Online Health Chat with Cassann Blake, MD & Maria Artze, MD

October 27, 2015


Description

Better screening has made a huge difference in the early detection and treatment of breast cancer. Breast tomosynthesis, or 3-D mammography was approved by the FDA in 2011, since then it has allowed doctors to find cancer even earlier and with more accuracy than traditional 2-D mammograms. 3-D mammography is a type of mammogram where multiple projection angles are acquired using low dose x-rays and then reformatted to form 3D images of the breast. Breast tomosynthesis does not currently replace traditional two-dimensional mammography testing, but instead, it is performed along with the conventional mammogram to provide a more accurate view of the breast.

The additional accuracy in the imaging of the tissue offers doctors and mammography technicians a much greater opportunity to discover small cancer cells obscured by surrounding tissue that may not be visible on standard mammograms. If cancers are found when they are small, treatment options are generally less traumatic and the chance of cure is greater.

Breast cancer treatments are local or systemic. A patient may have just one form of treatment or a combination. Local treatments include surgery or radiation, which are used to remove, destroy, or control the cancer cells in specific area. The various surgical techniques differ in the amount of breast tissue that is removed with the tumor. Systemic treatments include chemotherapy and hormone therapy, which are used to destroy or control cancer cells throughout the body.

Cleveland Clinic Florida’s team of physicians and surgeons includes surgeons with fellowship training specifically in breast surgery. A tumor board consisting of members from our multidisciplinary staff meets each week to review patient cases and discuss treatment options. Treatment plans are tailored to each patient’s needs, based on their type of cancer, age, the degree to which their cancer has spread and the individual’s overall health. Log on to speak with a Cleveland Clinic Florida radiologist and breast surgeon to learn more about the latest innovations in the treatment of breast cancers.


About the Speakers

Cassann Blake, MD is a Breast Surgeon in the Department of General and Vascular Surgery at Cleveland Clinic Florida. Dr. Blake received her Medical Degree from Howard University and her Masters in Public Health from Harvard University. She completed her residency at the State University of New York and her fellowship training at Wayne State University.  Dr. Blake is board-certified and specializes in Breast Surgical Oncology.

Maria Artze, MD is a Radiologist in the Department of Radiology at Cleveland Clinic Florida. She earned her Medical Degree from the University of Miami and completed her residency there as well in Diagnostic Radiology and Nuclear Medicine. Dr. Artze specializes in the imaging and diagnosis of breast cancer. Her specialty interests include breast imaging, breast ultrasound, nuclear imaging, nuclear medicine, stereotactic breast biopsy. She is also board-certified in Diagnostic Radiology and Nuclear Medicine.


Let’s Chat About Advances in Breast Cancer Detection and Treatment

Welcome to our Online Health Chat “Advances in Breast Cancer Detection and Treatment " with Cassann Blake, MD and Maria Artze, MD. We are thrilled to have them here today for this chat. Let’s begin with the questions.

Breast Cancer Risk Factors & Symptoms

SCHACHD: Does the rate of breast cancer go down as women enter menopause or post menopause?

Cassann_Blake,_MD: The rate of breast cancer actually increases with age. Most breast cancers occur in women who are in menopause.

edawg007: If someone has a close family member who is BRCA positive does that mean their other family members should get tested?

Cassann_Blake,_MD: It is recommended that the other family members meet with a genetic counselor and proceed with BRCA testing to determine if they have also inherited the mutation. If the mutation is identified appropriate screening or risk reducing options can be discussed.

RachelG750: What might be some warning signs that I may have breast cancer? Is it only discoverable during a mammogram?

Maria_Artze,_MD: There are several warning signs including nipple retraction, bloody nipple discharge, a lump in the breast, redness, skin changes such as thickening are the most important signs. No, it is not only discoverable with mammogram, sometimes you only see the cancer in ultrasounds or breast MR.


Diagnosis and Mammograms

FSUmom08: I'm interested in getting a 3D mammogram but am wondering do most insurance cover this? Also, there is a lower or greater dose of radiation involved in this type of mammogram.

Maria_Artze,_MD: No. Most insurance do not cover this. At the Cleveland Clinic, we would usually charge $50 for the tomo. It is a slightly greater dose but within FDA guidelines.

Skewer_Matt: Should someone with a family history of breast cancer have their check-ups done more often versus someone without? Should they get 3D mammogram versus traditional mammogram?

Maria_Artze,_MD: High risk patients should receive check-ups more often. Usually they will have done a mammogram and ultrasound and six months later an MRI so they are examined twice a year rather than once. For these type of patients, a 3D mammogram is recommended, especially patients with dense breast tissue.

kingb: If you have dense breasts are you automatically a candidate for the 3D mammography?

Maria_Artze,_MD: It is not mandatory, but it is beneficial and can give you more information rather than a 2D mammogram.

SCHACHD: Why is the older compression model of detection still used since we now have 3D
imaging?

