Breast Cancer

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Breast Cancer

October 9, 2012
12:00 p.m. – 1:00 p.m. (EST)

  • Elizabeth Stone, MD – Oncologist

Cleveland_Clinic_Florida_Host: Welcome to our Online Health Chat "Breast Cancer" with Elizabeth Stone. To ask a question, type in the box below and then click 'Ask'.

Cleveland_Clinic_Florida_Host:

zaneyB: Are breast rashes common? Is it a sign of cancer?

Dr_Stone: It depends. It is common for women to have rashes that look red and can be itchy underneath the breast particularly in the summer or if they have medical problems such as diabetes. These are usually fungal and require treatment with antifungal. Scaling of the nipple can be a sign of a special type of cancer called Paget's disease. Also generalized redness of the breast can be a sign of cancer or infection. Therefore any rash on the breast should be evaluated by either your primary care or your GYN.

motherof5: Is there any relationship with HRT and breast cancer?

Dr_Stone: Yes, there is a relationship between breast cancer and hormone replacement therapy. Therefore, all women should discuss this with their GYN prior to starting on treatment to discuss risk benefit ratio in their particular situation. This should include information on family history and discussion of what the goal of HRT is. There are some menopausal symptoms such as hot flashes that can be treated with other non hormonal medications.

MattVanPelt: Does breast cancer run in families?

Dr_Stone: Yes it does. Most breast cancers are random events that occur sporadically. There are about a third of breast cancers that are familial, meaning one or two individuals have been diagnosed with breast cancer but none at an early age (generally early means before age 50). There is no gene testing for this but these patients may benefit from taking medications that might reduce risk of developing breast cancer if their risk is high enough. This can be discussed with a primary care doctor who may refer the woman to a breast specialist. Roughly 10% of all breast cancers are hereditary and these are families that have multiple individuals diagnosed with cancers particularly at an early age. The most common cause for breast cancer is mutations in one of 2 genes called BRCA 1 and BRCA 2. Testing is available for this through genetic counselors.

philnlyn: Hello doctor, my wife sometimes has a pinkish discharge from her right breast? Is this normal, we had our last child 1 year ago? Thanks.

Dr_Stone: The pink color implies that there could be blood in the discharge and this is something that should be evaluated by a physician and likely a breast specialist. They may ask questions about whether she breast fed and when she stopped.

varielle_D: What are your thoughts on the drug Tamoxifen? Are there major side effects?

Dr_Stone: Tamoxifen is a medication that is used to treat breast cancer and also prevent breast cancer in high risk patients. It does have some serious side effects including a small risk of uterine cancer (roughly 2-3%) and a risk of blood clots similar to hormone replacement therapy and birth control pills. It is a very important part of the treatment of breast cancer for some patients. There are other medications that might be an option depending upon the patient's individual situation and reason for taking the medication.

mgmistress: Please provide tips on how I can make sure I am doing my self-breast exams the right way.

Dr_Stone: The most important part of the breast exam relates to the timing with relation to your period (if you are still menstruating). It is important to perform it roughly a week after your menstrual period which is the time when your breasts are the least lumpy. I generally recommend dividing the breast into quadrants and then make sure you are examining each area completely. Generally we recommend using your fingertips and moving them in a circular pattern. You also want to make sure you feel in the axilla for any lumps as well. It may be helpful to show your GYN or primary care doctor how you perform your breast exam to make sure you are doing this correctly.

Cleveland_Clinic_Florida_Host: For those now joining us, we are currently chatting with Elizabeth Stone, MD, who is taking your questions about Breast Cancer. To ask a question, type in the box below and then click 'Ask'.

photogurl: Is there any connection between taking “the Pill” and breast cancer? I took the pill in my 20s and 30s and now I’m on Nuvaring in my 40s?

Dr_Stone: This is a more difficult question. We know that use of hormones in any form may increase risk of breast cancer. Duration of therapy also seems to increase risk. We generally recommend from a breast cancer stand point that once you are done with your childbearing that you consider a non-hormonal means of contraception or a more permanent means of contraception to try to minimize risk, especially if you have family history.

js1960: Is going to an oncologist still necessary when I did not have chemo or radiation treatment?

Dr_Stone: Generally if you have been diagnosed with breast cancer, regardless of whether you required chemotherapy or radiation, follow up should be once every 3 months for the first 2 years and then once every 6 months until year 5 at least. The oncologist will perform physical exams and evaluate any symptoms that might be a sign of a recurrence.

Cleveland_Clinic_Florida_Host: We are getting ready to close for today. Again, we apologize for the delay and the shortened chat time.

Cleveland_Clinic_Florida_Host: A large number of questions were received and we apologize if we did not get to your question. We will try to answer as many questions as possible in these last few minutes. If you have additional questions, please go to clevelandclinic.org/health/livepersonchat to chat online with a health educator.

tampajoana: Does Cleveland Clinic Florida have any current breast cancer trials? How can I enroll?

Dr_Stone: The Cleveland Clinic Oncology Program does offer a variety of trials for cancer patients of all types. The easiest way to look into what is currently available is to go on our web page, clevelandclinicflorida.org and search oncology trials to obtain more information.

davehelf: Can you explain the symptoms for male breast cancer.

Dr_Stone: Male breast cancer presents similar to female breast cancer. Generally men will complain of a lump in their breast. The lump may or may not be associated with pain. Nipple discharge is not as common. Men who notice a lump in their breast should be evaluated by their primary care physician.

SCohen88: Can breast calcifications ultimately turn into cancer?

Dr_Stone: There can be various different types of calcifications detected by mammograms. Some can be worrisome and require biopsy because they could be a sign of cancer. Others may not be worrisome at all. It depends upon the size of the calcifications and the pattern of distribution and if they are changing over time. These are the factors that radiologists evaluate when looking at mammograms to decide whether a biopsy is necessary or not.

Cleveland_Clinic_Florida_Host: I'm sorry to say that our time with Elizabeth Stone, MD is now over. Thank you again, Dr. Stone, for taking the time to answer our questions today about Breast Cancer. To make an appointment with Dr. Stone, or any other specialist at Cleveland Clinic Florida, please call 877.463.2010. You can also visit us online at vanity clevelandclinicflorida.org.