(upbeat music) - [Man] The region's premier medical information program, Call the Doctor.

- A diagnosis of breast cancer can be frightening.

There are many different types of breast cancer and how it's treated can depend on what type it is and whether it's spread to other parts of the body.

Breast cancer can be a devastating illness, but many women these days are learning to live with breast cancer, managing it, they say, like any other chronic disease.

We'll talk with some of the area's best experts on breast cancer, finding it, treating it, living with it now on Call the Doctor.

- Hello, and thank you so much for joining us for this episode of Call the Doctor.

I'm Julie Sidoni.

I'm the News Director here at WVIA and I'll be the moderator for the series this season.

It'd be hard to find somebody whose life has not been in some way affected by breast cancer.

Whether it be you, your spouse, a loved one or friend, or even a neighbor, according to federal statistics, just about 13% of women will be diagnosed with breast cancer at some point in her lifetime.

So we know there are a lot of questions about that, and we have assembled a panel to discuss it.

And I can't wait to introduce that panel to you now.

I'd love for you all, thank you for being here, first of all, and I'd love for each of you to take a minute or two and just tell us who you are and where people can find you.

I'll start with you, Dr. Haggerty.

- Sure.

So my name is Dr. Meghan Haggerty.

I'm a Radiation Oncologist in Dunmore.

I work at NROC, Northeast Regional Oncology Center.

We take care of all types of cancer at NROC, and I really enjoy taking care of women with breast cancer.

It's a very scary diagnosis for women, and I love being able to meet them, to teach them about their diagnosis and help them walk through it and come out on the other side.

- All right.

Thanks for being here, Dr. Burdge.

- Yes, ma'am.

My name is Dr. Eric Burdge.

I am part of the Commonwealth Physician Network.

I work with the Wilkes-Barre General Hospital and I'm a Surgical Breast Oncologist.

I take care of benign and malignant diseases of the breast, and I've been enjoying practicing in your area.

- And Dr. Oxenberg.

- My name is Jacqueline Oxenberg.

Thank you for having me here.

I work at Geisinger Wyoming Valley.

I'm a Surgical Oncologist.

A great deal of my practice is with benign as well as malignant breast diseases as well as high risk patients, and thanks for having me.

- Yeah.

Thanks for being here.

We'll go sort of chronologically, I guess, and start with the very beginning.

We'll talk about mammograms and screenings, self exams, that kind of thing.

What can women who are what this do right now even if there is no cancer in their family, even if they're doing everything they're supposed to do, when it comes to screenings and mammograms, talk about that early stage.

What should women be really thinking about?

Anybody can take this one.

- So I can take this one.

So, you know, with or without a family history of breast cancer, every woman should know their own breasts.

They should understand their family history and understand their risk factors.

It's now recommended to try to figure out what your lifetime cancer risk is by age 25.

And that's been recognized by multiple societies because that does affect how we screen people moving on, obviously screening, preventative measures.

These are all things that can help us detect breast cancer early, give patients the best chance of cure and even prevent it.

- What are the current recommendations where mammograms are concerned, Dr. Burdge?

- So the current recommendation is first mammogram at age 40.

If you have a family member's post for arguments sake, your mother was diagnosed with breast cancer at age 40.

Then the protocol is to start screening the children 10 years prior, so the female would be screened.

The daughter would be screened at age 30, and then if someone is less than age 40 and they have issues, then I usually get a baseline mammogram and then I follow them annually with an ultrasound of the breast.

Sonography is the best modality for young dense breast.

Whereas the mammogram is the gold standard for patients that are age 40 and above.

- I'll stick with you just because we were talking a little bit earlier about self exams, and I know the recommendations there have changed a little bit, is that right?

- They have, there was a paper that came up from the American College of Surgeons that kind of poo pooed the idea of patients doing a self breast exam or even of the clinical breast exam and I feel that that's a disservice.

I think that a patient is the patient's own best advocate and many times the patient that brings a mass to my attention because they found it on their breast exam.

They call the office, we set up appropriate imaging, and then we evaluate the patient and if it hadn't been for that patient doing her self breast examination, we may not have found that mass until I actually did the exam perhaps a year later.

- And once you can feel a lump or a tumor, is it safe to say that's a fairly advanced tumor or not in all cases?

- So not in all cases.

So for example, the majority of breast masses that patients feel are most likely fibrocystic breast changes.

So it could just be a cyst, but the key is for them to understand their breast and know when something changes.

And when I tell the patient if a mass is there for more than 30 days, it's something they need to alert their doctor.

If it's a cyst, it may get larger, get smaller during that 30 day window, because the cyst fluctuate with a female menstrual cycle with the pulses and surges of the hormones.

But if it is cancer, which is back to what you were asking then, and it is found as a mass, it usually is advanced.

