Lymphedema Risk Factors and Treatment Options for Breast Cancer Patients

If you are currently undergoing treatment for breast cancer, it’s important to know about possible complications that may occur afterward. One such complication is lymphedema. Lymphedema is the persistent swelling of the arm that may occur after mastectomy and lymph node removal during breast cancer treatment, due to the buildup of excess lymphatic fluid.

But what are the risk factors of lymphedema? Moreover, what treatment options are available for those who receive this diagnosis?

Factors That Increase the Risk of Lymphedema

At MedStar Georgetown University Hospital, we have observed that approximately 20 percent of women who undergo breast cancer treatment will end up with lymphedema. While there is no way of knowing during treatment who would be diagnosed, there are some risk factors we’re aware of that may increase the chances of getting lymphedema after breast cancer treatment.

For example, women with a higher chance of lymphedema have had many of their lymph nodes removed. Another risk factor is exposure to radiation during treatment, since this can cause scarring and blockages. Women who smoke or are obese are also more likely of developing lymphedema after breast cancer treatment.

While not all risk factors are avoidable, some are. If a patient is looking for ways to reduce their risks, smoking cessation and weight loss are two options.

Diagnosis of Lymphedema

Some patients get relief by having the affected area massaged and the excess fluid drained. But most patients end up needing surgical treatment for more long-term relief.

To find out the best treatment options, you should meet with a multidisciplinary team that includes oncologists, physical therapists and other medical professionals who will help with diagnosis and immediate action.

A common way to diagnose lymphedema is called bioimpedance, which is a way to measure electrical flow through body tissue. Once it is confirmed that the lymphatic channel - which contains clear, thin lymphatic fluid - is blocked, a team of doctors will determine the best treatment. In the meantime, they will try to reduce the swelling, often by wrapping the arm with a sleeve to get some relief.

Treatment Options for Lymphedema

One surgical option for mild to moderate lymphedema is a lymph node transfer.  Lymph nodes are located in multiple places throughout your body; as a result, doctors can take lymph nodes from anywhere - such as the neck, groin or back - and transplant them wherever they’re needed using a microsurgical technique.

It’s akin to bringing in a pump and activating it by making sure blood can flow in and out to avoid swelling.

Another procedure that may be considered is lymphaticovenular bypass, also known as LV bypass. This is referred to as super-microsurgery, as it involves connecting the lymphatic channel right into a vein to ensure proper flow.

If lymphedema is more severe, liposuction may need to be performed on this area. This surgery uses a cannula to suck out the extra swollen tissue and fat that’s behind lymphedema. All three of these options work best in a team environment where they are being managed before and after surgery.

Recovery for Lymphedema Treatment

Whatever path is chosen, most patients can look forward to a quick recovery. Most treatment options take about three to four hours to complete, and you can usually return home the next day. They typically involve small incisions, followed by a wrap to protect and compress the area that was treated. The patient returns to the doctor a week later to have the sutures removed.

Expect to see results immediately, as the swelling will greatly reduce at first. Since lymph nodes are typically still dormant at the time of diagnosis and treatment, the arm may swell in the future, however, as they start functioning properly again, the swelling will recede once more.

Due to advancements in less invasive treatment options, lymphedema is no longer a lifelong concern for life after breast cancer treatment.

We are here to help.

If you have questions about the MedStar Georgetown Cancer Institute or are ready to schedule a consultation with one of our specialists, call us at 202-295-0513.

Breast Cancer: Is Natural Breast Reconstruction Right for You?

Breast cancer patients who undergo mastectomies are often faced with the decision of how best to reconstruct their breasts. Currently, implant reconstruction is the most common way of rebuilding the shape of their breasts after surgery. However, one drawback of implants is that they typically need to be replaced every 10 to 15 years.

An alternative to implant reconstruction that's growing in popularity is known as natural breast reconstruction, or breast reconstruction using natural tissue. This method uses skin and fat from certain body parts to create a natural-feeling breast.

But what exactly does natural breast reconstruction entail, and is it the right choice for you?

What Is Natural Breast Reconstruction?

The human breast consists mainly of fat, especially after a woman's child-bearing age. At its core, natural breast reconstruction involves transplanting fat from one area of the body — such as thighs, buttocks and back — to another.

