Ask the Expert: Understanding Breast Cancer

Dr. Barry Uhl, a Sharp-affiliated radiation oncologist, answers commonly asked questions about breast cancer.

What is breast cancer?
Breast cancer is a group of diseases that cause breast cells to change and grow out of control.

What causes it?
There’s a lot of different things that cause breast cancer. It’s not really just one. If you have first-degree relatives or other relatives that have breast cancer at a young age you’re at a much higher risk for breast cancer. Other things such as hormones actually can induce breast cancer, women on birth control or estrogen replacement, those types of things, there’s a slight increased risk of breast cancer in those populations.

Also things like obesity, plus mutations, just happen as a general course of being alive.

What is the common age for breast cancer to occur in women?
The median age for breast cancer is 61 so half of all breast cancers are diagnosed after the age of 61. A lot of times you hear the stories about all the young women and such but the group that really needs to still get screened are those women in their 60s and maybe early 70s in addition to the younger women.

What about breast cancer in men? Is it common?
Male breast cancer is breast cancer but it tends to be more aggressive because it goes undiagnosed. It’s approaching 1 percent of breast cancers. There’s definitely a link between obesity and breast cancer. The less fat tissue in the body, the less  you’re going to have circulating estrogens and less the breast cells are gonna be stimulated.

Do birth control pills cause breast cancer?
Some the birth control pills are shown to cause an increase in breast cancer but if you look at the raw numbers it’s not a tremendous increase. It’s something that patients need to speak with their doctor about and kind of weigh the risks and benefits.

Should I go to the doctor if I have a breast concern?
Physical exam is very important and being really aware that different things they find on physical exam are important and also sending women for mammograms. The radiologists are very, very good and they’re picking up these small breast cancers on mammogram and they’re using ultrasound for lesions that might be suspicious and you know they just do a very, very good job at picking up some of these cancers that might be missed. Basically a mammogram is an X-ray study where they try and flatten the breast out as much as possible and use low energy X-rays to try and detect abnormalities in the breast. 

I think that’s important that you not be afraid to bring up any breast abnormalities or things like that or also not be afraid of screening or being afraid of what could happen because you really need to level with yourself and trust yourself and trust your doctor to get to the bottom of this, ’cause the longer you wait, if this actually is breast cancer, you’re better off discovering this early and really being on top of this because it’s your health.

What should I do if I have a family history of breast cancer?
With the family history, I recommend that women in their 30s, especially if they have some type of suspicious lesion or something, you know, start with a mammogram but even then they don’t need a yearly mammogram. At 40 I’m really in the camp that believes you should have yearly mammograms. But it is controversial and there’s data to support it on both sides.

Will a mammogram always determine breast cancer?
Ten percent of breast cancers aren’t even seen on mammograms for whatever reason, whether they just aren’t a solid mass or they’re close to the chest wall where the mammogram really can’t pick them up.

What happens if a breast mass is found?
But once that mass is localized, generally you go for a needle biopsy. And if the needle biopsy can’t be done there’s some situations where an incisional biopsy is necessary. We go in and take the lump out surgically. And then, once the diagnosis is established, then you go on to different treatment options.

What can I do to be proactive?
You can only see your physician so many times a year and no one knows your body better than the woman patient and so, whether it’s in the shower or whatever, just being very familiar with your breast and the different lumps and bumps that come along is important. The changes in your breast, especially that happen quickly, can be important.

What are the different types of treatment for breast cancer? What types of doctors would be treating the cancer?
There’s three different main specialties that actually treat breast cancer. The first is surgical oncology, the surgeons. Next is radiation oncology, which I do; and then medical oncology, which deals with the systemic treatments, whether they be hormone therapy or chemotherapy or biologic.

What are the different categories of breast cancer?
You can really break down breast cancer into three different categories. The first is just localized tumor where you take it out and there’s no other cancer. The second is local-regional, where you take out the breast cancer mass but it’s spread to the lymph nodes and either the auxilla in that lymph node extends on up to the, above the collarbone. And then the third is the metastatic, or if it’s spread other parts of the body. That’s more serious. That’s kind of widespread.

What are the surgical options for breast cancer?
Mastectomy is a surgery that removes the entire breast. Lumpectomy basically removes the tumor mass with a margin of normal tissue around it. After a lumpectomy, you’ll need radiation treatment to try and sterilize any additional microscopic disease left in the breast. Now the overall survival for both groups is the same — in actuality that’s really a cosmetic decision but you know it’s also important that you got to keep the breast, keep the same sensation of their breast and overall they’re equivalent but some women just don’t want to go through the additional six and a half weeks of radiation after a surgery.

What is up-and-coming with breast cancer treatment?
Medical oncology has made amazing strides with the number of hormone therapy options available. The chemotherapy and new things like Erceptin, biologic modifiers which really are making a difference specifically in Her2 node positive breast cancers that before was a very poor prognosis and as we’re seeing this one drug Erceptin might be changing that completely and turning that into a situation where women might actually just do better because they have such a good treatment like that.

Find a San Diego Oncologist
To find a Sharp-affiliated doctor, search for a San Diego oncologist specializing in breast cancer or call 1-800-82-SHARP (1-800-827-4277), Monday through Friday, 8 am to 6 pm.