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Frequently Asked Questions

How should I be checked for breast cancer?
The American Cancer Society recommends that women in their 20s and 30s have a breast examination by a health expert at least every three years. After 40, women should be examined yearly. Breast self-examination is also important. By becoming familiar with the usual appearance and feel of your breasts, you are more likely to notice a change and promptly bring it to your doctor's attention. Yearly screening mammograms are recommended for all women 40 and older. Women who are at increased risk may be advised by their doctor to begin having them sooner.

When should I perform my breast self-exam?
Examine your breasts about a week after your menstrual period.  If you no longer have menstrual periods, examine yourself on the same day each month.

What is digital mammography?
This procedure uses an electronic process to collect and display X-ray images on a computer screen.  This allows the radiologist to manipulate the image (to adjust the darkness/contrast or to magnify the image), which can make it easier to identify subtle differences in tissue. The images can also be transmitted electronically (like an email) so they can be reviewed by an expert who might be located elsewhere. Digital mammography has been found to be especially useful for evaluating younger women with dense breast tissue. Digital mammography is now available in the Calvert Medical Arts Center on the main hospital campus.

What other tests are available?
Breast ultrasound is sometimes used to evaluate an abnormality seen on a mammogram or found on a breast examination. This test uses sound waves to produce images of structures within the body.  It can be useful to determine whether a breast lump is solid or cystic (fluid filled).

Breast MRI captures detailed images of the breast using a computer with magnetic and radio frequency waves. It is very expensive and is not routinely used as a screening test. It can be useful when more routine diagnostic methods (examination, mammograms and sonograms) are inconclusive. It also can be used to evaluate women with dense breasts and to screen those women who are at very high risk for the development of breast cancer.

When is a breast biopsy performed?
A biopsy is used to determine whether an abnormality seen or felt within the breast is cancerous or benign.  Most biopsies are performed by withdrawing a specimen of tissue through a needle inserted into the breast under local anesthesia.  Usually either ultrasound or a computer combined with a mammography unit (stereotactic unit) is used to guide the placement of the needle into the suspicious area. Occasionally, biopsies are still performed by surgical removal of all or part of a breast lump.

How do I choose between a lumpectomy and a mastectomy?
The majority of patients with breast cancer undergo a surgical procedure known as a "lumpectomy." This refers to removal of the malignant tumor with a surrounding margin of normal breast tissue. Most patients undergoing this procedure are advised to also receive a course of radiation treatment to the breast. This has been shown to reduce the chance of cancer reappearing in the treated breast. The other surgical choice is a mastectomy; a procedure that removes the entire breast.

The breast surgeon will help guide the patient through the decision-making process.  For most small tumors, a lumpectomy permits removal of the tumor while allowing the breast to retain an acceptable appearance.  A mastectomy may be a better choice when removal of a large tumor would result in a significantly deformed breast.  Many patients undergoing a mastectomy also opt for breast reconstruction, which can often be started at the time of the mastectomy.

Every patient is unique and, therefore, the final decision should take into account the specific features of the tumor while also addressing the individual concerns and wishes of each patient.

What is a sentinel lymph node biopsy?
Sentinel lymph node biopsy (SLNB) has been performed at Calvert Memorial for many years.  It is a minimally invasive procedure in which a lymph node near the site of a cancer is first identified as a sentinel lymph node and then removed for microscopic analysis. This technique was developed after research demonstrated that the lymphatic system could be mapped with radioactive tracers and/or blue dye. This allows the identification of the lymph node (s) closest to the tumor, which serve to filter and trap cancer cells. The detection of cancer in these lymph nodes warns the doctor that the patient's cancer is spreading, hence the term "sentinel" lymph node.  If the sentinel lymph node (s) is clear of tumor, it is not necessary to remove the other lymph nodes in the armpit, thereby minimizing the occurrence of arm swelling (lymphedema) and other side effects.

Will I need radiation therapy and/or chemotherapy after surgery?
Patients undergoing a lumpectomy are usually advised to receive radiation therapy at some point following their surgery. Patients undergoing a mastectomy usually do not receive radiation unless their cancer is large, has invaded the skin or the chest wall or has spread into several lymph nodes.

Chemotherapy utilizes drugs to kill cancer cells. The size of the tumor, characteristics of the cancer cells and extent of spread of the cancer as well as other considerations help determine the need for chemotherapy.  If the cancer has a high chance of returning or spreading to another parts of the body, chemotherapy may be advised to diminish the chance that the cancer will recur. These decisions are made in conjunction with a medical oncologist.

What are my options for breast reconstruction?
Some women choose to undergo breast reconstruction immediately following a mastectomy.  Methods to reconstruct the breast include:  using tissue expanders and implants, using your body's own tissue or a combination of the two.  Breast reconstruction is a complex procedure performed by a plastic surgeon. It may require more than a single surgery to obtain a correctly positioned and symmetrical breast. Often, surgery will be performed on the opposite healthy breast so it more closely matches the size, shape and position of the reconstructed breast. Since the need for the surgery is related to breast cancer, the cost for reconstruction is usually covered by insurance.

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