Selected Podcast
Breast Cancer Myth Busters with Dr. Ragulin Coyne
Dr. Elizaveta Ragulin Coyne discusses how to tell when lumps and breast pain are signs of cancer, as well as breast cancer surgery options.
Featured Speaker:
Learn more about Elizaveta Ragulin Coyne, MD, FACS
Elizaveta Ragulin Coyne, MD, FACS
Elizaveta Ragulin Coyne, MD, FACS is a General and Breast Surgeon and Director of Emerson’s Comprehensive Breast Health Program.Learn more about Elizaveta Ragulin Coyne, MD, FACS
Transcription:
Alyne Ellis (Host): Checking your breasts for lumps every month is an important habit to keep for both women and men. Here to tell us more as we begin a five part series on breast cancer, is Dr. Ragulin Coyne. She is the Director of the Comprehensive Breast Health Program at Emerson Hospital. This is the Healthworks Here podcast from Emerson Hospital. I’m Alyne Ellis. Thanks so much Dr. Ragulin Coyne for joining me today.
Elizaveta Ragulin Coyne, MD (Guest): It’s lovely to be here.
Host: So, let’s begin with what happens when you find a lump in your breast and you have a mild amount of breast pain. What does that mean? Does that mean that it’s necessarily cancer?
Dr. Ragulin Coyne: No. not every lump in your breast automatically means there’s cancer. Especially if there’s pain related to it. Most of the painful lumps are actually related to hormonal and fibrocystic changes. However, so if somebody has breast pain most of the time, once we do the proper workup, which includes exam as well as imaging that might include mammogram and ultrasound; a lot of times we can reassure the patient. However, occasionally, when there’s a lump with or without pain, and most of the time without pain, we definitely want to rule out cancer. And again, that’s usually done with imaging as well as an exam and sometimes a biopsy is needed. But the great thing about imaging and the screening mammograms is the things that we can see on imaging is way smaller. So, think more like a pea size lumps or abnormalities that we can really find early whereas if you only rely on exam, it really sometimes takes a while and only things quarter size or larger can really be appreciated even by experienced hands.
Host: Now I know for example, that you can have a mammogram, or you can have imaging. Is that right that you can have one or the other or both?
Dr. Ragulin Coyne: Generally the guidelines recommend starting with the screening mammogram and at this point it could be either 2-D or more new technologies, 3_D with tomo mammogram and then selectively we do ultrasound of the area or interest or concern.
Host: So, what about if you do find breast cancer. Is it primarily found in older women? Or is it found in people with a family history of breast cancer? Who is likely to get this?
Dr. Ragulin Coyne: You know we look at the Bell curve. Most of the patients – the peak of the breast cancer is usually patients in their 60s and early 70s. However, just like with any Bell curve, you have patients of all ages. I think the youngest patient I’ve seen in my practice was in her 20s and I think it’s not uncommon to see patients in their 40s who had abnormal mammogram or find a lump that triggers workup that finds most of the time early cancer that needs treatment. Although, some genetic abnormalities will cause patients to have much higher risk, lifetime risk of breast cancer. For instance BRCA I or II can give you lifetime risk 60 to 90% sometimes of breast cancer as well as associated increased risk of other cancers. Majority of the patients I see have no family history of breast cancer or ovarian cancer. I would say if we look at percentages of patients who actually have family history; it’s probably 5% of my practice that has some family history related to cancer. The rest of them are random.
Host: And I assume we have to include men in this discussion a little because men can get breast cancer.
Dr. Ragulin Coyne: Yes. It is a lot more uncommon and usually more likely to be related to genetic abnormalities but certainly, men can get breast cancer and if they do feel a lump or something feels different, they actually will still need a mammogram and an ultrasound as well as an exam and possible biopsy to get that checked out and rule out any pathology.
Host: So, once the breast cancer is discovered, what are one’s surgery options? Do most doctors just rush into getting a mastectomy as the preferred option?
Dr. Ragulin Coyne: So, what we found – thankfully not. So, what we found twenty plus years ago now is that patients can have a smaller surgery. This is done in addition with radiation. The long term survival rates and outcomes are the same as for patients who have mastectomy. So, if patient is a candidate for smaller surgery, which would be called a lumpectomy; we always try to offer it to the patient. And sometimes that means that we can switch the order of treatment. For instance, get chemotherapy first or endocrine therapy first to shrink down the tumor to make it smaller and now make it an option for the patient. But of course, every patient is different and most of the time, we are able to offer that as well as different types of lumpectomy with really good cosmetic outcomes. It is not always possible for everybody.
Host: Well let’s talk about those cosmetic outcomes for a minute because I understand that you can have a second surgery after a lumpectomy that would help to make things feel more normal for the patient and an oncoplastic surgery?
