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DrAttai
(Physician
- Surgery - Breast
(Verified)
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| Communities: Breast Cancer | Thank You's: 37 |
| Member Since: Jun. 2011 | Questions: 12 |
| Answers: 102 |
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Professional Statement
I am a breast surgeon in Los Angeles, CA. My private practice is dedicated to providing the highest quality care in a comfortable, supportive setting. I treat patients with both benign and malignant breast disease, and recognize the anxiety that both conditions can cause. Patient education plays a key role in maintaining health as well as in treating disease, and I strive to provide as much information as possible so that patients have a good understanding of their condition and of the treatment options.
I am an active member of the American Society of Breast Surgeons, and am currently a member of the Board of Directors, as well as Chair of the Communications Committee. I also serve as a faculty member for our annual meeting and for ultrasound and technology courses, educating other physicians on some of the latest devices and procedures. In addition, I am frequently invited to speak to community groups and I welcome these opportunities to provide education to those looking to lead healthier lives. I am also a member of the Board of Advisors for Circle of Hope, a nonprofit organization which provides financial, emotional, and educational support for breast cancer patients and their families in the Santa Clarita Valley.
I am an active member of the American Society of Breast Surgeons, and am currently a member of the Board of Directors, as well as Chair of the Communications Committee. I also serve as a faculty member for our annual meeting and for ultrasound and technology courses, educating other physicians on some of the latest devices and procedures. In addition, I am frequently invited to speak to community groups and I welcome these opportunities to provide education to those looking to lead healthier lives. I am also a member of the Board of Advisors for Circle of Hope, a nonprofit organization which provides financial, emotional, and educational support for breast cancer patients and their families in the Santa Clarita Valley.
Professional Info
Credential:
MD
Primary specialty:
Surgery - Breast
State Licenses:
CA
Languages:
English
Medical school:
Georgetown University School of Medicine
Residency:
Georgetown University Hospital
Internship:
Georgetown University Hospital
Board certifications:
American Board of Surgery
Professional memberships:
American Society of Breast Surgeons, American Society of Breast Disease
Areas of expertise:
Benign and malignant breast disease, cryoablation for benign fibroadenomas and breast camcer, accelerated partial breast irradiation, risk assessment, lifestyle modification
Research interests:
Cryoablation, accelerated partial breast irradiation, minimally invasive diagnosis and treatment for benign and malignant breast disease
Hospital affiliation:
Providence St. Joseph Medical Center, Providence Tarzana Medical Center
Practice name:
Center For Breast Care, Inc
Practice address:
191 S. Buena Vista #415
Burbank, CA
91505
Practice phone number:
818-333-2555
Webpage:
www.CFBCI.com
Twitter
http://twitter.com/#!/DrAttai
Personal Bio (My story)
Breast Surgeon, Advocate, Teacher, Author
DrAttai Activities
The stage of cancer is determined by the size of the tumor and the presence or absence of spread to the lymph nodes and other areas of the body. While often the stage can be estimated by imaging studies of the breast (such as mammogram, ultrasound, and MRI) or imaging of the body (such as CT scan, PET/CT scan, bone scan), the pathologic stage can only be determined after the tumor and lymph node(s) have been removed and have been evaluated by the pathologist. Examination under the microscope remains the most accurate way to determine if the cancer has spread to the underarm lymph nodes (assuming that they are not abnormally enlarged). If a woman has received chemotherapy prior to surgery, the "true" pathologic stage may never be known, as the tumor will often decrease significantly in size as a result of preoperative chemotherapy.
The stage of cancer is determined by the size of the tumor and the presence or absence of spread to the lymph nodes and other areas of the body. While often the stage can be estimated by imaging studies of the breast (such as mammogram, ultrasound, and MRI) or imaging of the body (such as CT scan, PET/CT scan, bone scan), the pathologic stage can only be determined after the tumor and lymph node(s) have been removed and have been evaluated by the pathologist. Examination under the microscope remains the most accurate way to determine if the cancer has spread to the underarm lymph nodes (assuming that they are not abnormally enlarged). If a woman has received chemotherapy prior to surgery, the "true" pathologic stage may never be known, as the tumor will often decrease significantly in size as a result of preoperative chemotherapy.
New answer by DrAttai (Physician - Surgery - Breast (Verified))
1
Answer |
14 days ago
There are many ways to perform risk assessment, and the most important is by taking a personal and family history. A prior breast biopsy, especially if it demonstrated "atypical hyperplasia", increases a woman's risk for the future development of breast cancer. Also the number of relatives who have had breast cancer, and their age at diagnosis, is also important. A history of other cancers in the family, especially ovarian cancer, may lead to a recommendation for BRCA gene testing.