- And also depend is on the breast size, the breast density and where it's located in the breast, you know, which is why patients really should have screening imaging because sometimes they may not feel it when it's deeper within the breast.

- And you said the very beginning, know your breasts, know what they look like, what they feel like, you know, what they typically might be.

I mean, are there, I guess I was gonna pull you in on this one, Dr. Haggerty, are there ways other than a self exam or a mammogram to know whether something is wrong?

- Sure.

Well, I think that, you know, the average patient, it makes up the majority of women in the United States of America, you know, should start their screening at the age of 40, but there are exceptions to that and I think it's very important for a woman to know what their family history is.

And that may very significantly change how that it needs to be screened.

So many people are aware of genetic syndromes that can run in families and in patients who have very strong family histories of breast cancer, those patients may be at very high risk of breast cancer and we may need to start screen them very early.

Those patients can meet with genetic counselors and possibly undergo genetic testing to see if they might harbor a abnormal gene that may place them at high risk.

So those patients we really need to be careful with and screen them appropriately and help them to reduce their risk of developing, you know, an advanced breast cancer.

But I think also, you know, just in terms of, you know, knowing what your risk is, I think just, you know, performing yourself, breast exams, knowing what is normal for you or how your breast might change throughout a month, you know, for a younger woman and, you know, examining your breast, looking at your breast, seeing if, you know, there are any changes and bringing that to your doctor's attention.

- Someone mentioned earlier, of course, family history is a very big predictor, but it's not necessarily the only thing and as a matter of fact, so many cancers that are diagnosed, breast cancer is diagnosed.

The woman had is no family history, I mean, I don't wanna put anybody on the spot with numbers, but about how often does that happen?

- I don't know the exact, you know, I mean, there are sporadic mutations that can also occur too, but I don't know the exact number, bur I think the bottom line is that the genetic mutation risks are not extremely high if you look at all patients with breast cancer, but what is important is that patients do have other risk factors besides just family history as well which is why it's important, you know, patients that have a long history of birth control, that have like increased hormone exposure because they didn't have their until later in life, you know, there's some preventative factors and there's some factors that can overall, you know, increase patient's risks.

So it's not just family history.

And I also wanna what Dr. Haggerty said is that, you know, when patients do recognize that they are increased risk, whether it's a genetic mutation or without a genetic mutation, there are actually medications that we can give to actually reduce the risk of breast cancer that can work depending on what the purpose is.

Sometimes 50 to 70% reduced risk for developing breast cancer.

So it's really important to know your risk.

- So you brought up medication and I kind of wanted to use this to segue into the different ways breast cancer might be treated.

Does it have a lot to do with what type it is, how far it gone?

I mean, there's surgery and radiation and drug therapy as you brought up, but how do you go about determining which patient gets which treatment, Dr. Haggerty?

- So there are so many different types of breast cancer.

You know, we kind of think of it like one disease, but there are multiple diseases, you know, within the category of breast cancer.

And so when a woman is diagnosed, the first, you know, kind of step is identifying what is the type of breast cancer?

Is it a breast cancer fed by estrogen?

Is it a breast cancer that's spread to lymph nodes?

Is it a breast cancer that has, you know, spread even further?

And that goes along with what the stage of the cancer is.

And so all these different factors really play into how the patient is going to be treated.

I think what's really nice for women with early disease typically caught early with mammograms is that these patients with early stage disease, they're the ones that have the highest risk of cure.

And they're also women that are going to have options when it comes to treatment.

They're gonna have surgical options, you know, that the surgeons can talk about, you know, when disease is more advanced, you know, patients may have to have more, you know, more extensive surgeries and more extensive treatments and worse outcomes.

So, yes, treatment is very much tailored to the extent of the disease present at, you know, when they present.

- I'll let you sort of take that one as well, Dr. Burdge as a surgical oncologist.

- So what we look for predominantly, and the way I explain to my patients is we try and figure out the fingerprint of the tumor and the fingerprint is basically the receptor status.

Is it an estrogen receptor positive tumor?

Is it a progesterone receptor positive tumor?

Is it (indistinct) positive tumor.

Tumors that are estrogen and progesterone receptor positive are favorable tumors because we have a lot of drugs in the arsenal to attack the tumor with.

The bad players, traditionally a triple negative tumor because we don't have very much dress that tumor, so we pretty much throw everything at that tumor.

And so when a patient is identified with a estrogen positive tumor, and let's say they've gone through all their therapy, and they've decided to keep both breasts, we like to put them on an aromatase inhibitor.

If they're postmenopausal to try and protect the remaining breast tissue for about five to nine years, if they're a triple negative patient or a patient with estrogen negative or progesterone negative tumor, then we don't use endocrine therapy for those patients.

- You talked about genetic testing a little bit earlier.

We brought up, you know, the BRCA gene, but there's probably a lot more genes than just that one.