Dr. Ragulin Coyne: Yes, it’s actually not a second surgery. Most of the time, it’s done at the time of surgery. So, from the time we meet the patient, and examine them; we potentially can think about where we can make an incision so that they heal better, they are not well noted. A lot of times we can hide it in the axilla or under the breast or in peri-areola area where the scar is truly not noticeable. As well as we don’t just remove the area, now we – the oncoplastic techniques essentially mobilize surrounding tissue to fill in the created defect which means that tissue is rearranged on the inside but from the outside the patient still has normal contour of the breast and good cosmetic outcome. And sometimes even for patients with larger breasts, if we are considering surgery for cancer, sometimes we can even do a breast reduction as part of the surgery because since the tissue has to be removed, we just do it in conjunction with a plastic surgeon. So, the patient gets a good outcome and are able to feel better about themselves despite having to go through the turmoil of cancer treatment.
Host: Let’s say the patient does have to have a mastectomy; is it common for the patient to then feel disfigured or self-conscious about their looks?
Dr. Ragulin Coyne: I think it is a very personal situation for everybody. I think there are so many different options even for mastectomy from nipple sparing mastectomy which gives you really nice contour of the breast and good symmetry as well as good functional outcome. However, I think treating cancer and going through cancer as a patient being part of that journey certainly also has a huge psychological component. So, I think sometimes the cosmetic result and the surgery can be a success and the treatment can be a success but the patient is going to still have long term anxiety related to the treatment and worries about potential recurrence and I think there’s many factors that go into play but certainly we can at least aim to have good functional outcomes, good cosmetic results so that when the patient wakes up in the morning, jumps out of the shower, that’s not the first thing they think about when they catch a glimpse of themselves in the mirror.
Host: Well thank you so much. Is there anything else that you’d like to add?
Dr. Ragulin Coyne: No, I think this was a great opportunity to talk to patients about the importance of getting early screening, importance of following up on things if they find new findings and just really knowing the options and doing the research because breast cancer surgery is not the same as it used to be and I think knowing the options and asking about those options is always a great thing for the patients.
Host: Well thank you very much Dr. Ragulin Coyne for joining me today.
Dr. Ragulin Coyne: Oh it’s lovely to be here. Thank you.
Host: Dr. Ragulin Coyne is the Director of the Comprehensive Breast Health Program at Emerson Hospital and a Fellow of the American College of Surgeons practicing at Emerson Hospital. For more information on breast cancer visit www.emersonhospital.org/breasthealth. Thanks for listening to Emerson’s Healthworks Here podcast. This is the first episode in a five part series on breast cancer. Our next topic will cover general reconstructive and aesthetic plastic surgery. Make sure to catch the next episode by subscribing to the Healthworks Here podcast on Apple podcasts, Google podcasts, Spotify or wherever podcasts can be heard. I’m Alyne Ellis. Thanks for listening.
Alyne Ellis (Host): Checking your breasts for lumps every month is an important habit to keep for both women and men. Here to tell us more as we begin a five part series on breast cancer, is Dr. Ragulin Coyne. She is the Director of the Comprehensive Breast Health Program at Emerson Hospital. This is the Healthworks Here podcast from Emerson Hospital. I’m Alyne Ellis. Thanks so much Dr. Ragulin Coyne for joining me today.
Elizaveta Ragulin Coyne, MD (Guest): It’s lovely to be here.
Host: So, let’s begin with what happens when you find a lump in your breast and you have a mild amount of breast pain. What does that mean? Does that mean that it’s necessarily cancer?
Dr. Ragulin Coyne: No. not every lump in your breast automatically means there’s cancer. Especially if there’s pain related to it. Most of the painful lumps are actually related to hormonal and fibrocystic changes. However, so if somebody has breast pain most of the time, once we do the proper workup, which includes exam as well as imaging that might include mammogram and ultrasound; a lot of times we can reassure the patient. However, occasionally, when there’s a lump with or without pain, and most of the time without pain, we definitely want to rule out cancer. And again, that’s usually done with imaging as well as an exam and sometimes a biopsy is needed. But the great thing about imaging and the screening mammograms is the things that we can see on imaging is way smaller. So, think more like a pea size lumps or abnormalities that we can really find early whereas if you only rely on exam, it really sometimes takes a while and only things quarter size or larger can really be appreciated even by experienced hands.
Host: Now I know for example, that you can have a mammogram, or you can have imaging. Is that right that you can have one or the other or both?
Dr. Ragulin Coyne: Generally the guidelines recommend starting with the screening mammogram and at this point it could be either 2-D or more new technologies, 3_D with tomo mammogram and then selectively we do ultrasound of the area or interest or concern.
Host: So, what about if you do find breast cancer. Is it primarily found in older women? Or is it found in people with a family history of breast cancer? Who is likely to get this?