Natural breast reconstruction is also known as DIEP flap, or deep inferior epigastric artery perforator flap. This procedure removes extra skin and fat from the lower abdominal area, where many women carry surplus tissue. However, the muscle and function of the abdominal area will still be maintained after the surgery.

Once this tissue is removed, blood vessels from the tissue are attached to blood vessels in the breast area. The arteries and veins from the removed tissue are sewn to arteries and veins in the chest area using a microscope to restore blood flow to the tissue and make the transplant a success.

Natural Breast Reconstruction Myths vs. Facts

Because synthetic implants are still the prevailing choice for breast reconstruction, several myths have propagated throughout the medical community regarding the downsides of natural breast reconstruction. Many patients worry that the surgery will be too long, that the recovery will be too difficult, or that there will be a significant chance of failure.

However, these concerns are usually unfounded. Typically, the surgery lasts about five hours when in the hands of an experienced physician. Patients usually recover in the hospital for two to three days, with nonopioid medications that mitigate the pain well.

A full recovery typically occurs within two to six weeks, with an average recovery time of four weeks. This is only slightly longer than implant breast reconstruction, which has an average recovery time of three weeks.

In addition, the risks of failure and complications are minimal. The failure rate of natural breast reconstruction is very low, at around 0.7 percent, and can be lowered with the right surgical team. The hernia rate from this type of operation is less than 2 percent.

By dispelling these myths around natural breast reconstruction, an operation that once seemed scary becomes something realistic and tolerable, and perhaps preferable for certain situations.

Making the Right Choice for You

The benefits of a successful natural breast reconstruction are invaluable. Rebuilding breasts with their own body tissue provides patients significant improvements in their mental attitude and bodily sensation.

Of course, there are real downsides to natural breast reconstruction surgery, including the risk of infection or serious bleeding, and not every patient is a good candidate for the surgery.

However, if you are curious about natural breast reconstruction, schedule a consultation with an experienced breast reconstruction surgeon. They can help by answering questions and empowering you with the knowledge you need to make the best decision.

We are here to help.

If you have questions about the MedStar Georgetown Cancer Institute or are ready to schedule a consultation with one of our specialists, call us at 202-295-0513 or click the request a consultation button.

Improving Breast Reconstruction Patient Outcomes with SPY Elite and Hyperbaric Oxygen Therapy

Sarah Bessin, a 47-year-old breast cancer survivor, received her diagnosis in July 2015. In October, Bessin opted to begin breast reconstruction at the same time as her mastectomy. The team at MedStar Georgetown University Hospital was able to save Bessin’s breast tissue and improve her breast reconstruction outcome through the unique combination of the following two tissue-saving technologies to diagnose and avoid serious complications:

  • The SPY Elite fluorescent imaging system that gives breast surgeons and plastic surgeons the ability to assess the quality of blood flow in the breast tissue in order to make the critical decision on whether to insert implants immediately or wait.
  • Hyperbaric oxygen therapy to facilitate the healing process.

“My surgeon told me he would decide during surgery whether or not I could undergo breast reconstruction immediately, but I’m so glad he decided to wait before proceeding with implants. It gave me a chance to heal, and the results of my reconstruction are just remarkable,” Bessin shared.  

“Everything that we do in plastic surgery involves blood flow. If blood flow is disrupted, the overlying skin can die. This is the reason we need to be able to anticipate these problems intraoperatively so we can act quickly,” said Troy Pittman, MD, Bessin’s breast reconstruction surgeon. 

SPY Elite: A New Valuable Player in the Operating Room

After a mastectomy, the plastic surgery team enters the operating room with a fluorescent imaging system called SPY Elite. SPY Elite has a long arm that connects to an infrared lamp device, which is used for scanning over a patient’s body. A special contrast is injected through the patient’s IV line, and a TV monitor shows the scans of breast tissue and blood vessels in real time.

A breast reconstruction surgeon will move the SPY Elite lamp over different areas of the breast to detect the quality of blood flow in breast tissue before proceeding with the surgery. The system’s monitoring of the blood flow helps surgeons determine if the patient’s tissue is in a safe state to move forward with surgery and place an implant.

If blood flow is limited, surgeons will add hyperbaric oxygen therapy after surgery to promote healing in the tissue.

