Questions For My Doctor

The American cancer society recommends the following guidelines for breast care. Mammogram: Women age forty and older should have a mammogram every year and continue to do so as long as they are in good health. Mammograms miss some cancers but it is still a good way to find breast cancer.
Clinical Breast Exam: Women in their 20s and 30s should have a clinical breast exam preferably every 3 years. After age 40, women should have a breast exam by a health expert every year. It’s a good idea to do a breast self-exam (BSE) before the clinical exam to become familiar with what your breast feel like.
Breast Awareness and Breast Self-Exam (BSE): BSE is an option for women starting in their 20s. If you do BSE on a regular basis, you will become familiar with how your own breasts feel and with this awareness, you are more likely to find a lump or suspicious area in the breast. The American Cancer Society has special programs to teach you how to examine your breast properly and cards describing the process can help you as you begin to examine yourself.

The most important thing is to see your doctor right away if you notice any of these changes: a lump or swelling, skin irritation or dimpling, nipple pain or the nipple turning inward, redness or scaliness of the nipple or breast skin, or a discharge other than breast milk. Remember that most of breast changes are not cancer but need to be checked out by your doctor.

A mammogram is an x-ray of the breast. The test is used to look for breast disease in women who appear to have no breast problems. This is called asymptomatic (without symptoms). Asymptomatic women usually have screening exams. This exam is usually limited to two x-rays of each breast. During a mammogram, the breasts are pressed between two plates to flatten and spread out the tissue. This is called compression and is necessary to see all the tissues and reduce the levels of radiation necessary to get a good picture.
A technologist (usually a woman) will position you correctly for the exam and take the pictures.

Results are usually available within 30 days. The imaging center will send you a letter in terms you can understand with the results. If there is a problem, you will hear in five working days. About one in ten women are called back for additional pictures to clear up an area not seen well in the mammogram. Most of these women do not have breast cancer so it is important to return to the center if additional pictures are needed.

Medicare, Medicaid and most private health plans cover all or part of the cost of the test. Breast cancer testing is now more available for women without health insurance for free or at very little cost through a special program called the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). There is also a program to pay for breast cancer treatment for women in need.

Usually addition films will be taken. This is called a diagnostic mammogram. If the mammogram is still not clear, the doctor may do a breast ultrasound using sound waves to see the area better. Many new techniques are becoming available for additional diagnosis before biopsy. Since most biopsies are benign (NOT CANCER), new methods are being tested to see better. Some of these are, MRI, PET scanning, and optical imaging. Optical imaging offers 3-D views of the breast and may be helpful to look for Angiogenesis, which is new formation of blood vessels in the breast that supply tumors.

A biopsy is done when other tests show you might have breast cancer. Sometimes, the only way to know for sure is through a biopsy. During the test, several cells are removed and examined by a special doctor (Pathologist) to determine if the cells contain cancer. There are different kinds of biopsies and the doctor will determine the best type for you.

Usually the types are as follows:
* FNA: (Fine Needle Aspiration) In this test fluid is drawn out to ck the cells in the fluid for cancer. Your doctor may use ultrasound to guide him.
* Stereotactic core needle biopsy: In this test the needle is larger and removes several cylinders of tissue. The area is numbed and this test is usually done on an outpatient basis.
* Surgical biopsy: Sometimes surgery is needed to remove all or part of a lump so it can be looked at under the microscope. Usually the surgeon will remove the lump and some normal tissue around it. Usually this is done in the hospital on an outpatient basis. Occasionally, light sedation is used to make the patient more comfortable and less aware of the process. After the lump is removed, the lab will determine if it is cancer and then, if so, if it is invasive or not. The most common type of cancer (DCIS) is contained in the ducts and the cure rate is very good. The sample will also be graded ER-positive or PR-positive. This has to do with how the cancer responds to hormone treatment and enables your oncologist (cancer doctor) to determine the best treatment for you if the biopsy shows cancer.

As you cope with breast cancer, it is important to have honest, open discussions with your doctor. Ask any question no matter how small it seems. The following are some questions you might want to ask. Nurses, social workers and other members of the health care team may be able to answer many of these questions or if you think of more, don’t hesitate to ask. Knowledge is power and will help you have a more positive outcome.
Additional questions you could ask might include the following:
* Would you please write down the type of cancer I have?
* May I have a copy of my pathology report?
* Has the cancer spread to lymph nodes or other organs?
* What stage is my cancer? What does that mean?
* What treatment choices do I have? What do you recommend and why?
* Am I eligible for clinical trials?
* Will I lose my hair? If so, what can I do about it?
* How long will each treatment last? What can I expect?
* Can I drive myself home after the treatment or will I need help?
* What are the chances of my cancer coming back after the treatment?
* Should I follow a special diet?
* What kind of breast reconstruction is possible in my case?
* Will the treatment cause menopause?
* Can I still have children?
* What should I do to get ready for my treatment?
* Will the treatment affect breast sensation?
* What are my chances of survival based on the type of cancer I have?

Most of the information above was taken from the American Cancer Society website www.cancer.org. Additional information is available at www.breastcancer.com, American Society of Clinical Oncology www.asco.org
* Ask NOAH about Cancer www.noah-health.org
* Association of Cancer Online Resources www.acor.org
* Breast Cancer Answers Project www.canceranswers.org
* National Breast Cancer Coalition www.natlbcc.org

Your doctor is always the best first resource. A good book is “I FLUNKED MY MAMMOGRAM” by Ernie Bodai, M.D. and Richard Zumba, copyright 2005.