What is UM Upper Chesapeake Health's overall approach to care for patients with breast concerns?

Finding an abnormal finding on a mammogram is very frightening, but it's important to know that most abnormalities on an initial mammogram are not cancer. But when there is an abnormal finding on a mammogram, our physician will meet with you to discuss your options. Both a breast center nurse navigator and your physician will guide you through the process of diagnosis and treatment. A unified team approach drives every aspect of our care at the Breast Center; we have experts in primary care, radiology, radiation oncology, medical oncology, pathology and plastic surgery. Our goal is to work together to provide the most individualized and up-to-date treatment possible for you.

What are the factors that determine whether or not someone is at higher risk for breast cancer?

A personal history of breast abnormalities (such as atypical cells, LCIS, or cancer) or multiple biopsies is an indication that someone is at higher risk for breast cancer. Family history is another key indicator. The risk of breast cancer increases if immediate family members have been diagnosed with either breast or ovarian cancer, particularly if they were diagnosed prior to menopause. There is also higher risk if there are multiple relatives over several generations with either of those diagnoses or if any male relatives have had breast cancer. Risk also increases with age and obesity, smoking and excessive alcohol use also amplifies risk. In addition, long-term use of hormone-replacement therapy can also boost your risk of breast cancer.

But there are things women can do to lower their risk of developing breast cancer, such as exercising, eating a healthy diet, quitting smoking, and limiting alcohol use. For women at very high risk of breast cancer, they may be candidates for preventative medications such as tamoxifen, or having prophylactic surgery. In addition to prevention, screening and early detection of breast cancer are important for all women. Current recommendations are to begin regular screening mammograms and clinical breast exams at age 40. But for women who are at higher than average risk of breast cancer, we will individualize their program of breast cancer prevention and early detection, which may include obtaining screening mammograms before age 40 or using other imaging modalities such as MRI, in combination with more frequent clinical breast exams and visits with a breast specialist.

When someone receives a diagnosis of breast cancer, will she require surgery?

Yes. When detected early, breast cancer is extremely treatable and surgery is usually the first step in the treatment plan. In some instances, patients will receive chemotherapy to shrink the tumor before we operate. Surgery is used to remove the cancer from the breast and provide staging information.

What are the surgical options?

The two main surgeries used to treat breast cancer are: 1) a partial mastectomy, also called a lumpectomy, in which the tumor and a surrounding rim of normal breast tissue is removed preserving most of the breast and 2) a mastectomy, in which the entire breast, nipple and areola are removed. Whenever safe to do so, we like to conserve as much of the breast as we can; however, each individual must make the decision as to which surgery is best. Because most of the breast tissue remains after a lumpectomy, we usually recommend radiation therapy in order to kill any potentially remaining cancer cells in the breast. Studies have shown that if radiation does not follow a lumpectomy, there is an increased risk of cancer recurrence. A lumpectomy plus radiation equals a mastectomy in terms of overall survival. The other component of the surgery involves removing several lymph nodes to determine if the cancer has spread to them. This provides prognostic information and also helps guide further treatment (chemotherapy, additional radiation, etc.).

What are my options for reconstruction?

Patients are referred to an experienced plastic surgeon, who will discuss your case in detail and explain the different reconstruction techniques. The two main types of reconstruction involve using either implants, which are usually silicone, or using a patient's own tissue, usually fat and sometimes muscle from the abdomen. Both types of reconstruction have their own benefits and drawbacks, which is why it is so important to discuss the options in detail with a plastic surgeon that is knowledgeable on all the different techniques used for post-mastectomy breast reconstruction.

Why do patients often require chemotherapy after surgery?

First of all, it is important to understand that breast cancer is a systemic disease and we use strategies to treat it as such, addressing the possible issue of reoccurrence. After any necessary surgery, the medical oncologist evaluates the individual on the stage and biology of the cancer, as well as the tumor characteristics. Based on that, a decision is made about chemotherapy and how aggressive we need to be.

How does chemotherapy work?

Essentially chemotherapy treats the microscopic cancer cells that can't necessarily be picked up by the diagnostic scans. Think of the analogy of cleaning floors. Although we sweep the floors, we still like to mop them in order to get them thoroughly cleaned. We don't see all the dust when we sweep, so that is why we mop the floors–to make sure that we get out all of the dirt. So with chemotherapy, we are trying to wipe out the cancer cells that we can't see.

How will the chemotherapy be given?

The chemotherapy will be given intravenously at our Infusion Center within the Kaufman Cancer Center. Depending on the type of chemotherapy, you will be asked to come in once every two or three weeks.

What are some of the side effects of chemotherapy?

The general side effects are nausea, hair loss and fatigue. But they are all very manageable and our team will help you cope. There are also emotional side effects; fortunately we have a great support group in Cancer LifeNet. Through Cancer LifeNet, patients can access navigator and many supportive care services that are completely free of charge for Harford and Cecil County residents regardless of where they receive their treatment. Complementary therapies by certified and/or licensed therapists are also offered to promote overall health and wellness and reduce the symptoms and adverse side effects of anti-cancer treatments.

During chemotherapy, will I be able to resume my normal daily activities such as work and taking care of my children?

Everybody reacts differently, but you will more than likely be able to do 80% of what you normally do. While you can go back to work, your supervisor and your job have to be a little flexible, because there are likely to be some good days and bad days during treatment. Then you must listen to your body. When your body says it needs rest, take the rest. It's also important to eat nutritiously and not push yourself too much.

What is the role of a diagnostic radiologist?

A diagnostic radiologist is a physician that interprets radiologic studies, such as x-rays, ultrasounds, cat scans and MRIs.

What can a mammogram tell you?

A mammogram is a specific type of low dose x-ray used to examine the breasts and may aid in the early detection of breast disease in women. A screening mammogram is an X-ray of the breast used to detect breast changes in women who have no signs or symptoms of a breast abnormality or problem. It usually involves two x-rays of each breast. Using a mammogram, it is possible to detect a cancerous or pre-cancerous condition early, when treatment can be most effective. A screening mammography still remains our most effective tool in the early detection of breast cancer.

What type of breast imaging and testing do you perform at the Upper Chesapeake Health Breast Center?

We utilize mammograms, breast ultrasound and breast MRI to help diagnose breast disease. Yearly screening mammograms are recommended for all women over the age of 40. Screening mammography is performed on women who have no symptoms. This usually consists of two views (x-rays) of each breast.

Diagnostic mammograms are performed on women whose screening mammograms showed a potentially abnormal finding. The diagnostic mammogram takes specialized images of the breasts to help differentiate between normal breast tissue and a potentially suspicious finding. It may be used to evaluate changes found during a screening mammogram. A breast ultrasound uses sound waves to image the breast and see whether a breast lump is filled with fluid (cyst) or if it is a solid lump. An ultrasound does not replace the need for a mammogram; it is often used along with a mammogram to check a problem in the breast. Breast MRI (magnetic resonance imaging) is non-invasive and uses a powerful magnetic field, radio frequency pulses and a computer to produce detailed pictures of the breasts MRI of the breast offers valuable information about many breast conditions that cannot be obtained by other imaging tests, such as mammography or ultrasound.

What should I do if I find a lump in my breast?

Find out what Dr. Meghan Garstka suggests you do next.