“SPY Elite lets me look at the blood supply of the breast tissue and the nipple in real time,” Dr. Pittman said. “This helps us diagnose a problem early on and initiate hyperbaric oxygen therapy within 24 hours, if we need to.”

SPYing a Problem During Bessin’s Procedure

During Bessin’s procedure, the SPY Elite imaging system informed Dr. Pittman’s team that there were worrisome vascular changes in her breast skin following the mastectomy. To avoid compromising the vascular health of the skin, Dr. Pittman decided on a different plan.

The new breast reconstruction approach for Bessin meant waiting on the implants and placing tissue expanders, a type of deflated temporary implant, in the surgery site. This plan allows for healing time in the hyperbaric oxygen therapy chamber. 

“Our goal is to get patients in for treatment as soon as possible. We are aggressively treating the patient to save their breast tissue and augment their healing,” said Kelly Johnson-Arbor, MD, medical director of Hyperbaric Medicine in the Department of Plastic Surgery. “Our dedicated team of physicians, nurses and technicians work to ensure that patients remain safe and comfortable during their treatment regimen.”

Healing Tissue Within Days with Hyperbaric Oxygen Therapy

Hyperbaric oxygen therapy exposes patients to pure oxygen in a pressurized space. Sending patients to the hyperbaric oxygen chamber treats the initial blood flow issue and can help the patient avoid future healing problems. Treatment begins within  24 hours after surgery and does not require patients to stay in the hospital. 

Bessin’s tissue healed in only 13 hyperbaric oxygen therapy treatments. Her hyperbaric oxygen therapy schedule began with two visits to the hospital per day, which later decreased to one visit per day near the end of her treatment.  

“I bounced back quite quickly. I’m already working my normal schedule, and my energy level is back to normal,” Bessin shared. “I’m so grateful to my doctors for providing this therapy!”

Hyperbaric Oxygen Therapy: Rest and Relaxation Time

Bessin recalled that she spent most of her time relaxing in the hyperbaric oxygen therapy chamber, which is a large glass tube. In the chamber, patients cannot wear makeup, lotion, nail polish or outside clothing, nor can they bring in a cellphone, books or paper. A glass of water and a cotton gown are permitted inside the chamber. During treatment, a nurse or technician stays in the room the whole time to administer the hyperbaric oxygen therapy, answer questions or assist with movie selections.

“Georgetown has a great movie selection,” Bessin pointed out.

Access for Every Breast Reconstruction Patient at MedStar Georgetown

Dr. Pittman has used SPY Elite with hyperbaric oxygen therapy at MedStar Georgetown for five years. For breast reconstruction, Dr. Pittman’s team uses SPY Elite on almost every patient, but particularly in those who want to begin breast reconstruction with an implant immediately after a mastectomy.

“SPY Elite and hyperbaric oxygen therapy allow us to aggressively treat patients safely and predictably,” said. Dr. Pittman. “This approach gives our patients the best chance for success.”

To date, MedStar Georgetown University Hospital is the only center in the greater Washington, D.C., region to offer both SPY Elite and hyperbaric oxygen therapy for patients with breast cancer.

We are here to help.

If you have questions about the MedStar Georgetown Cancer Institute or are ready to schedule a consultation with one of our specialists, call us at 202-295-0513.

Genetic Testing for Breast Cancer

The last several years have produced significant advances in the field of genetic testing. Doctors are utilizing preventative measures to decrease cancer risk, and are now using genetic testing to help patients and their families understand their cancer risks. So how does generic testing work and what are the potential positive outcomes for those with a breast cancer diagnosis?  What are the concerns about the risk?

When and How Genetic Testing Is Used

Genetic testing can be considered at various stages, depending on the individual and their background. For example, an individual recently diagnosed with breast cancer may undergo genetic testing in an attempt to understand why she developed cancer and whether her family is at risk.

On the other hand, healthy women with a family history of breast cancer may want to know their risks.

Modern genetic testing can be performed using either a blood test or a saliva sample collected to look for specific genetic information. The sample is sent to a lab, where a team of specialists looks for unique genetic mutations that indicate an increased risk for breast cancer.

