Q: I am a 51 year old Black women, whose mother died 13 years ago from breast cancer & her sister was diagnosed last year. I had a mammography 2 weeks ago and got the dreaded come back letter. Should I get genetic counseling?
Dr. Ananthakrishnan: I would suggest that your sister with the breast cancer get tested first, and if her test result is positive then you should get tested. Furthermore, it is likely that even though you got a “call back” letter after your mammogram, it is very possible that you don’t actually have a breast cancer. I would advise you to go in as soon as possible to work up whatever abnormality was seen. If you do in fact have a breast cancer, then you should certainly undergo genetic testing yourself.
Q: What is considered “early detection” of breast cancer?
Dr. Ananthakrishnan: Early detection is finding a breast cancer before symptoms actually occur. This could be by finding it on a mammogram before actually feeling a lump in the breast, or by finding a small lump before it becomes a big lump. Early detection can sometimes allow for less aggressive treatments and improved outcomes.
Q: Is radical mastectomy surgery still performed? I hear little about it now.
Dr. Ananthakrishnan: Radical mastectomy which involves removing the pectoralis major muscle along with the breast above it is now rarely performed.
Q: After 40 years old, I thought instead of every year, mammography would be every 2 years. Is this correct?
Dr. Ananthakrishnan: This is based on the USPTF task force recommendations which came out in 2010, however these recommendations have not been widely adopted. Current recommendations by the American Cancer Society still include annual mammography in women over age 40.
Q: I watch the Dr. Oz Show and he spoke about a shield to cover your neck when having a mammogram. What are your thoughts on the subject?
Dr. Ananthakrishnan: The American College of Radiology does not recommend using a thyroid shield, since the amount of radiation the thyroid is exposed to is so low during a mammogram. In addition, use of a shield can cause artifact in the mammogram (meaning shadows or other findings that can make your mammogram more difficult to read,) which would mean that your mammogram would have to be repeated. This would expose you to even more radiation than if you had not used the thyroid shield in the first place.
Q: Breast Cancer and HIV – can you treat both and which is the priority to treat first?
Dr. Ananthakrishnan: Yes, breast cancer can absolutely be treated in patients with HIV. In fact, the patients do very well from both diseases. The idea is to keep the HIV under control with maintenance therapy, and treat the breast cancer as aggressively as it would be treated in a non-HIV patient.
Q: Is Arimidex, a chemoprevention drug used as readily as Evista or Tamoxifen – why or why not?
Dr. Ananthakrishnan: The aromatase inhibitor drugs include anastrazole (Arimidex), exemestane (Aromasin), and letrozole (Femara). Anastrazole is currently being studied for its role in chemoprevention, as part of the IBIS-II trial. Recent data was just reported earlier in June at the ASCO conference that exemestane reduces the risk of an initial breast cancer occurrence. Concerns about using the aromatase inhibitors for breast cancer prevention are mainly related to side effect profiles, including bone pain and joint pain.
Q: Can I drink green tea if taking Lovenox? (80 mg every 12 hours)
Dr. Ananthakrishnan: Talk to your physician about this. The concern about green tea and anticoagulants is that green tea contains vitamin K, which can make some anticoagulants ineffective.
Q: Shortly after being diagnosed with breast cancer I started feeling a pain in my thigh. I had a PET-scan, X-ray, Venous & Doppler all coming back negative. Any suggestions on a cause or treatment?
Dr. Ananthakrishnan: It is best to discuss this with your physician, since a physical exam would also be helpful in determining the etiology of your pain.
*This blog post was originally published at Columbia University Department of Surgery Blog*