter)

• Personal history of breast cancer

• History of abnormal breast biopsies

• Known genetic abnormality

• Younger age with first period (before age 12) or later menopause (after age 55)

• Never having a baby or having your first child later in life (after 30 years old)

• Never breastfeeding

• Older age (there is a higher incidence in women over 50 years old)

• Postmenopausal hormone replacement therapy

• Alcohol use (drinking more than one drink daily)

• Decreased exercise (even limited exercise decreases the risk of breast cancer)

• Obesity and high-fat diets.

When should a woman first get a mammogram?

Most agencies recommend a baseline mammogram at age 35 with yearly mammograms starting at age 40, assuming no significant risk factors for breast cancer.

Are there any risks involved in having a mammogram?

There is some discomfort with having a mammogram. There is also some small radiation exposure associated with a mammogram; however, the risk from this is very small and decreases as a woman ages.

What questions should a woman ask her doctor about breast cancer if diagnosed with the disease?

There are several questions that should be asked. Some of those include:

• Do I need to see a specialist? A surgeon or medical oncologist?

• Do I need to have any genetic testing?

• What are the specifics about my pathology?

• Tumor size

• Are there any lymph nodes involved?

• Receptor status (ER/PR/Her2)

• Grade

• Do I need chemotherapy and, if so, what type and what are the side effects (short-term and long-term)?

• Do I need radiation?

• What stage am I, and do I need any additional testing (PET scan or CT scan)?

What are the different stages of breast cancer and what does it mean to be diagnosed at one stage as opposed to another stage?

The stages of breast cancer are I-IV. Stage I-II is early and can be cured with appropriate treatment. Stage III breast cancer almost always requires chemotherapy and radiation for cure. Stage IV means that the cancer has spread distantly from the site where it started.

If a woman is young , with no family history of breast cancer, should she still do self-exams and/or have a mammogram?

She should do monthly self breast exams and yearly mammograms if she is of age. If she feels any lumps or masses or other abnormalities, she should seek medical attention.

Dr. Johnetta Blakely is well-published and participated as a lead researcher in a study investigating the effects of pregnancy on cancer outcomes. She joined the West Clinic in July 2004.

Blakely is a member of the American Society of Clinical Oncology, the American Association for Cancer Research, the American Society of Hematology, the Connective Tissue Oncology Society, and the Herb Fred Medical Society. She graduated cum laude with a bachelor of arts in biology from David Lipscomb University in Nashville and received her medical degree in Memphis at the University of Tennessee. Dr. Blakely completed her fellowship in oncology at M.D. Anderson Cancer Center in Houston, Texas.

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