Today, there are two primary forms of genetic testing:

  • Single or limited numbers of gene testing which analyzes a small number of genes to test for the presence of mutations.
  • Multigene panel testing which analyzes many genes for mutations. While this field is evolving rapidly, some of the gene mutations included in these panels do not yet have clearly defined cancer risks or clear data on the impact of more intensive screening or prevention options.

While both tests are useful, many factors such as family history, personal preference, health coverage and a need for immediate results, will influence which test is most appropriate for an individual.

Benefits We’ve Seen from Genetic Testing

Georgetown University's Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research in Washington, D.C., has served as the epicenter for research to improve cancer identification and diagnosis, including the use of genetic testing.

People who test positive for mutations in BRCA1 or BRCA2 (two of the most common cancer genes) can take preventative action to decrease their risk of developing or succumbing to ovarian or breast cancer. This is one of the most compelling benefits of modern genetic testing.

There are, of course, concerns regarding the added stress of knowing one carries a mutation or from receiving an inconclusive outcome from testing.  However, multiple studies conducted at the Fisher Center have concluded that the benefits of genetic testing far outweigh those challenges, as the genetic testing results allow patients to make better-informed decisions about the most effective treatment options and course of action in their medical care.

What's more, genetic testing can also determine that some relatives of people with a known mutation in a breast cancer gene understand that they do not carry mutated genes. This can relieve a significant amount of mental and emotional stress and alleviate a person's concern about an increased risk for cancer. 

What to Keep in Mind

It is possible to test for either one gene or multiple genes associated with breast cancer. While this is an exciting possibility, choosing which test to perform can be extremely complicated, but working with a genetics counselor will help ensure you choose the right test for you.

Genetic testing is complex, and in many cases, the results of the test may have implications for other members of their family such as a sibling or cousin. Patients should keep in mind that results may not resonate in the same way with their family members and should be prepared for how to handle that conversation. A genetic counselor can be instrumental in helping to understand genetic test information and in disseminating the information gleaned from it.

Finally, it's critical to keep in mind that genetic predisposition only accounts for 10 to 15 percent of all breast cancer cases.

The Case for Genetic Testing

If you were tested over three or five years ago, you should consider getting tested again in light of the recent advances that have taken place. Genetic testing for breast cancer has the potential to increase the health and longevity of women and men around the country.

We are here to help.

If you have questions about the MedStar Georgetown Cancer Institute or are ready to schedule a consultation with one of our specialists, call us at 202-295-0513 or click the request a consultation button.

What You Should Know About Pre-Pectoral Breast Reconstruction

If you have been diagnosed with breast cancer, your thoughts might jump ahead to the possibility of needing a mastectomy and/or breast reconstruction, as part of your treatment. But just as each cancer is unique, so are your breasts.

There are several methods of breast reconstruction and you will need to speak with your breast surgeon and plastic surgeon to determine which is best for you. Pre-pectoral reconstruction involves placing the breast implant over the chest muscle.

But what are the advantages of pre-pectoral reconstruction? And are there any challenges you should be aware of?

Traditional Procedures and Drawbacks

During mastectomy, breast tissue is removed along with the cancer. Many times the cancer is located in a portion of the breast where the nipple can be spared, Traditionally, the plastic surgeon inserts a tissue expander or breast implant either partially or completely under the muscle.

Tissue expanders are meant to gradually stretch the skin, however it’s often painful because the chest muscle is slowly stretched as well. In addition to the post-operative discomfort, the aesthetic outcome tends to look flat and unnatural since the implant is under the muscle.

Due to the pain of stretching muscle and the aesthetic deficiencies of under the muscle implants, other methods have been developed, including one that involves partial muscle coverage. But like the previous method, this type of breast reconstruction method also has disadvantages.

For example, this procedure often produces a flat, unnatural look because the implant is located under the muscle. Furthermore, given the fact that it is directly under the skin, the muscle is visible especially when the patient uses their chest muscles. This is similar to watching a body-builder flex their chest muscles. This tends to be distracting when women are exercising in public, since every time they use their chest muscles, the implant shows visible distortion.

Looking beyond the individual outcomes for each of these procedures, traditional reconstruction techniques overall can result in chronic soreness for patients, in the years following their procedure.

How Pre-Pectoral Reconstruction Works

These drawbacks have left an opening for a more advanced option: pre-pectoral breast reconstruction. With this method, the implant is placed over the muscle. This means there is little to no muscle deformity or pain associated with the procedure, since the muscle does not have to be cut. Instead, the implant is placed directly under the skin.

