| Ho S. Myong, M.D.: |
Good afternoon. I am Ho S. Myong, M.D., medical oncologist/hematologist. In recognition of Breast Cancer Awareness Month, I am pleased to be speaking with you today on Breast Cancer Diagnosis and Treatment. |
| Chloe: |
What's your opinion on mammograms? Is it really important and how often do I need to have one? |
| Ho S. Myong, M.D.: |
A mammogram is still the best screening test we have available for breast cancer. Although there is sonme limitation is has demonstrated survival benefit. It allows earlier detection of breast cancer. The recommendation for a screening mammogram is on a annual basis after the age of 40. The frequency of the testing can sometimes be varied depending on family history or other risk factors. Some of the other sreening modalities that are being studied include other imaging techniques such as MRI, ultrasound. But these are still not practical for usage. |
| Rebecca: |
My mother was diagnosed with breast cancer when she was 62. How can I reduce my risk, and is there anything I should be doing besides frequent self exams? |
| Ho S. Myong, M.D.: |
There are models available that can help to estimate the risk of breast cancer for women. One of the most common models used is the "Gail Model." Using this model, if there is a significant risk of breast cancer, there's a medicine called Tamoxifen that has demonstrated in preventing and lowering the risk of breast cancer. Other than that, the most common thing to be cautious with is reducing other risks such as smoking, high fat diet, and hormone replacement therapy. It is also very important that with the family history, that you undergo diligent screening mammograms. Since by detecting early disease, we now can have a very high cure rate. |
| Chloe: |
Does the hospital participate in any clinical trials? How does the public learn about these? |
| Ho S. Myong, M.D.: |
Yes, we do participate in various national studies and pharmaceutical company studies. Depending on one's situation we can see what type of study they would be eligible for. Most of the studies we do have open concentrate on patients who have been diagnosed with active disease. |
| Bill: |
What types of radiation treatments are available at the hospital? Our doctor told us about brachytherapy, but we're not sure exactly what it is or where it is offered. |
| Ho S. Myong, M.D.: |
At our hospital, radiation therapy for breast cancer is still given with external beam radiation therapy. We are in the process of obtaining brachytherapy here. Brachytherapy is a process where we can provide radiation therapy directly to the breast tissue by instilling radioactive agents into the tissue. Traditionally external beam radiation therapy is given by x-ray beam through a linear accelerator machine. It is most likely available at larger academic centers at this time. |
| Holly: |
How reliable are self exams? I never really know what to look for and feel as if I might miss something. |
| Ho S. Myong, M.D.: |
The self breast examination is very helpful since women usually can tell very subtle differences early on. However, there really is no good study that has been done to indicate that it improves the overall outcome. Still, it is recommeded because it is a simple test to do and it allows the individual to be more consciencious about their general health. |
| Kaya: |
I've recently found a small lump in my breast, and I've got an appintment with my doctor, and a mammogram in April showed nothing. I'm scared and I was wondering what will happen at this visit with my doctor and about what will happen next. |
| Ho S. Myong, M.D.: |
A lump can indicate a number of different things. It doesn't always indicate cancer. Depending on the characteristics of the lump, a doctor may perform additional testing, repeat mammogram, ultrasound, and if indicated, a needle biopsy. Even if the lump is cancerous, given the small size, it should be very treatable. |
| Martha: |
Do you offer mammograms in your Yorkville office? |
| Ho S. Myong, M.D.: |
We do not currently offer mammograms at this time in the Yorkville office. Currently, all mammograms are performed at the Women's Diagnostic Center at the Rush-Copley Heart Institute building. |
| Bill: |
What are the benefits of breast conservation and how common would you say that is? |
| Ho S. Myong, M.D.: |
The benefit is better cosmetic results. Because we are detecting earlier disease, we probably perform lumpectomy in 60-70% of cases. Contraindication for lumpectomy includes locally advanced disease (skin involvement, multiple tumors, high tumor to breast tissue ratio). |
| Kaya: |
My aunt had a sentinel lymph node biopsy. Can you explain what this is? |
| Ho S. Myong, M.D.: |
As part of breast cancer surgery, we traditionally done lymph node disection of the axillae. However, this procedure was associated with some post surgical complications, such as infection risk, mobility difficulty, and lymphedema. Sentinal lymph node biopsy is a technique where we can determine initial lymph node from the breast that can predict lymph node status of the axillae. If the sentinal lymph node shows no cancer involvement, cancer in the lymph node is highly unlikely and lymph node disection can be spared to prevent future problems. If however, the sentinal lymph node does have a cancer involvement, the patient will still need a axillary lymph node disection. The sentinal lymph node biopsy is much less invasive than lymph node disection, but it does require injection of dye and radioactive colloid. |
| Meghan: |
Your web site talks about a patient navigator? Is that a special service for breast cancer patients? |
| Ho S. Myong, M.D.: |
The patient navigator is available for all cancer patients. This person helps to facilitate patient's care through our cancer center and the hospital. |
| Meghan: |
I had a mammogram recently, and everything seemed ok, but there was a little shadow that the doctor seemed a little worried about. But, he explained that things- like calicification- can show up on mammograms, and its nothing to be worried about. Still, I'm scared! |
| Ho S. Myong, M.D.: |
Calcifications in mammograms can be either benign or associated with underlying malignancies. More than the calcification itself is the pattern of the calcification that is important. Usually in this type of situation, they would recommend earlier follow-up mammogram. It is very important that you have a follow-up to make sure that this not a pattern of malignancy. |
| Beth: |
So, why do mammograms have to hurt so bad? |
| Ho S. Myong, M.D.: |
Sorry! I wish there was a better way. |
| sneamah: |
A friend of mine said she was having a breast ultrasound. Is this the same as a mammogram? |
| Ho S. Myong, M.D.: |
Ultrasound is a sonographic imaging technique which can help to differentiate or locate any solid mass. This is usually done if there is any questionable areas on the mammogram, which is an x-ray. By combining ultrasound with the mammogram radiologists can give a better opinion. |
| DP: |
I am 38 years old and had my first mammogram last year. I do self breast exams, but have very lumpy breast. Should I start to have mammograms on a yearly to assure that none of these lumps are cancerous? |
| Ho S. Myong, M.D.: |
It is common for younger women to have a lumpy breast due to the hormonal effects. It does not mean that this increases the risk of cancer. It is a somewhat challenging problem when mammograms are done in younger women who usually have a much denser tissue making it more difficult to locate subtle abnormalities. But the mammogram techniques are getting better and if indicated ultrasound can be done for further study. Unless there is a significant family history, annual mammogram can be started at age 40. |
| julie: |
There has been a lot of confusion lately regarding hormone replacement therapy. As a cancer doctor, what is your recommendation regarding women taking hormones to control the unpleasant effects of menopause? |
| Ho S. Myong, M.D.: |
The confusion rose from the data from the Women's Health Initiative study. This study showed that in patients who had received Prem/Pro, there was a higher incidences of breast cancer. The hormone seems to increase breast cancer risk or it may promote early occurences. It does not mean that all women should not take hormone replacement. You need to discuss with your physician the benefits as well as the risks involved. Depending on the symptoms you have from the menopause, there may be other treatments that can be considered. |
| Rebecca: |
Does the hospital really give you mammogram results within an hour? What does that mean exactly. |
| Ho S. Myong, M.D.: |
Rush-Copley does offer mammogram results within an hour. This means that you will actually get a printed report of your results the same day. |
| Ho S. Myong, M.D.: |
Thank you to all who joined my chat this afternoon. If you have any other questions, please feel free to call 630-375-2935. Thank you again. |
