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Breast Cancer Archive Questions

Below are Dr. Tkaczuk’s answers to Breast Cancer questions
received through the Ask the Expert feature.

This content is provided for informational purposes only, and is not intended
to be a substitute for individual medical advice in diagnosing or treating a
health problem. Please consult with your physician about your specific health
care concerns.

Questions about this topic have been organized into several categories.
Click on a category name below or select "View All" to read all the Q&As in this archive.

. Diagnostics
. Family history
. General information
. Symptoms
. Treatments
. View all Questions
. All Questions

Now displaying records 1 to 15 of 101.

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Q : 1

What does an intense, continuous pain in both breasts mean? There is no swelling, redness or skin changes.

This could be due to hormonal changes in your body, especially if you take birth control pills, or hormone replacement therapy. I suggest visiting to your GYN or primary care doctor to be evaluated.

Q : 2

Have any studies been done comparing the result of a lumpectomy with radiation versus a partial mastectomy without radiation? My original tumor is a 1 cm lesion and is ductal.

Yes, of course. NSABP06 Sweden, Ontario and Milan studies showed a local recurrence rate of 10-34 percent without radiation therapy versus 0.3-8 percent with radiation therapy. In the NSABP B-06 trial, the resection margins were likely small and the local failure rate was 21 percent (15/72) among patients with tumors less than 1 cm in size. For most randomized studies, numbers of patients are small for tumor sizes less than 1cm.

Q : 3

I am taking Arimidex for breast cancer, after having a lumpectomy. The drug causes bad joint pain which subsides when I take curcumin, but I've read conflicting information on the combination. My surgeon wasn't concerned, but my radiation oncologist is wary of any health product that is a phytoestrogen. She says turmeric may cancel out the effect of the Arimidex. What's your opinion?

The polyphenol curcumin is the active ingredient in the herbal remedy and dietary spice turmeric. The spice curcumin, derived from the rhizome of the plant curcuma longa, has a long history of use in traditional medicines of China and India, where it is used to treat inflammatory diseases, abdominal disorders, and a variety of other ailments. I found one abstract on the combination of curcumin and letrozole below which showed that the 2 were synergistic. I also found a couple of abstracts where synergy was seen between curcumin and chemotherapy agents (Paclitaxel and Gemcitabine), so curcumin cannot be considered completely inert. However, I could not find any firm data that is detrimental and that it interferes with anastrozole.

Q : 4

Can I get reconstruction if I have bone metastases?

Breast reconstruction in the setting of metastatic breast cancer to the bone and other places can delay certain treatments for breast cancer such as chemotherapy. If you are not on chemotherapy, than the decision about reconstruction would really depend on how you are doing otherwise and how well your cancer is controlled on current therapies. This should be something you discuss with your medical oncologist.

Q : 5

What is the difference between the FISH test and the Oncotype DX test to customize breast cancer treatment? Which is more accurate to determine whether one would benefit from chemo or not?

FISH-testing is typically performed to assess the HER2 expression in the breast tumor. The Oncotype DX test is a multi-gene test, not approved for patients with HER2 overexpressed tumors and is done by RTPCR. This test can be considered for patients with Estrogen-positive tumors without axillary lymph node involvement.

Q : 6

How many patients have you treated under the age of 40 with stage 3 inflammatory breast cancer? What's the survival rate?

Inflamamtory breast cancer is an uncommon presentation of breast cancer with a relatively poor prognosis. However, the treatment which usually includes chemotherapy first, followed by surgery and radiation therapy, can still cure many patients. In terms of survival rates, they still depend on some other prognostic factors such as presence or absence of estrogen and progesterone receptors and HER2/neu overexpression and response to chemotherapy. Patients who have complete response and no residual cancer in the breast after systemic therapy (chemotherapy+/- herceptin) have the best prognosis.

Q : 7

After having breast cancer, can the risk of recurrence ever decrease to the point where the risk is equal with that of a person who has never had breast cancer?

I think it is safe to say that someone with history of breast cancer, will always be at higher risk of developing another primary breast cancer and therefore screening for second primary breast cancers is indicated and recommended.

Q : 8

How do you determine the stage of breast cancer after finding a lump in the breast?

The stage of breast cancer is based on tumor size, lymph node involvement and presence or absence of distant metastases. Most of the time we use the final pathology results from breast surgery (lumpectomy or mastectomy) to assess the stage, so most patients will have surgery first to assess the final pathological staging.

Q : 9

Are stem cells used for treating breast cancer, or for treatment after mastectomy?

Not at this point, but breast cancer researchers are very interested in breast cancer stem cells and their role in breast cancer relapse/recurrence. We believe that these cells may partially or fully be responsible for recurrence of cancer.

Q : 10

My mother was diagnosed with breast cancer two years ago and had to have her right breast removed. She had hemotherapy and radiation and then her oncologist found that it had moved to her lungs. She was treated with intercept medicine and she has been doing well for the past two years. Currently, she is regularly suffering from joint pain. Is this a common symptom?

Joint pain can be related to arthritis or even some medications commonly used for treatment of estrogen positive breast cancer, such as Aromatase inhibitors (FEMARA, ARIMIDEX or AROMASIN). You should check with your mother's oncologist and discuss this further with them in order to identify the best solution.

Q : 11

Is there always a spontaneous nipple discharge with intraductal papilloma? I have a discharge (bloody) after squezzing the nipple. Mammogram, ultrasound and ductogram were negative.

Not always. Other causes have to be considered for bloody nipple discharge such as malignancy. You need to see a breast surgeon for further evaluation of this problem.

Q : 12

What are the chances that a 3 cm nodule found on a mammogram is cancerous? I am 43 years old and I don't believe I have any of the risk factors.

If the nodule is suspicious on the mammogram, the chances are pretty high even in the absence of family history. If a biopsy was recommended, you should have it.

Q : 13

My sister is 57 years old and was diagnosed with Stage 4 bilateral inflammatory breast cancer (triple negative) with bone mets. After chemotherapy (FAC, Taxol and Carboplatin), she was declared cancer free after an ultrasound, CAT scan and PET scan last week. How likely is recurrence? Is a mastectomy and/or radiation done for patients like her?

Stage 4, bone biopsy positive breast cancer cannot be cured, but certainly your sister had an excellent response to chemotherapy. This indicates a better prognosis. Neither mastectomy nor chest wall radiation is curative, but patients who have responded well to systemic chemotherapy can be considered for these treatment options.

Q : 14

Recently, I have been experiencing mild pain on the edge of my left breast. I had an ultrasound three days ago and it showed that there were three different sized fibroadenomas. Is the pain in my left breast normal? The doctor told me I had hyperplasia of the mammary gland.

Fibroadenoma can be associated with breast pain. I suggest that you are evaluated by a breast surgeon to further discuss your options, but typically no surgical intervention is necessary. In some cases having persistent breast pain may be an indication for surgical excision.

Q : 15

My mom is 85 and we recently learned that she has a tumor in her left breast. She says she has had it for almost 4 years, but that it has never had any noticeable symptoms. The ultrasounds showed a couple of lymph nodes under the left arm are affected. Her doctor says the treatment options are a lumpectomy or mastectomy with radiation. She says she doesn't want an invasive procedure on her breast, not even a biopsy. The doctor is fairly certain that by the look of the tumor that it is cancerous. Is there anything else we can do?

I think that the cancer has to be managed and it is going to be hard to not to do anything. Sometimes surgery can be avoided and radiation therapy alone can be offered, although this approach would not be considered the "standard of care." In addition, if the cancer is Estrogen positive your mom can be considered for therapy with antiestrogens such as Anastrozole.

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