Of course, like most surgeries, there are some disadvantages. Early complications may include bleeding, infection, pain or seroma, which is fluid collection around the implant. Once you heal, there is a small chance your implants will rotate so they look upside down, and or they may rupture. In addition, most implants last for 10 to 15 years, so most women will need to have another procedure for new implants in future.

It should be noted that, women who benefit from this procedure are in relatively good shape and have small to medium sized breasts that are not overly saggy. Additionally, the breast cancer cannot have been located in the nipple area, which must be left intact.

Finding the Right Surgery Team for You

If you are considering pre-pectoral breast reconstruction, you should set up an appointment with a board-certified plastic surgeon who specializes in this area and can offer individualized care. This way, your doctor can guide you toward the right type of surgery for your circumstances.

The top priority of breast cancer treatment is to remove cancer and do an extensive enough surgery to ensure the risk of recurrence is low. The second goal is to give you a safe, aesthetically pleasing breast reconstruction. For this reason, you need a team of surgeons and specialists working closely together with constant communication between doctors.

We are here to help.

If you have questions about the MedStar Georgetown Cancer Institute or are ready to schedule a consultation with one of our specialists, call us at 202-295-0513 or click the request a consultation button.

Breast Cancer Nutrition Tips: How to Eat Well During Treatment

If you have been diagnosed with breast cancer, your diet may be the last thing on your mind right now. But it’s very important to focus on this aspect of your health, since a good diet can help your body heal as quickly as possible during treatment.

If you’re looking for a way to improve your energy, strength and overall wellness during breast cancer treatment, incorporate these tips into your diet.

What You Should Eat on a Daily Basis

One of the best ways to stay healthy during breast cancer treatment is to make fruits and vegetables part of your diet every day. In particular, you should eat five to nine servings of a variety of fruits and vegetables. While it's common to see recommendations for leafy greens, you should also incorporate other colorful fruits and vegetables.

The many colors in fruits and vegetables indicate the presence of phytochemicals, all of which work to protect our bodies in different ways. Colorful fresh food foods including those that are blue, yellow, orange, green or red play a significant role in helping to protect your body.

You should have at least one serving of whole grains each day since nutrition from these foods can help to reduce inflammation. Whole grains like bulgur, quinoa, buckwheat, oats, brown rice, barley, rye and corn contain complex carbohydrates, a little bit of protein and fat, a good amount of fiber, vitamins, minerals, antioxidants and phytochemicals, that all help to protect the body.

Protein is also essential, to help maintain body functions and weight. Losing weight during chemotherapy can make you feel sicker from the treatment and may result in treatment breaks.

Some great ways to incorporate protein into your diet include eggs, peanut butter, yogurt, turkey, chicken and seafood, as well as legumes, such as beans and peas.

One type of food you can eat during breast cancer treatment might surprise you: soy. Many people assume that soy and breast cancer don't go together, since they have heard soy can increase the risk of cancer or allow it to come back after treatment.

However, this is based on old research that turned out to be misleading. According to recent studies, unprocessed soy, such as in soybeans, soymilk and tofu are safe to eat. Highly processed soy products, such as vegan hot dogs and hamburgers, are not a healthy option, since much of the beneficial plant properties are lost in manufacturing.

Foods to Limit During Breast Cancer Treatment

Processed foods including high-sodium, high-fat lunchmeat, bacon and sausage should be limited as much as possible. You should also limit red meat - including beef, pork and lamb - to once a month if you want the healthiest diet during breast cancer treatment.

How to Manage Your Diet When Treatment Gives You Nausea

These diet guidelines are best for patients who have minimal side effects from breast cancer treatment. It’s common to experience nausea or loss of appetite during treatment. But you need to focus on getting enough healthy calories every day to keep up your energy, fight off infection and avoid losing a lot of weight during treatment.

Poor nutrition during breast cancer treatment can lead to more serious side effects and complications. You need proper nutrition and enough calories every day. If you struggle to eat as much as you should, scheduling several small meals throughout the day should help.

It’s important to lean on your oncology nutritionist during treatment to make sure you are doing your part to make your treatment and future health successful.

