Frequently Asked Questions

Did you know?

* October is breast cancer awareness month.
* 1 in 7 women will be diagnosed with breast cancer during her lifetime.
* This year, approximately 216,000 individuals will be diagnosed with breast cancer.

Questions:

Answers according to Cancerlynx.com

Since I was able to feel a lump in my breast, why didn't it show up on the mammogram?

The most likely explanation for this occurrence is that the tumor was hidden in the middle of ``glandular'' tissue. Another explanation is that the mammographer did not see it because it was very small or subtle. Another possibility is that some cancers do not form lumps which would show up as a spot on the mammogram. ``Infiltrative'' cancers are more spread out. Many, many cells are spread out over an area and are not visible on mammogram. Another explanation is that some tumors are confined to the skin of the nipple and won't show up on mammogram.

How many nodes will be sampled (removed)?

Each patient is different. An area of fatty tissue under the armpit is removed. This pad of tissue contains varying numbers of nodes in each patient- generally 5-20. It is not known how many nodes are removed until the pathologist dissects the pad of tissues in the laboratory. There are a total of three levels of axillary lymph nodes. Level one nodes refer to nodes below the pectoralis minor muscle. These are the nodes closest to the breast. In a traditional Lymph Node Dissection, level 1 and 2 are removed. Level three nodes are rarely removed in the United States.

How often should I do breast self -exam?

Once a month. Breast self-exams should be done 5-7 days after your period starts. For postmenopausal women, pick the same day of every month for your breast self-exam.

What is the difference between the recurrence rate and the survival rate?

Survival rate refers to how long the patient will live and does not take into consideration whether or not the patient has recurrences. The recurrence rate represents recurrences in the breast, as well as metastases (spread of the cancer from original site to a distant site) elsewhere in the body. There are two aspects of breast cancer; the local control and the distant metastases. A recurrence in the breast, generally does not affect survival. On the other hand, when we use the term ``recurrence'' to mean metastatic events -- we're talking about disease that's outside of the confines of the breast. This may effect survival time.

Is the recurrence rate lower if the patient has a mastectomy?

The local recurrence rate would be lower but survival time would be the same. Very rarely a recurrence will occur in the tiny amount of breast tissue that remains after a mastectomy. Many women are concerned about the possibility of recurrence and spread of the cancer if they don't have a mastectomy. In theory, it is more dangerous to keep the breast because a recurrence has the potential to spread and become metastatic, but in reality statistics show that with good follow-up, the recurrences are caught at an early stage and survival is not affected. This has been born out in research studies comparing large numbers of women who have either mastectomy or lumpectomy and radiation- the survival rates are the same. Radiation is also very effective in destroying any leftover cancer cells that may remain in the breast. It is so effective that some researchers are starting to recommend that women have radiation even if they have a mastectomy, especially if their tumor was large or aggressive. Currently, radiation after mastectomy is only used when there is a very high likelihood of residual disease in the breast, in the chest wall, or very high risk for recurrence.

When is radiation an appropriate treatment?

Radiation is usually done after the tumor is removed by lumpectomy. Radiation is done to prevent spread of tumor cells in the breast that may have been left over and to prevent local (in the breast), recurrence of cancer. Radiation is also done after a mastectomy if there is a high risk for chest wall cancer. Recent studies may indicate that there may be some benefit to routine administration of radiation to the chest wall after mastectomy.

When is chemotherapy administered?

If the tumor is relatively small, a lumpectomy or mastectomy is performed first followed by chemotherapy. In many cases, the biopsy that originally diagnosed the cancer, also served as ``lumpectomy'' to remove the cancer. If the surgical margins surrounding the tumor were adequate, that is free of cancer, then a patient can procede to chemotherapy. If the margins are too small or transected (cut through), then a re-excision may be needed before chemotherapy is administered. (Please see section on Surgery). Sometimes chemotherapy is administered before surgery in order to shrink a large tumor. This is called neo-adjuvant chemotherapy. This may make it possible for a woman to have a lumpectomy rather than a mastectomy. Some patients (usually stage III patients who's tumors are 5 cm or larger) are given the ``sandwich'' method. First chemotherapy is given, for two to three cycles followed by surgery. Then three cycles of chemotherapy and finally radiation therapy. Then an additional course of chemotherapy is given.

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