There are various risk assessment models available - the most commonly used one is the Gail Model: http://www.cancer.gov/bcrisktool/ and it uses known risk factors such as age, age at first menstrual period and first term pregnancy, whether or not prior biopsies have been performed (and if so, was atypia present?), and family history. A disadvantage of the Gail model is that it only takes into account first-degree relatives (mother, sister, daughter) and it may underestimate the risk of disease in some women.
A form of genetic testing, known as the OnvoVue test, is a saliva test which assesses various genes involved in breast cancer development; results are reported as standard risk, moderately elevated, and significantly elevated - this test can help us determine if an otherwise asymptomatic woman might be at higher risk for the future development of breast cancer. Additional information on the OncoVue test can be found here - http://www.cancerriskassessment.com/what-is-oncovue-2.
Another form of risk assessment testing uses milk duct fluid (nipple aspirate fluid) to determine if there are abnormal cells present; the presence of abnormal cells or atypia would mean that a woman is at increased risk for the development of breast cancer and additional testing may be recommended.
Realize that no risk assessment test is a crystal ball - we do not at this point have the ability to predict with certainty if someone will or will not develop breast cancer. However they can help to identify women that might be at higher than average risk for which additional testing might be indicated. Additional information on risk assessment can be found here - http://www.cfbci.com/halo.html. There are many ways to perform risk assessment, and the most important is by taking a personal and family history. A prior breast biopsy, especially if it demonstrated "atypical hyperplasia", increases a woman's risk for the future development of breast cancer. Also the number of relatives who have had breast cancer, and their age at diagnosis, is also important. A history of other cancers in the family, especially ovarian cancer, may lead to a recommendation for BRCA gene testing.
There are various risk assessment models available - the most commonly used one is the Gail Model: http://www.cancer.gov/bcrisktool/ and it uses known risk factors such as age, age at first menstrual period and first term pregnancy, whether or not prior biopsies have been performed (and if so, was atypia present?), and family history. A disadvantage of the Gail model is that it only takes into account first-degree relatives (mother, sister, daughter) and it may underestimate the risk of disease in some women.
A form of genetic testing, known as the OnvoVue test, is a saliva test which assesses various genes involved in breast cancer development; results are reported as standard risk, moderately elevated, and significantly elevated - this test can help us determine if an otherwise asymptomatic woman might be at higher risk for the future development of breast cancer. Additional information on the OncoVue test can be found here - http://www.cancerriskassessment.com/what-is-oncovue-2.
Another form of risk assessment testing uses milk duct fluid (nipple aspirate fluid) to determine if there are abnormal cells present; the presence of abnormal cells or atypia would mean that a woman is at increased risk for the development of breast cancer and additional testing may be recommended.
Realize that no risk assessment test is a crystal ball - we do not at this point have the ability to predict with certainty if someone will or will not develop breast cancer. However they can help to identify women that might be at higher than average risk for which additional testing might be indicated. Additional information on risk assessment can be found here - http://www.cfbci.com/halo.html.
There are various risk assessment models available - the most commonly used one is the Gail Model: http://www.cancer.gov/bcrisktool/ and it uses known risk factors such as age, age at first menstrual period and first term pregnancy, whether or not prior biopsies have been performed (and if so, was atypia present?), and family history. A disadvantage of the Gail model is that it only takes into account first-degree relatives (mother, sister, daughter) and it may underestimate the risk of disease in some women.
A form of genetic testing, known as the OnvoVue test, is a saliva test which assesses various genes involved in breast cancer development; results are reported as standard risk, moderately elevated, and significantly elevated - this test can help us determine if an otherwise asymptomatic woman might be at higher risk for the future development of breast cancer. Additional information on the OncoVue test can be found here - http://www.cancerriskassessment.com/what-is-oncovue-2.
Another form of risk assessment testing uses milk duct fluid (nipple aspirate fluid) to determine if there are abnormal cells present; the presence of abnormal cells or atypia would mean that a woman is at increased risk for the development of breast cancer and additional testing may be recommended.
Realize that no risk assessment test is a crystal ball - we do not at this point have the ability to predict with certainty if someone will or will not develop breast cancer. However they can help to identify women that might be at higher than average risk for which additional testing might be indicated. Additional information on risk assessment can be found here - http://www.cfbci.com/halo.html. There are many ways to perform risk assessment, and the most important is by taking a personal and family history. A prior breast biopsy, especially if it demonstrated "atypical hyperplasia", increases a woman's risk for the future development of breast cancer. Also the number of relatives who have had breast cancer, and their age at diagnosis, is also important. A history of other cancers in the family, especially ovarian cancer, may lead to a recommendation for BRCA gene testing.
