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Breast Cancer Screening - What You Should Know

Dr. Katharine Yao October 25, 2010 10:00 AM This chat has ended. Thank you for participating.
Kristin Philbin (Moderator) - 10:01 AM:
Welcome! Today’s chat ‘Breast Cancer Screening - What You Should Know’ will begin shortly. Please start submitting your questions and Dr. Katharine Yao will begin answering them as soon as we get started. While you are waiting for the chat to begin, feel free to visit the Cancer Department to obtain more information about Breast Cancer Screening.

Moderator (Moderator) - 10:07 AM:
The doctor is momentarily delayed but will be joining us shortly. Please continue to submit your questions and they will be answered when the doctor arrives.

Dr. Katharine Yao (NorthShore) - 10:17 AM:
Good morning, I am DR Yao, Director of the Breast Surgical Program here at NorthShore and I am happy to answer your questions about screening guidelines.

Marlene Friedman (Lincolnshire, IL) - 10:17 AM:
With respect to HER2 Cancer, what's the difference between negative and positive and which is more aggressive?

Dr. Katharine Yao (NorthShore):
About 20-25% of invasive breast cancers are HER2neu positive and these cancers do tend to be more agressive, patients who are positive for HER2neu are candidates for herceptin which is given along with standard chemotherapy so most patients who have the HER2neu marker in their tumor will get a recommendation for chemotherapy.

Angela (Evanston, IL) - 10:19 AM:
What is the most accurate form of breast cancer screening?

Dr. Katharine Yao (NorthShore):
Mammography is the only screening measure that has been tested in a randomized fashion repeatedly to decrease breast cancer mortality in women aged 40-69 years old.

Lisa (Skokie, IL) - 10:20 AM:
What does a breast MRI entail?

Dr. Katharine Yao (NorthShore):
Breast MRI uses a magnet and does not involve radiation. You lie on your stomach for the exam and contrast is injected thru an IV that is placed prior to the test. It takes approximately 45mins. It is somewhat claustrophobic and loud so if you have bad claustrophobia you may not be a candidate for breast MRI.

Lisa (Skokie, IL) - 10:23 AM:
Are all screening types safe?

Dr. Katharine Yao (NorthShore):
Mammography is safe, there is a very small amount of radiation associated with the amount of radiation you get from a mammogram is equivalent to a airline flight to Denver, we use MRI to screen some high risk patients and this is safe as well, it does involve placing an IV and it can be claustrophobic but otherwise very safe.

Angela (Evanston, IL) - 10:25 AM:
What type of breast screening is the least painful?

Dr. Katharine Yao (NorthShore):
All screening modalities involve some level of discomfort but none are that great. Mammogram, which is the accepted and tried and true screening modality involves compression of the breasts but it is quick. MRI , which we use to screen some high risk women can be uncomfortable because you have to lie on your stomach and it does involve an IV injection of contrast.

Stephanie (Evanston, IL) - 10:28 AM:
Is it possible to avoid surgery in treating breast cancer?

Dr. Katharine Yao (NorthShore):
We sometimes avoid surgery in elderly patients with multiple medical problems who we know will not tolerate surgery very well otherwise most studies show that even if you treat a cancer with a hormonal agent it will likely grow back with time so we mostly operating for most breast cancers.

Angela (Evanston, IL) - 10:29 AM:
If breast cancer runs in my family how early and often should I be screened?

Dr. Katharine Yao (NorthShore):
You should have a yrly breast exam and a yearly mammogram 10 yrs younger then the affected relative

Angela (Evanston, IL) - 10:30 AM:
How can I join a breast cancer support group?

Dr. Katharine Yao (NorthShore):
You can go to the American Cancer Society website, they usually have lots of good support groups, the Breast Cancer Network of Strength also has access to support groups in the area.

Angela (Evanston, IL) - 10:31 AM:
How can I find out about clinical trials of breast cancer?

Dr. Katharine Yao (NorthShore):
Go to the National Cancer Institute (NCI) website,they have all the clinical trials listed for each institution.

Stephanie (Evanston, IL) - 10:32 AM:
What is the last age you can be diagnosed with breast cancer at? Is there a point when women should stop getting screened?