Maria_Artze,_MD: With a 3D mammogram everything is the same, position and compression, as a 2D mammogram. However, the difference in the 3D mammogram is that the x-ray tube moves acquiring multiple images that are used to make the 3D mammogram.

jfkacres: Are digital mammograms safer?
Also, many of my acquaintances were diagnosed with breast cancer in their mid-40s which was when they were going through the "change of life". Is that common?

Maria_Artze,_MD: There is no difference. They are both equally safe. Menopause isn't necessarily a risk factor, but age is a risk factor.

kingb: Have they made advancements in the 3D mammography machines? If another institution has been using a 3D for several years is CC's better/more advanced? Do you have to request 3D or is that given to you as an option at your appointment (with extra $50 fee)?

Maria_Artze,_MD: Yes, it is the first time we are able to acquire multiple images since the x-ray tube moves in an arc over the breast. The 3D mammogram machines are similar. Your doctor can give you a prescription for a 3D mammogram; however you have the option to ask for a 3D mammogram the day of your screening mammogram.

BostonStrong246: Can a mammogram cause breast cancer? Should I be worried about radiation exposure?

Maria_Artze,_MD: No, it cannot and the radiation exposure is minimum and safe.

Sandra_Lopez25:
How often should I get mammograms? At what age should they start? I've heard different ages referenced in the news recently.

Maria_Artze,_MD: For an average risk patient, the recommendation is once a year starting at age 40.

KRS1965: My mother was just told she is breast cancer free after a long year of treatment. How often should she have a follow up mammogram done to make sure there is no reoccurrence?

Maria_Artze,_MD: She should follow up on the breast that had the cancer every six months for a minimum of two years, and the other breast yearly.


Breast Cancer Stages/Types

CBSanchez10:
My mother is 53-years-old and has been diagnosed with stage 4 metastatic breast cancer what are her treatment options? And does her age affect her treatment plan?

Cassann_Blake,_MD: Many factors will impact her treatment and this has to assessed by her team of doctors.

Marlins2015: What is the difference between stage 2 and stage 4 cancers?

Cassann_Blake,_MD: Some Stage 2 breast cancers are considered early breast cancer. A Stage 4 breast cancer is one where the cancer has spread beyond the breast and the lymph nodes in the axilla.

Beachgirl247: What is HER2+ breast cancer?

Cassann_Blake,_MD: Please see the below information from our Cleveland Clinic website:
"HER2 (which stands for human epidermal growth factor receptor 2) is another type of growth signal receptor, or antenna, which may be present on your breast cancer cells. About 25 percent of breast cancers are HER2-positive. HER2-positive cancers are a mix of good and bad news. The bad news is the tumors tend to grow more aggressively than those without the HER2 receptor. The good news is that, like ER/PR-positive cancers, medicines can switch the HER2 growth receptor off. New drugs such as trastuzumab, pertuzumab, T-DM1 and lapatinibare extremely effective at this, and have dramatically improved the prognosis for HER2-positive patients, Dr. Abraham says. Treatment outcomes are now as good as those with HER2-negative tumors. But HER2-positive tumors bigger than half a centimeter, or that have spread into the lymph nodes, may require treatment with chemotherapy and one of the medicines specifically targeting the HER2 receptor, such as trastuzumab"

GiantGreen17: Can benign cysts become cancerous at any point? Do these cysts show up on mammograms?

Cassann_Blake,_MD: A benign simple cyst does not become cancerous. Cyst can be seen on a mammogram as mass that needs to be further evaluated with an ultrasound

PPMS1008: What is the possibility breast cancer can spread to the lymph nodes or other organs? How does this happen? Are the lymph nodes removed if the cancer spreads?

Cassann_Blake,_MD: It depends on the biology of the tumor. Breast cancer may spread to the lymph nodes and beyond to other organs. Ongoing research is trying to answer that question. Lymph nodes may be removed to help determine the stage of breast cancer.


Lumpectomy and Mastectomy

ILMD4: My mother is overweight with breast cancer. Can her weight cause any negative impact towards her treatment? Will her weight affect which surgical options are appropriate for her?

Cassann_Blake,_MD: Her Body Mass Index(BMI) can impact her surgical options. Higher BMIs are associated with more complications.

Doglover4ever: My test results came back and I’ve been diagnosed with Stage 1 breast cancer. What are my surgical options?

Cassann_Blake,_MD: The surgical options usually include a lumpectomy or a mastectomy. Many factors are used to determine if the breast can be safely saved with a lumpectomy.

Caligirl90210: Are there non-invasive treatments for breast cancer? Is surgery the first choice of treatment?

Cassann_Blake,_MD: Surgery remains the standard first part of treatment for early stage breast cancer.

PhiliGirl4Life: I am a 33-year-old female diagnosed with stage 2 breast cancer. What are my treatment options?