That one gained a lot of notoriety, of course, because of Angelina Jolie.

I'm not even sure what year that was maybe 10 or so years ago, you thought, so people might be familiar with that one, but what other kind of tests are there when it comes to genetic testing, or I guess the right is what other genes are out there that people need to be worried about and not just that one.

- One of the common ones that we're seeing a lot now are what's called a check two mutation, there's a different variety of them.

Not all of them pose breast cancer risk as high as some of the others, but sometimes that can be about a 20 to a 40% chance of developing a breast cancer.

There's a PELP2 mutation, which, you know, Dr. Burdge spoke about receptors and the ability to treat.

And PELP2 is also similar to the BRCA1 mutation commonly presents with cancers that are not responsive to estrogen and progesterone.

There are a number of others.

I'm sure I can go down a whole list, but there's a lot of different ones that typically if we're trying to figure out what to do with a patient in regards to what type of surgery, and if there would be any prophylactic role in it, there's at least a 10 gene panel that we're sending to get a quick answer to figure out if a patient should have any prophylactic component of surgery too.

So there's a number of 'em besides BRCA1 and 2.

- Are more women opting for that?

- A lot of women are opting for it.

We're also learning that there's a lot of mutation, you know, as the number of mutations grow and we recognize more of them, the criteria for testing has also widened, you know, for pancreatic cancer, everybody with pancreatic cancer is recommended to get genetic testing.

In the breast cancer world, actually even testing for BRCA1 and 2 actually may help guide therapy as well for advanced disease.

So there's a whole bunch of reasons to have patients undergo genetic testing, whether it's pre-screening or treatment.

- And oftentimes, they'll identify a variant of unknown significance, which means we don't know exactly what place this mutation has in terms of driving breast cancer or other cancers.

And the beauty of the system now is that they'll maintain a database, the company that runs the test, and as they acquire more data on that particular mutation or variant of unknown significance, they can then redirect the treatment of the patient so that the database continues to grow.

You brought up that the BRCA was out maybe 10 years ago, and a patient may have popped negative at that time, but perhaps should be tested nowadays with the more current testing regimen just to see if they have these variants of unknown significance or the variants that may drive pancreatic cancer or colon cancer.

- I'm gonna take a little veer off here for a second, because I'm interested now in maybe the psychology of all of this.

You talked earlier about, you know, a woman will come to your office and now we're talking about breast cancer.

This is a scary thing.

This is completely frightening, of course, but it sounds as though there are a lot of different ways to treat, and as you mentioned, there's a lot of great outcomes these days.

What's behind the great outcome?

Is it that we're screening earlier?

- Yeah.

So I think that, you know, we're talking about genetic abnormalities that might predispose and, you know, maybe birth control pills or, you know, breastfeeding might increase or decrease.

But when it really comes down to it, being a woman and getting older, puts us at risk of getting breast cancer, you know, so I think we're screening, we're doing a good job screening.

We're finding earlier breast cancers and we're curing a lot of women.

And there are millions of women in this country who are alive and well who have successfully been treated and who are living healthy, normal lives.

You know, and patients need to be reminded of that when they get diagnosed with an early stage breast cancer that, you know, they're going to get through this.

And unfortunately we know that some don't and some succumb to their disease, but, you know, so many of these patients are going to do well.

And even in the patients who do have more advanced disease or who do develop metastatic disease, meaning the cancer has spread to somewhere else in their body.

You know, our treatments have really been advancing and even those patients typically are living longer and they're living better.

You know, we're trying to minimize the toxicity of treatments and try to, you know, maximize not only the quantity of life, but the quality of life.

So, you know, sometimes we need to be our patients cheerleaders, you know, we know it's scary and we need to just help them get through a really, really difficult time in their life and make them believe they're going to get through the treatment and they're going to be survivors.

- Like Dr. Haggerty pointed out, the technology has really developed within the past, say one to three years, we're now using tomosynthesis, which is three dimensional imaging of the breast instead of the classic standard, two dimensional mamography.

And so we can find cancers earlier and avoid lengthy and perhaps deleterious treatments just to cure the cancer.

So I think that the way women empower themselves is to being on top of their surveillance, getting their annual surveillance studies done, and then follow up with their clinician to make sure there's nothing that needs to be pursued in terms of a biopsy or any other situation.

- Go ahead.

- Breast cancer, you know, in terms of treatment, I mean, it's common.

I mean, you even said in the beginning, it's about, you know, lifetime risk is 13%.

One in eight women get it.

But the benefit is that we have so much data that as Dr. Haggerty said that, you know, everybody knows somebody with breast cancer for the most part, but a lot of them have had maybe bad experiences because it's been 15, 20 years ago.

We're now working more towards quality of life because we know that the survival is very good for a majority of the patients.

