Published on October 28, 2021

Early Detection: The Best Protection Against Breast Cancer

Breast cancer prevention and resources

Breast cancer is the second-leading cause of cancer death in women, according to the American Cancer Society. It is also the most common cancer among American women, excluding skin cancer. In fact, 1 in 8 women will develop this disease. But, the best protection is early detection.

Suzie Lawry-Hall, podcast host: Hello, everyone, I’m Suzie Lawry-Hall, and today we welcome back breast surgeon Dr. Soumya Pai from Enloe Comprehensive Breast Care. We are here to talk about breast cancer prevention, treatment options and more to help patients be breast aware this Breast Cancer Awareness Month. Let’s get started.

SLH: So thank you Dr. Pai for being here. Can you just start from the beginning, tell us what is breast cancer exactly?

Soumya Pai, M.D., Enloe Comprehensive Breast Care: So, cancer is when there is an uncontrolled overgrowth of cells. If it happens inside the breast it is called breast cancer, and this can affect different parts of the breast.

SLH: Who is most at risk?

SP: Thank you for asking that question because everyone, all women are at risk of breast cancer. There is a lifetime risk of about 13 percent. That means there is about an 1 in 8 to 1 in 12 chance that a woman can get breast cancer during her lifetime. And it’s not just women: men are at risk too, but at a much lower rate.

SLH: What are some of the signs of breast cancer that we could look out for?

SP: Breast cancer can present in different ways in different people. The most common way that people feel is a painless lump or a mass in their breast. Some of the other ways that they can feel it is if they see any skin changes where the skin changes its texture - there is some dimpling in the skin. There might be some texture changes on the nipple or the pink part which is called the areola. It might have some nipple discharge, usually a bloody or clear discharge. And sometimes people feel a swelling in their armpit where there is basically an enlargement of the lymph nodes in their armpit. These are the common ways that a person can feel a breast cancer for themselves. Obviously, we would prefer that it was detected much earlier. So, having a screening mammogram, which is a special x-ray to look at your breasts, is important because that can catch cancer before a person actually feels the lump or skin changes themselves.

SLH: So I have two questions. Number one is, at what age would we start getting mammograms? It’s my understanding it’s a little later in life. And then, how would you screen for cancer prior to your mammogram?

SP: This is an excellent question because there’s been a lot of controversy. I think everyone’s aware that people keep changing these guidelines. So, the guidelines from the American College of Radiologists, as well as the American Society of Breast Surgeons, is that every woman who is 40 and above should have an annual screening mammogram. Now if you have high risk, which means that if you had somebody in your family with breast cancer - especially somebody with breast cancer at an early age - or if you yourself have had radiation in the past to the chest and the head and neck, or if you have had Ashkenazi Jewish heritage, then that puts you at a higher risk. In those cases we may advise you to have breast screening earlier. And screening involves mammograms. Sometimes it involves other imaging modalities like ultrasound or MRI’s.

SLH: Excellent, and then can you go ahead and talk a little bit about self-exams? Is that still recommended?

SP: I think self-exam is a good idea. It is definitely something that a woman can do in the privacy of her own house, her own bedroom or shower. Checking the breast once a month at the very least, in at least a couple of different positions, either standing up or lying down, is very helpful. It is important that the test or the check be done the same way each time so that you have something to compare. And if you feel a lump or a bump or any skin change that is persistently there, then definitely, you should get it checked out by your physician.

SLH: So Dr. Pai since we’re talking about this about mammograms and self-checks, I also want to talk about the COVID vaccine and how that has also played a role in some of the lumps and bumps that women are feeling in their breasts. Can we talk on that a little bit?

SP: Yes, so a COVID vaccination sometimes leads to enlarged lymph nodes, especially in the arm that the patient received the vaccination in. So these can cause some confusion if you have a screening mammogram, because we know that breast cancer can go to the lymph nodes. If we see it in a screening mammogram then we feel obligated to follow this further with other imaging and maybe biopsies. So to avoid unnecessary biopsies it’s recommended that if you have a COVID vaccination that you should wait at least four weeks to get your screening mammogram. Now this does not apply to someone who already feels a lump in their breast or has skin changes. If you feel that, then you should have a discussion with your physician and then probably get going with diagnostic imaging and biopsy as needed.

SLH: That’s great, thank you so much. If someone is diagnosed with breast cancer, what are their treatment options?

SP: So, the treatment options for breast cancer have evolved a lot. We use what we call multidisciplinary treatment. So there is, Usually any patient with breast cancer gets surgery, sometimes with or without radiation. And this is to treat the cancer in the breast and in the lymph nodes and in the local area. So this is called Local Regional Control. They’re also given medicines to treat the cancer cells that may have already spread to other parts of the body or to prevent it from spreading to other parts of the body. These anti-cancer medicines, which are called Systemic Therapy, can be medicines which block your hormones; this is also known as endocrine Therapy, and can be the chemotherapy that we are all aware of. And there can be something called Targeted Therapy where they use antibodies to fight against some of the cancer cells.

SLH: So I now understand that Enloe has a new Cancer Survivorship Service clinic for our patients. Can you tell us more about it and some other resources that Enloe offers to help patients through their journey?

SP: We’re very proud of the new Survivorship services, but Enloe has a host of what I would say both treatment and support services available for the cancer patient. We have breast surgeons. We have the medical oncologist who do the Systemic Therapy. We have radiation oncologists who give radiation to the breast when needed. We also have a nurse navigator who’s a specially trained oncology nurse, who basically guides the patient from the time of diagnosis through their treatment and helps them make sense of this big, life-changing event. You’ve mentioned support services - our support services include things like lymphedema services, genetic counseling and patient support services, which includes patient education and programs that help the patient navigate through the cancer. But also some fun programs like the Brighter Smiles Brighter Day program. Our Survivorship Clinic, which is our newest addition, is a clinic where our nurse practitioners basically follow a patient who is finished with all the cancer treatment, and follow them to help prevent and detect recurrence before it becomes a big problem. So this, I think, is a great service because we find that patients tend to have a recurrence in the first five years. So all our patients are followed for five years and beyond.

SLH: So what can we do to prevent or reduce our risk of breast cancer?

SP: This is a question I get asked quite often in clinic. There are some factors that we can control ourselves and some that we can’t. The factors that we can’t control are our family history and if we’ve had any exposure to radiation in the past. But the factors that we can control are to take better care with our diets, eat a healthier diet, avoid excessive alcohol. Definitely avoid smoking or any tobacco products. It also helps to stay active and to maintain a healthy weight because we found that obesity has an increased risk of breast cancer.

SLH: What is one thing you would want our viewers to take away from today’s discussion?

SP: Early detection is the best way to fight this cancer. Because what we found is that if breast cancer is detected early, there is a 90 percent chance that the person who had the cancer would be still alive at five years after diagnosis. Early detection also usually means that the cancer is found at an earlier stage and if it’s found at an earlier stage, that survival is up to 99 percent up to five years. So, breast cancer is a problem, but it is a problem that can be controlled and early detection is going to help with this control.

SLH: Thank you Dr. Pai again for being here, Dr. Pai. And thank you to all of you for watching.

SLH: We hope you found this information helpful. If you want to hear more about breast cancer and would like to hear a survivor’s story, check out Enloe’s new podcast, Health Matters. We’ve placed a link to it in the comments field.

SLH: Remember to get your mammograms. And again, early detection is the best protection against breast cancer, so please be breast aware!

SLH: See you next time!