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Bill Klaproth (Host): Hearing that you have breast cancer can be a frightening experience. One way to reduce your fear and anxiety is to learn about the condition and your treatment options. Joining me now with more on breast health and self-awareness is Dr. Jeremy Albin, a general surgeon with Columbus General Surgery. Dr. Albin, thank you so much for your time. So, when it comes to breast health and breast cancer, what conditions do you see most often?

Jeremy Albin, MD (Guest): You know we see the full range of breast conditions here in our Columbus clinic. You know anything from the very benign stuff, just what we would call breast pain or mastalgia, to lumps and bumps and masses and things that can be concerning to people. Then we also see concerning masses. You know abnormal mammograms. Things that have been picked up on screening exams, typically done by the radiologist, and then also recently diagnosed breast cancers. And then follow up as well. So, we generally take care of all of those things here in our office.

Host: So, when it comes to these conditions, can they impact both men and women?

Dr. Albin: Yeah. You know we don’t typically associate breast cancer or breast problems with men, but men are at risk of these conditions as well. You know 1% of breast cancers that are diagnosed every year actually occur in men. Other things that can happen to them as well is the painful swelling of the breast tissue called gynecomastia. Typically, that’s related to hormonal treatments or various medications, but it can be problematic. Then there are also cosmetic reasons why men may seek to get evaluated for breast diseases as well.

Host: So, you were talking about some of these signs and conditions. When it comes to breast cancer, what are some of the signs that we really need to watch out for?

Dr. Albin: So, most breast cancers are actually diagnosed on imaging studies. That would be mammograms and ultrasounds. But if you're someone who is diligent in doing your own self-breast exams and things to watch for would be changes in the contour of your breast, changes in the feel of the breast. Specifically, things that can prompt an evaluation or further examination would be discharge from the nipples. We generally, in women what we would worry about for breast cancer would be one side versus both sides. Especially if that discharge is bloody. That can be a symptom of underlying problems.

Other things to watch for can be dimpling or reddening of the skin. If your skin around your breast may start to look like what we can an orange peel or have that appearance of an orange, if it gets swollen or hard, those are all things maybe to certainly get in to visit with your physician about. They may end up being benign, but they may also be signs of underlying problems. So, all those things should prompt a visit either to your gynecologist or your primary care provider. Of course, you could always call our office and we’d be happy to talk with you about those things as well.

Host: Certainly, things to know about. You mentioned imaging. When should someone start screening for breast cancer?

Dr. Albin: So, the typical recommendations for women of average risk for breast cancer start at 40. Mammogram is typically performed every year until the age of 69 or 70. Then it is up to the patient and their doctor after that whether continued screenings are necessary. In addition to the mammogram, often times women with dense breasts will need to undergo an ultrasound as well. That just provides some additional clarity to the radiologist who’s looking for things within the breast. Some women do need to start screening earlier than others. Specifically, women who are at a high risk of breast cancer. Whether that be from personal history of breast cancer or family history of breast cancer or a family history or certain types of genetic diseases that would cause a woman to be at a higher risk for breast cancer. In addition, sometimes an MRI would be indicated, although that’s fairly rare.

Host: So, Dr. Albin, is there anything that can be done to prevent the risk of breast cancer?

Dr. Albin: The only way to prevent breast cancer would be to remove all the breast tissues. In the majority of people, that’s unreasonable. However, in a certain number of people who have a genetic predisposition for breast cancers that’s… If you recall, Angelina Jolie has the BRCA, a breast cancer gene. She did choose to have a bilateral or double mastectomy to remove all the breast tissue on her chest in order to dramatically reduce her risk of breast cancer. Even in that situation, however, there’s still a 1-2% risk of breast cancer.

Now, I want to remind you that one in eight women will get breast cancer. So, it is a incredibly common cancer. It happens to a large number of women. So, when it does happen, when you do get that diagnosis, know that you are not alone. Other things to talk about in regard to risk of breast cancer. Breast cancer is typically hormone sensitive. So, doing things and having things in your history to reduce your exposure to hormones, such as estrogen and progesterone, actually do reduce the risk of breast cancer. So, the number one thing that people can do to reduce their risk of breast cancer would be if you are overweight, would be to lose weight. We know that excess fat acts like an additional organ that produces a large amount of estrogen. So, by reducing the excess weight we carry, that lowers the risk of breast cancer.

Additional things that we may or may not have control over but that can reduce the risk of breast cancer do have to do with estrogen exposure. So typically, women who begin their cycles later in life, women who start menopause earlier in life, and then the number of pregnancies that a woman has undergone will also reduce the risk of breast cancer. Certainly, that does not eliminate the risk of breast cancer, but they can reduce the risk.

Host: Right. You mentioned one in eight women will be diagnosed with breast cancer. After someone is diagnosed, what treatments and surgical procedures do you offer?

Dr. Albin: We are fortunate in our community to have a full range of cancer services. So not only from the surgical side of things, but also oncology. Medical oncology and radiation oncology are available here in our community. In addition to that, we also have reconstructive surgery on site as well. So, in terms of what we offer to the women and men who come in with breast cancer, typically it has to do with the stage of breast cancer that they're diagnosed with. Whether it’s what we call a stage zero, which is cancer cells that have not invaded, or even a stage four, which is breast cancer that has gone to other organs. We can offer surgical treatments to help with that from removing a small amount of the breast tissue to removing the entire breast. The small surgery is what we could call a lumpectomy or partial mastectomy. The larger surgery is what we traditionally think of as the mastectomy where we try and remove all the breast tissue.

Now in addition to that, in order to get an accurate picture of how aggressive or how advanced the breast cancer is, we do also sample the lymph nodes in the underarm. Those are called axillary lymph nodes. Oftentimes we’ll do an axillary lymph node biopsy where we only take a few lymph nodes out to see if the breast cancer has moved into the lymph nodes. In addition, we also can do an axillary lymph node dissection. Meaning where we take a majority of the lymph nodes in the underarm if it appears that from our clinical exams that there’s already breast cancer in these underarms. That just helps us determine how aggressive we need to be with our other modalities or ways of treating breast cancer with chemotherapy, radiation therapy, and hormonal therapy.

Host: And Dr. Albin, my last question. If there’s one thing you would want people to remember or think about when it comes to overall breast health and self-awareness, what would that be?

Dr. Albin: I think it’s important for people to continue to do your self-exams. No doctor is going to know or understand your body as well as you do. So, if you think something is wrong or has changed, it’s very important to get in and talk to somebody about it. It does not have to be a general surgeon. It could be your gynecologist, it could be your primary physician or provider, but talk to somebody about it and get it evaluated. Certainly, any time that you are dealing with breast cancer, the earlier that you can treat it, the better the outcomes are. Breast cancer is a tremendously treatable disease with cure rates in the 90% range.

Host: Alright. Well that is really good news. Dr. Albin, thank you so much for your time. For more information on breast health or Columbus General surgery, visit columbushosp.org. That’s columbushosp.org. This is Columbus Community Hospital Healthcast from Columbus Community Hospital. I'm Bill Klaproth. Thanks for listening.