So it it's really more about the quality of life aspects of it that maybe 15, 20 years people, you know, had suffered from problems from, you know, some of the treatments that we offer, the surgical treatments or, you know, even radiation and chemotherapy.

So we have so much data now and we have progressed so much in the past few years, you know, that really, it's not a death sentence.

And I think patients sometimes think it is, but the cure rate is high.

You know, so I think that's some of the fear.

- We've talked about family history a little bit, and, you know, if you have a family history of breast cancer, that's the obvious one, but what other family histories should you be considering when it comes to screening or whether you are at high risk?

- I mean, family history of breast cancer is definitely one of them, family history of ovarian cancer, pancreatic cancer, some of those linked towards the BRCA mutations.

You know, I mean, personal factors are probably the next best thing and breast density.

When we put patients through risk models and we try to determine what their breast cancer risk is, a BMI of overweight will put somebody from a normal risk to a high risk.

So, you know, breast density sometimes alone will change our risk models from a normal risk to a high risk.

Some of these factors are controllable.

You know, diet and exercise are always important.

Not more than I think the rules one alcoholic at night, I think is the rule for the risk for breast cancer.

But some of these factors, you can't control.

And that is the family history part of it.

- We've been talking about women and breast cancer clearly, but I know that men also do get breast cancer, I assume you've treated men, who've had breast cancer.

I mean, might be worth talking about that a little bit, just to kind of cut through that stigma.

What cases have you seen?

I'm sure it's not very common, but how common is it?

Is it more common than we think?

- So it's not very common, but we've seen it.

We've all seen it.

You know, men don't necessarily have a worse outcome than women, they're treated very similarly, but men, you know, who have a lump in their chest may not think it's breast cancer as quickly as a woman who has a lump in her breast and so men sometimes can present, I'm sorry, with more advanced disease, male breast cancer makes up only about 1% of all the breast cancer.

We don't see it very often, when we do see it, we definitely need to be thinking is this associated with some type of, you know, genetic syndrome, genetic deficiency or abnormality that the patient has inherited from their mother or their father.

So, you know, men should be very, very in tune to a BRCA gene mutation in their family because, you know, they're at a significant risk of developing breast cancer if they have a genetic mutation.

And if a man has breast cancer, they should be tested for the genetic abnormality.

- It's usually a BRCA2 that drives male breast cancers.

So if there's a, for example, family member or father or an uncle that had breast cancer, the important question I ask is, well, were they BRCA tested?

If not, then I would test the patient because invariably they may carry the BRCA2 mutation, which not only drives breast cancer males, but may also drive prostate cancer.

So a clue that you have prostate cancer may suggest that you may have some mutation that may also drive breast cancer, perhaps not in you, but in your offspring.

- Is it easier to find in men?

Does the tumor happen somewhere in the middle?

Is it the same?

I mean, is it possible say the lymph nodes or, I mean, where would a man typically find?

You said a chest tumor, but is there a certain spot where that happens to grow or not one in particular?

- Well, I wouldn't say that for males there's one spot in particular.

We know that, for example, that the majority of breast cancers occur in the upper out quadrant of the breast.

So in the area leading up and out towards the (indistinct) most males present with breast cancer at advanced stage.

So they had a mass, they ignored it.

And literally the whole breast is one big mass of cancer.

So for males, it's just really important to not only do your testicular exam, but also check your breasts and many ignore the breast and just worry about the testicular exam.

- Right.

Well, so what would be a message, Dr. Oxenberg, that you would like people to take from this panel?

If they're sitting here watching, what's something that you want people to understand?

- You know, I think as we all talk about, you know, the risk for breast cancer, the biggest message I think I would have is know your risk and make sure you get screened appropriately based on your own personal risk.

I think that is probably the strongest message because one, it empowers women to know what they should do to prevent breast cancer, but also pick it up early.

Breast cancer is curable in many, many cases, you know.

So know what your risk factors are, if you're are not sure, ask your doctor, get referred to a high risk clinic.

You know, if you have a strong family history and start getting your mammograms and additional imaging if it's recommended.

- And the self exams, as you said, Dr. Burdge, as well.

- Exactly, and staying on top of their annual imaging, don't let it lapse.

Don't let it go two, three years.

Oh, I forgot or I was busy doing something else, do it religiously.

I think that's really the key.

I mean, when we had this COVID going on, the CDC shut down a lot of the elective screening.

And so now there's an upsurge in findings that we perhaps could have found a year or two years ago.

- Right.

Well, thank you to all of you.

If I get any questions, I'll be sure to send them your way.

We really appreciate your time and your expertise tonight.

And that's gonna do it for this episode of Call the Doctor.

We are very glad you joined us.

If you missed a portion of the show, head to wvia.org for more information on how and when to catch it.

And, of course, the other Call the Doctor episodes of the season.

Thanks for watching and for all of us here at WVIA, we'll see you next time.

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