Overall, it’s important to keep a healthy diet during breast cancer treatment. Doing so can help your body recover, keep your weight steady and avoid fatigue. So if you have questions about your own diet, your oncology nutritionist can provide you with additional guidelines tailored to your unique needs as you undergo breast cancer treatment.

We are here to help.

If you have questions about the MedStar Georgetown Cancer Institute or are ready to schedule a consultation with one of our specialists, call us at 202-295-0513 or click the request a consultation button.

I’m a Breast Cancer Survivor, How Can I Reduce My Risk of Future Cancers?

When you’ve been through breast cancer and have weathered the storm of diagnosis and treatment, it’s normal to want nothing more than to climb back ashore and reclaim your former life.

Many cancer survivors, however, harbor a profound fear about what the future may hold: they worry about their cancer coming back or about finding a different type of cancer that would place them once again in the middle of treatment.

One way to regain a feeling of control over your body after the chaos of breast cancer is to take steps to reduce your risk of future cancers. Though there are some risk factors that you can’t control, such as your genes or the number of children you’ve already given birth to, there are three major risk factors that you can actively address to keep your cancer at bay.

1. Achieve and Maintain a Healthy Body Weight

Though fighting obesity is a major component of good health for all people, staying lean also reduces your risk for breast cancer. Experts recommend that your body mass index (BMI) stay between 19 and 25, and that you should avoid excess weight gain at any age.

Though losing weight can be challenging, even a five-to-10-percent reduction in your overall body weight can reduce your risk of breast cancer as well as diabetes, another serious risk factor for the development of breast cancer.

2. Increase Your Physical Activity

A sedentary lifestyle in which you spend most of your time sitting at your desk, in your car, or in front of the television or other screen-based entertainment devices (phones, tablets or computers) is a significant risk factor that you can control.

Increasing your physical activity will protect you from cancer and help you maintain a healthy weight. Adults should get at least 150 minutes of moderate intensity or 75 minutes of vigorous intensity activity each week (or a combination of these), preferably spread throughout the week.

However, for maximum health benefits, scientists recommend that we aim for 60 minutes or more of moderate activity every day, or 30 minutes or more of vigorous activity.

But what types of activities are considered moderate or vigorous?

  • Moderate activity is something you can do while carrying on a conversation, such as walking or a bicycling.
  • Vigorous activity can be taking an aerobics class, running or other high-cardio activities.

In addition, strength training using resistance bands or weights will help you build and maintain muscle mass. You should also limit the time you spend sedentary by taking the stairs, parking farther from the building or getting off the bus at a different stop to increase your activity on a regular basis.

3. Improve Your Diet

Adding healthy foods to your diet will help you keep your weight in check and add these cancer-fighting nutrients to your body:

  • Fruits and vegetables:
    Try to eat about 2 1/2 cups (five to nine servings) of fruits and vegetables every day. Choose a variety of colorful fruits and veggies to get a good balance of vitamins, minerals, antioxidants and phytochemicals to protect against cancer.
  • Whole grains:
    Add a serving of whole grains to your diet each day to boost your cancer protection at a cellular level.

There are also certain foods that increase your risk for cancer. Avoid these foods in your diet:

  • Processed foods:
    Highly processed foods are loaded with sugar, fat and salt. Salty foods, in particular, have been linked with stomach cancers.
  • Sugary foods and drinks:
    Energy-dense foods lead to weight gain and blood sugar spikes that are bad for your overall health. Though sugar doesn’t “feed” cancer, obesity and diabetes are definite risk factors.
  • Red meats or processed meats:
    Limit your intake of beef, pork and lamb to once per month and avoid processed meats like bacon, cold cuts and ham at all costs. The link to colorectal cancer is simply too strong to ignore.

Final Thought

By watching your weight, staying active and sticking to a plant-based diet, you can take control of your health and feel good about doing all you can to lower your risk for future cancers.

We are here to help.

If you have questions about the MedStar Georgetown Cancer Institute or are ready to schedule a consultation with one of our specialists, call us at 202-295-0513 or click the request a consultation button.

Why Doctors Are Rethinking Early-Stage Breast Cancer Treatment

Most women with early-stage breast cancer discover the disease only after screening with a mammogram. Symptoms may not present in a dramatic or noticeable way, so women diagnosed with early-stage breast cancer are understandably shocked and unprepared as they begin their cancer journey.