Dr. Katharine Yao (NorthShore):
You could be diagnosed with breast cancer at any age,even if you are over 100 years old, the mammography trials often did not include women >70years old so there is insufficient data in this age group to know if mammography leads to saved lives or not, I would say that if you are healthy and in your 70's then I would go ahead and get a MGM-you always have to consider what are you going to do about an abnormal finding if there is one? If you are not healthy then I would either not get one but get regular annual breast exams or get a mammogram every two years. For my elderly patients in their 80's I am not getting regular mammograms, I just examine them once a year. At that point finding a potential breast cancer at and early stage will likely not significantly change their survival since they are 80 and likely have other competing causes for death.

Stephanie (Evanston, IL) - 10:36 AM:
What is a lumpectomy?

Dr. Katharine Yao (NorthShore):
A lumpectomy is removal of a tumor with a rim of normal tissue, the specimen has to be oriented in the operating room, people use the term lumpectomy loosely, it really technically refers to removal of cancers but many people use the term when referring to removal of benign lesions as well.

Angela (Evanston, IL) - 10:38 AM:
Does a lack of Vitamin D cause breast cancer?

Dr. Katharine Yao (NorthShore):
There is no data to show that vit D deficiency causes breast cancer.

Gretchen (Moderator) - 10:41 AM:
Does North shore follow the guidelines that were put out last year for mammograms?

Dr. Katharine Yao (NorthShore):
The guidelines put out last year came from the US preventive task force and NorthShore does not follow those guidelines. NorthShore advises patients and physicians to get an annual MGM starting at 40 years old and annual breast exam and to continue this practice until the physician and patient agree there is no benefit at which time the mammogram could be omitted.

Stephanie (Evanston, IL) - 10:44 AM:
If I don't have a family history of breast cancer, when should I start?

Dr. Katharine Yao (NorthShore):
You should get an annual mammogram and annual breast exam starting at 40 years old.

Lisa (Skokie, IL) - 10:45 AM:
I heard you can get tested for a breast cancer gene? Is this true, and if so should I get tested for it?

Dr. Katharine Yao (NorthShore):
There are two genes you are referring to - BRCA1 and BRCA2. If you do not have breast cancer you should only get tested if there is a suspicious family history of breast or ovarian cancer; this would mean multiple family members on mom or dad's side with breast or ovarian cancer especially if they are young (under 50 yeard old). First degree relatives with breast cancer, relatives on mom or dad's side with breast cancer at a young age (under 50 years old), any men in the family with breast cancer; remember that these genes can be passed down thru mom or dad's side.

Moderator (Moderator) - 10:46 AM:
Thank you everyone for your great participation, the chat will be ending in approximately 5 minutes. Please submit any final questions you have.

Becca (Moderator) - 10:49 AM:
Do mammograms require a referral for patients under a certain age? If I don't have a family history, but I just want to be sure? Is 40 still the best age to start?

Dr. Katharine Yao (NorthShore):
Mammograms do require a referral at most centers because if there is an abnormal finding the radiologist needs to know who to follow up with. To insure that the patient gets any additional testing needed, Mammograms should be started at age 40 (unless there is family history at which point it shoud start at 10 years of age younger then the affected relative) and starting earlier in the 30's markedly increases the chances of a false positive and unneccessary biopsy because the breasts are very dense when you are younger so I would not do a mammogram in your thirties.

Lisa (Skokie, IL) - 10:54 AM:
Is it safe to take Hormone Replacement Therapy for Menopausal Symptoms? Can this lead to breast cancer?

Dr. Katharine Yao (NorthShore):
There was a Women's Health Initiative randomized trial published in 2002 that showed that hormone replacement therapy significantly increased a women's risk of breast cancer. The risk was dependent on how long a women was on the HRT so if you need to take it, take it for a short time period (definately less then five yrs). It is all about weighing the risks with your quality of life.

Dr. Katharine Yao (NorthShore) - 10:58 AM:
I think we are out of time and I appreciate all the interest in this topic and thanks for the questions, it always helps to know what people are interested in and questioning about breast cancer treatment so that we can try and improve things on our end! Thanks

Moderator (Moderator) - 10:59 AM:
Thank you again for participating in our chat today. For more information please visit our Breast Cancer Screening & Diagnosis Center pages.

Also, a transcript of this chat will be available shortly.
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