Dr. Ragulin Coyne: You know we look at the Bell curve. Most of the patients – the peak of the breast cancer is usually patients in their 60s and early 70s. However, just like with any Bell curve, you have patients of all ages. I think the youngest patient I’ve seen in my practice was in her 20s and I think it’s not uncommon to see patients in their 40s who had abnormal mammogram or find a lump that triggers workup that finds most of the time early cancer that needs treatment. Although, some genetic abnormalities will cause patients to have much higher risk, lifetime risk of breast cancer. For instance BRCA I or II can give you lifetime risk 60 to 90% sometimes of breast cancer as well as associated increased risk of other cancers. Majority of the patients I see have no family history of breast cancer or ovarian cancer. I would say if we look at percentages of patients who actually have family history; it’s probably 5% of my practice that has some family history related to cancer. The rest of them are random.
Host: And I assume we have to include men in this discussion a little because men can get breast cancer.
Dr. Ragulin Coyne: Yes. It is a lot more uncommon and usually more likely to be related to genetic abnormalities but certainly, men can get breast cancer and if they do feel a lump or something feels different, they actually will still need a mammogram and an ultrasound as well as an exam and possible biopsy to get that checked out and rule out any pathology.
Host: So, once the breast cancer is discovered, what are one’s surgery options? Do most doctors just rush into getting a mastectomy as the preferred option?
Dr. Ragulin Coyne: So, what we found – thankfully not. So, what we found twenty plus years ago now is that patients can have a smaller surgery. This is done in addition with radiation. The long term survival rates and outcomes are the same as for patients who have mastectomy. So, if patient is a candidate for smaller surgery, which would be called a lumpectomy; we always try to offer it to the patient. And sometimes that means that we can switch the order of treatment. For instance, get chemotherapy first or endocrine therapy first to shrink down the tumor to make it smaller and now make it an option for the patient. But of course, every patient is different and most of the time, we are able to offer that as well as different types of lumpectomy with really good cosmetic outcomes. It is not always possible for everybody.
Host: Well let’s talk about those cosmetic outcomes for a minute because I understand that you can have a second surgery after a lumpectomy that would help to make things feel more normal for the patient and an oncoplastic surgery?
Dr. Ragulin Coyne: Yes, it’s actually not a second surgery. Most of the time, it’s done at the time of surgery. So, from the time we meet the patient, and examine them; we potentially can think about where we can make an incision so that they heal better, they are not well noted. A lot of times we can hide it in the axilla or under the breast or in peri-areola area where the scar is truly not noticeable. As well as we don’t just remove the area, now we – the oncoplastic techniques essentially mobilize surrounding tissue to fill in the created defect which means that tissue is rearranged on the inside but from the outside the patient still has normal contour of the breast and good cosmetic outcome. And sometimes even for patients with larger breasts, if we are considering surgery for cancer, sometimes we can even do a breast reduction as part of the surgery because since the tissue has to be removed, we just do it in conjunction with a plastic surgeon. So, the patient gets a good outcome and are able to feel better about themselves despite having to go through the turmoil of cancer treatment.
Host: Let’s say the patient does have to have a mastectomy; is it common for the patient to then feel disfigured or self-conscious about their looks?
Dr. Ragulin Coyne: I think it is a very personal situation for everybody. I think there are so many different options even for mastectomy from nipple sparing mastectomy which gives you really nice contour of the breast and good symmetry as well as good functional outcome. However, I think treating cancer and going through cancer as a patient being part of that journey certainly also has a huge psychological component. So, I think sometimes the cosmetic result and the surgery can be a success and the treatment can be a success but the patient is going to still have long term anxiety related to the treatment and worries about potential recurrence and I think there’s many factors that go into play but certainly we can at least aim to have good functional outcomes, good cosmetic results so that when the patient wakes up in the morning, jumps out of the shower, that’s not the first thing they think about when they catch a glimpse of themselves in the mirror.
Host: Well thank you so much. Is there anything else that you’d like to add?
Dr. Ragulin Coyne: No, I think this was a great opportunity to talk to patients about the importance of getting early screening, importance of following up on things if they find new findings and just really knowing the options and doing the research because breast cancer surgery is not the same as it used to be and I think knowing the options and asking about those options is always a great thing for the patients.
Host: Well thank you very much Dr. Ragulin Coyne for joining me today.
Dr. Ragulin Coyne: Oh it’s lovely to be here. Thank you.
Host: Dr. Ragulin Coyne is the Director of the Comprehensive Breast Health Program at Emerson Hospital and a Fellow of the American College of Surgeons practicing at Emerson Hospital. For more information on breast cancer visit www.emersonhospital.org/breasthealth. Thanks for listening to Emerson’s Healthworks Here podcast. This is the first episode in a five part series on breast cancer. Our next topic will cover general reconstructive and aesthetic plastic surgery. Make sure to catch the next episode by subscribing to the Healthworks Here podcast on Apple podcasts, Google podcasts, Spotify or wherever podcasts can be heard. I’m Alyne Ellis. Thanks for listening.