If you or a loved one has been diagnosed with early-stage breast cancer, it would be rational and reasonable to jump to quick conclusions, some dire. But keep in mind that doctors are rethinking early-stage breast cancer treatment.

You or your loved one might benefit from recent research that allows doctors to prescribe treatment options that are more targeted, more focused and more effective than ever before.

The Three Types of Breast Cancer

Current research shows that breast cancer usually falls into one of three categories:

  • Endocrine receptor-positive, wherein estrogen or progesterone receptors play a role;
  • HER2-positive, wherein human epidermal growth factor receptor 2 plays a role; or
  • Triple negative, wherein none of the above are involved.

This discovery allows doctors to identify the exact factors at play in your cancer diagnosis, thereby narrowing down appropriate treatments options to the most efficient and effective. Over-treating breast cancer can cause significant side effects for some women.

As much as doctors want to avoid a passive treatment regimen that doesn’t target or kill cancer, they also strive to eschew unnecessary treatments that might lead to other health problems. The ability to identify which type of cancer you have ensures that your treatment is balanced and purposeful.

Chemotherapy Isn't Always Useful

In the past, it was typical for doctors to surgically remove breast cancer tumors and to employ chemotherapy as a method for treating breast cancer, including early stage forms. Contemporary research indicates that chemotherapy doesn't always play a decisive role in early stage breast cancer treatment or in the prevention of recurrence.

Because research has proven that chemotherapy might not always be the best approach, cancer specialists might be less likely to use it as a treatment option except for when absolutely necessary. This discovery means that many women might be able to avoid the unwanted side effects of chemotherapy, including:

  • Heart problems
  • Osteoporosis
  • Anemia
  • Vomiting
  • Memory loss
  • Fatigue

No one wants to go through chemotherapy unless the treatment is essential. Doctors understand this, and they now have the information they need to make better decisions regarding your treatment.

If you have tiny tumors that are difficult to remove surgically, or if you have conditions that make it likely for tumors to return in the future, you may need chemotherapy. The side effects of this treatment plan will make life difficult for a while, but your cancer specialist should be able to prescribe a focused regimen that works specifically for your unique needs.

Final Thought

Your diagnosis of early stage breast cancer will be emotionally daunting and physically exhausting. However, you can find some reassurance in the fact that doctors know more today than ever before about identifying and treating breast cancer.

That way your recovery can happen with as few side effects and treatments as possible.

We are here to help.

If you have questions about the MedStar Georgetown Cancer Institute or are ready to schedule a consultation with one of our specialists, call us at 202-295-0513.

National Mammography Day: Why Mammograms Matter

For many women, the fear of breast cancer is very real, due to certain risk factors - for example, a family history of breast cancers, being a member of a high-risk group or even aging. The presence of these risks, however, is no guarantee that a cancer will ever materialize; nor is the lack of these risks a guarantee that one will not.

The key to positive outcomes for breast cancer treatment is early detection, which is why annual mammograms for women starting at age 40 - when risk substantially increases - are so important.

In fact, according to the Society for Breast Imaging, one in six breast cancers occur in women aged 40 to 49 years, and 40 percent of all the years of life saved by mammography are among women in their 40s.

How Mammograms Help

A mammogram is an x-ray image taken of the breast, which is then used to screen for cancers. Often they are able to detect breast cancers in their early stages, even before a lump can be felt through self-examination.

“Despite common fears, the majority of women experience little to no discomfort while undergoing a mammogram," says Amy Campbell, MD, Chief, Division of Breast Imaging at MedStar Georgetown University Hopsital.

Given that 75 percent of women who receive a diagnosis of breast cancer in their lifetime do not have any apparent risk factors, it is important that all women go for an annual screening, once they turn 40 years old - otherwise most cases will be missed.

Other studies have shown there is a 30 to 40 percent lower mortality rate among women who engage in annual mammograms against those who do not.

And while there are other screening options available, such as magnetic resonance imaging (MRI) and ultrasounds, both of which can be utilized in women at an increased risk of breast cancer, mammography remains the cornerstone of screening.

But Are Mammograms Safe?