Cassann_Blake,_MD: Breast cancer treatment for stage 2 breast cancer always involves surgery (mastectomy or lumpectomy). The features of the cancer and whether or not the lymph nodes are involved will help to determine if chemotherapy and/or endocrine therapy will be needed to provide the best treatment. Radiation therapy is always offered if the breast is saved and sometimes if the lymph nodes are involved even if the breast has been removed.

Liz_Romero: My sister was diagnosed with early stage breast cancer, she’s 36 years old. What new surgical options are available for her?

Cassann_Blake,_MD: This is best discussed with her team of doctors as many factors determine appropriate surgical options.

BreakingBad45: What is the difference between lumpectomy and a mastectomy?

Cassann_Blake,_MD: A mastectomy is removal of the whole breast. A lumpectomy is also called a partial mastectomy. With this procedure the breast is saved and only the part of the breast that has cancer is removed.

Diva44: What is a sentinel node biopsy? Will any of my lymph nodes (located under the arm) be removed? Why?

Cassann_Blake,_MD: A sentinel lymph node biopsy is a procedure to determine if breast cancer has spread to the lymph nodes. This is done by injecting a dye in the breast which creates a "roadmap" so your surgeon can identify the first lymph node or few lymph nodes that are draining the breast. Because a sentinel lymph node is located and removed does not mean that there is cancer in that lymph node. It just means that if the cancer went to the lymph nodes it would most likely be in that lymph node first. Whether or not your cancer has spread to your lymph nodes helps to stage your breast cancer and helps your team of doctors offer appropriate treatment.

Madandhat: My breast surgeon is recommending that I have a mastectomy. I’ve heard of procedures where the nipple is spared. Would I be a candidate for that? How is that determined?

Cassann_Blake,_MD: There are a number of factors that are used to determine if someone is a candidate for a nipple sparing mastectomy. Two main factors include the stage of the cancer and the distance of the cancer from the nipple.

Diver2541: After diagnosis how long do I have to consider a treatment option? If surgery is recommended, does it need to take place immediately?

Cassann_Blake,_MD: Once the diagnosis has been made and your team has completed its additional test if needed surgery should be scheduled promptly.


Breast Reconstruction

Rbbe: I had a mastectomy done last summer, am I eligible for the federal law of reconstruction? What other procedures does this law cover?

Cassann_Blake,_MD: Most insurance companies including Medicaid will cover reconstruction after breast cancer. Bras and prosthesis are covered as well.

Sammi2014: If I choose to have breast reconstruction, what are my options? When should it be done?

Cassann_Blake,_MD: Reconstruction after a mastectomy usually involves either an implant or taking tissue from one part of the body to create a flap that is used to rebuild the breast.

CallieDaniels54: Will my breasts lose feeling after treatment or reconstructive surgery?

Cassann_Blake,_MD: Some women do lose feeling after a reconstructive surgery, however everyone heals differently and some women do not have a significant loss of sensation after surgery.


For Appointments

To make an appointment with Cassann Blake, MD, Breast Surgeon or any of the other specialists in the Department of General and Vascular Surgery at Cleveland Clinic Florida, please call 877.463.2010.  You can also visit us online at my.clevelandclinic.org/florida.


For More Information On Cleveland Clinic Florida

Cleveland Clinic Florida, located in Weston, West Palm Beach, Atlantis, Palm Beach Gardens and Parkland, is a not-for-profit, multi-specialty, academic medical center that integrates clinical and hospital care with research and education. Cleveland Clinic Florida has 240 physicians with expertise in 35 specialties. The medical campus is fully integrated and includes diagnostic centers, outpatient surgery and a 24-hour emergency department located in the state-of-the-art hospital. Cleveland Clinic Florida ranked third among the 66 best hospitals in the Miami-Fort Lauderdale metro area and ninth in Florida in US News & World Report’s 2015-2016 ranking of Best Hospitals metro area rankings. Cleveland Clinic Florida is an integral part of Cleveland Clinic Ohio, where providing outstanding patient care is based upon the principles of cooperation, compassion and innovation. Physicians at Cleveland Clinic are experts in the treatment of complex conditions that are difficult to diagnose.

For more information about Cleveland Clinic Florida, visit my.clevelandclinic.org/florida.


On Your Health

MyChart®: Your Personal Health Connection is a secure, online health management tool that connects Cleveland Clinic patients with their personalized health information. All you need is access to a computer. For more information about MyChart®, call toll-free at 866.915.3383 or send an email to: mychartsupport@ccf.org

A remote second opinion may also be requested from Cleveland Clinic through the secure Cleveland Clinic MyConsult® website. To request a remote second opinion, visit eclevelandclinic.org/myConsult


This information is provided by Cleveland Clinic as a convenience service only and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. Please remember that this information, in the absence of a visit with a health care professional, must be considered as an educational service only and is not designed to replace a physician’s independent judgment about the appropriateness or risks of a procedure for a given patient. The views and opinions expressed by an individual in this forum are not necessarily the views of the Cleveland Clinic institution or other Cleveland Clinic physicians. ©Copyright 1995-2015. The Cleveland Clinic Foundation. All rights reserved.