From Self-Exams to Immunotherapy, Breast Cancer Patients Tell All
In Honor of Breast Cancer Awareness Month, Cedars-Sinai Physicians and Patients Outline What Every Woman Needs to Know About Preventing and Surviving Breast Cancer
As women scramble to keep up with work, family and the scores of chores they tackle, it’s easy for breast care to fall by the wayside.
So, in recognition of Breast Cancer Awareness Month, Cedars-Sinai breast surgical oncologist Nimmi Kapoor, MD, breast medical oncologist Reva Basho, MD, and breast cancer survivors Mayra Lara, 38, Nora Hostetler, 67, Cathy Angel, 65, offer advice—from mammograms to immunotherapy and breast reconstruction—to keep women in the know:
1. Get screening mammograms.
More than 240,000 U.S. women are diagnosed with breast cancer every year and more than 40,000 die from it, according to the Centers for Disease Control and Prevention. Mammography—an X-ray picture of the breast that looks for early signs of cancer—is the standard of care for screening for the disease.
To determine the age of a woman’s first mammogram, a primary care physician or gynecologist should do a personalized risk assessment for breast cancer, which includes a family health history, information about a prior breast cancer diagnosis, the age of her first period and other personal risk factors, Kapoor said. If the breast cancer risk is average, mammogram screening begins at age 40. If a woman’s risk is high, Kapoor advises she consider additional screening, such as breast ultrasound or MRI, sometimes even before age 40.
Angel’s mammogram detected her cancer, which “turned out to be very aggressive,” she said. “If you’re worried about a lump, get to your doctor quickly, and assertively request a mammogram.”
2. Perform self-exams.
Perform monthly breast self-exams to look for any changes, Basho said. “Monitor your breasts, because you know your body better than anyone and you know what’s normal. And be sure to get a professional breast exam annually.”
A week after the first day of their periods, women should use the pads of their fingers and move around the entire breast, including the nipple, in a circular pattern. Also check the armpit area for lumps. Perform the exam in the shower, in front of a mirror or lying down.
“Show your doctor how you do a self-exam, to make sure you’re doing it right,” Angel said.
It's important to know we have made strides with breast cancer treatment...It is a diagnosis with a lot of hope and a cure is possible.
3. Find out if genetic testing is recommended.
Most cancers are not inherited from parents. Certain types of cancer, however, do run in families, possibly because of genetic mutations or shared lifestyles or environmental factors, Basho said.
If there is a family history of breast cancer, determine how many and which members had it—and at what age they were diagnosed (pre- or post-menopause), Kapoor said. Also learn if any of them has had genetic testing to learn if breast cancer gene mutations are present.
“If many women in your family have had breast cancer, and at a young age—in their 30s—you should get genetic testing,” Kapoor said. Women who test positive for certain gene mutations should ask their doctors to discuss options for early cancer detection and prevention.
But genetic testing doesn’t predict all cancers, as Hostetler learned. Her sister and mother had breast cancer and her brother had prostate cancer—but Hostetler tested negative for all gene defects, or mutations. “I was very surprised to find a lump in my breast. I never thought cancer would happen to me. I’m grateful that I did self-exams.”
4. State a preference for receiving biopsy results.
Lara advises women to tell their doctor to wait until all of the results are in, including the type of cancer and staging before giving the test results. Patients should request a face-to-face meeting with the doctor, Lara said, “so you can process the information and ask all of your questions—with a friend or family member present.”
5. Line up the right cancer specialists.
Most breast cancer patients are treated by multiple specialists, usually beginning with a surgical oncologist, Basho said. Additional specialists may include medical and radiation oncologists (in some cases, all three), who will treat the cancer and provide medical care. A plastic surgeon; a dietitian; and a physical therapist may also be involved.
Women with a high-risk tumor type, such as HER2-positive or triple-negative, often see a medical oncologist before the surgery, Basho said. “You may also need chemotherapy before surgery to shrink the tumor if it’s bulky. We will also assess the response to the treatment and determine if it worked. Those who respond well before surgery usually do well with treatments going forward.”
6. Determine which, if any, breast reconstruction is preferred.
Following the removal of a breast or breasts, women have several options for breast reconstruction. They include forgoing reconstruction, undergoing reconstruction immediately after a mastectomy, getting implants or using their own body tissues to reconstruct a breast, Kapoor said. Sometimes options are combined.
“Many women go for reconstruction at the time of mastectomy,” Kapoor said. Others, such as older women who prefer not to undergo a long procedure, or women who need more aggressive treatment, wait for reconstruction. Depending on the extent of the surgery, surgeons sometimes recommend waiting in case they have to “go back in and get clear margins,” Basho said.
“I wanted anesthesia only once, so I had a breast reduction on both sides and reconstruction at the time of my partial mastectomy,” Angel said. “To hide post-surgery drains and allow you to go out, I recommend wearing large shirts that have pockets in the front, where your hands meet inside.”
7. Find out about clinical trials.
A broad range of clinical trials at Cedars-Sinai are focused on immunotherapy—treatment that uses parts of a patient’s immune system to fight diseases—for breast cancer patients, Basho said. Clinical trials are studies that help researchers find new and improved treatments for people with disease. They are available for patients with all stages of cancer who meet certain criteria. Some new clinical trials are looking into therapies that combine immunotherapy, chemotherapy and radiation, Basho said.
For a list of Cedars-Sinai clinical trials, click here.
8. Stay positive during treatment.
Cancer treatments can be notoriously difficult to handle: Nausea, fatigue and loss of appetite are some of the common side effects of chemotherapy, Kapoor said. Family support, getting out of the house and maintaining life routines all help get women through the experience.
“I told myself, ‘I have this, deal with it,’ and I did just that,” Angel said. “You have to deal with one issue at a time so you don’t get overwhelmed. I also kept and keep a positive attitude: Live in the moment and try not to worry about what’s around the corner.”
Hostetler’s advice: “Steer clear of the internet! You’ll read too much that doesn’t apply to you and get frightened. Find a support group—they are on Facebook if you prefer to stay home. And don’t worry about chemotherapy on Friday when it’s only Tuesday.”
Lara said that what got her through her treatments was following her doctor’s instructions and “ignoring all the well-meaning advice you get from everyone! ‘Try these herbs, drink this tea,’” Lara said. “I just say thanks and then eat and drink what my doctor suggests. I keep up my daily routine, picking my kids up at school, going to my daughter’s dance competitions. My routine reminds me that cancer is not my life. It’s just temporary. I keep those words on my mirror.”
To learn more about breast cancer, visit the Cedars-Sinai Breast Cancer Program.