As with any procedure or screening involving radiation, there are risks involved. That being said, the benefits of mammograms in breast cancer detection far outweigh the minimal risk associated with the process. Meaning it is much less likely that a mammogram will cause cancer, rather than detect it.

In fact, you encounter multiple times the amount of radiation exposure from your natural surroundings in a single year than you do from a mammogram.

Take Charge of Your Breast Health

As the Society for Breast Imaging notes, mammography is by no means perfect. It detects the majority of breast cancers, but not all of them. There are also some downsides to regular mammograms, such as the necessity for a biopsy or additional imaging.

However, mammograms do unearth a large percentage of cancers in earlier stages, when there is a higher likelihood of being cured and before they increase in size.

Dr. Campbell shares, “Our goal as breast imagers is to save as many lives as possible with mammography and we can achieve that goal by starting annual screening at the age of 40.”

So if you are 40 years old, take charge of your health this National Mammography Day and schedule your annual mammogram today. And if you have concerns or other questions, reach out to your physician. Because sometimes the best course of action is to start with an open and honest conversation.

We are here to help.

If you have questions about the MedStar Georgetown Cancer Institute or are ready to schedule a consultation with one of our specialists, call us at 202-295-0513.

Beyond the Lump: Signs and Symptoms of Breast Cancer

Many women with breast cancer never experience any of its signs or symptoms, such as a breast lump, says Christopher Gallagher, MD, medical director of the Cancer Institute at MedStar Washington Hospital Center. Dr. Gallagher wants women to have their breast cancer discovered before it even has a chance to cause symptoms.

But because not all women get regular mammograms, and because mammograms aren't infallible, women need to know the common signs of cancer and be willing to advocate for their own treatment.

Changes in the Breast

Women with early-stage breast cancer may notice a physical change in one or both breasts. “The main signs or symptoms would be feeling something that felt new or abnormal in the breast — a nodule or a bump," says Dr. Gallagher. "Or sometimes it’s breast pain." A lot of women and their primary care doctors overlook breast pain as a possible cancer symptom, he explains, but it's often the initial sign of a problem.

Sometimes the first signs of breast cancer are visible to the eye. “There could also be skin changes to the breast that are new or different," Dr. Gallagher points out. Nipple discharge is another potential warning sign, though it's one of the less common symptoms of cancer.

Changes Elsewhere

In some women, the first sign of cancer appears somewhere other than the breast. That can happen in women whose cancer has spread to other parts of the body. Dr. Gallagher says that sometimes a woman will discover a lump or bump under her arm. "That would be indicative that maybe they had something in the breast that spread to a lymph node."

"If a woman has a new pain in a bone that comes and doesn’t go away, that’s always to me suspicious of something that needs to be evaluated," he says. Other symptoms include involuntary weight loss and new abnormalities on routine blood work such as liver dysfunction and anemia.


Unfortunately, telling the difference between normal breast lumps and cancerous bumps isn't easy. "Historically, we always told women to do breast self-examinations on a regular basis, whether that be every couple weeks or once a month," Dr. Gallagher explains. However, there's not much evidence supporting the diagnostic validity of these exams.

Ultimately, Dr. Gallagher says, whether or not to do breast self-exams is a decision for every woman to make for herself. "I never say not to do it. But some women get so anxious they do it every day." He's noticed that this anxiety is especially strong in women who survived early-stage breast cancer and worry about it coming back.

Familiarize yourself with the feeling and texture of your own breasts, and talk to your doctor about anything that feels unusual for your body. But don't obsess over self-exams.

Next Steps

It's important not to panic if you notice any symptoms that are tied to breast cancer. Dr. Gallagher advises going to your primary care physician, who can then send you for a mammography and imaging or refer you directly to a specialist. "Make sure your primary care physician takes your report seriously," says Dr. Gallagher.

He's seen many breast cancer patients under the age of 40 whose doctors wrote their symptoms off at first. "Women need to follow their gut," he says. "If they think something is new and different ... they need to keep seeking medical attention until someone adequately explains what's going on."

In addition to suggesting women advocate for themselves, he urges them to speak to their friends and other women in their community about getting regular mammograms. He wants women to spread the message that "early-stage breast cancer is curable and you need to have your screening," he explains. "That's the way you're cured — by [your cancer] being found early."

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