There are various risk assessment models available - the most commonly used one is the Gail Model: http://www.cancer.gov/bcrisktool/ and it uses known risk factors such as age, age at first menstrual period and first term pregnancy, whether or not prior biopsies have been performed (and if so, was atypia present?), and family history. A disadvantage of the Gail model is that it only takes into account first-degree relatives (mother, sister, daughter) and it may underestimate the risk of disease in some women.
A form of genetic testing, known as the OnvoVue test, is a saliva test which assesses various genes involved in breast cancer development; results are reported as standard risk, moderately elevated, and significantly elevated - this test can help us determine if an otherwise asymptomatic woman might be at higher risk for the future development of breast cancer. Additional information on the OncoVue test can be found here - http://www.cancerriskassessment.com/what-is-oncovue-2.
Another form of risk assessment testing uses milk duct fluid (nipple aspirate fluid) to determine if there are abnormal cells present; the presence of abnormal cells or atypia would mean that a woman is at increased risk for the development of breast cancer and additional testing may be recommended.
Realize that no risk assessment test is a crystal ball - we do not at this point have the ability to predict with certainty if someone will or will not develop breast cancer. However they can help to identify women that might be at higher than average risk for which additional testing might be indicated. Additional information on risk assessment can be found here - http://www.cfbci.com/halo.html.
New answer by DrAttai (Physician - Surgery - Breast (Verified))
1
Answer |
14 days ago
Most of the time the breast surgeon will want to review all of your records, so make sure you have all reports from mammograms, ultrasound, MRI exams, and any biopsy pathology. In addition, most breast surgeons will want to view the actual films (often they are provided on a CD), not just the reports. Your history will be taken and questions will be asked not only about the current problem, but of any other breast-related problem. Other medical history and family history will also be reviewed. A breast examination will also be performed and additional imaging such as ultrasound may also be performed.
When you make the appointment, ask if there is paperwork that you can fill out ahead of time; many of our patients find it helpful to fill out their paperwork in consultation with another family member so that important medical conditions and family history are included. Providing your surgeon with as much information as possible will ensure that you receive a thorough consultation. Most of the time the breast surgeon will want to review all of your records, so make sure you have all reports from mammograms, ultrasound, MRI exams, and any biopsy pathology. In addition, most breast surgeons will want to view the actual films (often they are provided on a CD), not just the reports. Your history will be taken and questions will be asked not only about the current problem, but of any other breast-related problem. Other medical history and family history will also be reviewed. A breast examination will also be performed and additional imaging such as ultrasound may also be performed.
When you make the appointment, ask if there is paperwork that you can fill out ahead of time; many of our patients find it helpful to fill out their paperwork in consultation with another family member so that important medical conditions and family history are included. Providing your surgeon with as much information as possible will ensure that you receive a thorough consultation.
When you make the appointment, ask if there is paperwork that you can fill out ahead of time; many of our patients find it helpful to fill out their paperwork in consultation with another family member so that important medical conditions and family history are included. Providing your surgeon with as much information as possible will ensure that you receive a thorough consultation. Most of the time the breast surgeon will want to review all of your records, so make sure you have all reports from mammograms, ultrasound, MRI exams, and any biopsy pathology. In addition, most breast surgeons will want to view the actual films (often they are provided on a CD), not just the reports. Your history will be taken and questions will be asked not only about the current problem, but of any other breast-related problem. Other medical history and family history will also be reviewed. A breast examination will also be performed and additional imaging such as ultrasound may also be performed.
When you make the appointment, ask if there is paperwork that you can fill out ahead of time; many of our patients find it helpful to fill out their paperwork in consultation with another family member so that important medical conditions and family history are included. Providing your surgeon with as much information as possible will ensure that you receive a thorough consultation.
New answer by DrAttai (Physician - Surgery - Breast (Verified))
1
Answer |
14 days ago
No - many women have "lumpy" breasts which is usually related to the combination of glandular tissue and fatty tissue in the breast, but lumpy is not the same as dense. Breast density refers to the appearance of the breast tissue on imaging, usually mammogram. Dense breast tissue appears more "white" on mammogram, which makes it harder to detect cancer, also usually "white" on mammogram. Younger women naturally have dense breast tissue, but some women still have dense breast tissue even as they get older. Hormone therapy will maintain the dense breast appearance on mammogram.
Women with dense breast tissue on imaging are at higher risk for the future development of breast cancer, and as mammograms may miss more cancers in women with dense breast tissue, additional imaging such as ultrasound or MRI may be helpful. No - many women have "lumpy" breasts which is usually related to the combination of glandular tissue and fatty tissue in the breast, but lumpy is not the same as dense. Breast density refers to the appearance of the breast tissue on imaging, usually mammogram. Dense breast tissue appears more "white" on mammogram, which makes it harder to detect cancer, also usually "white" on mammogram. Younger women naturally have dense breast tissue, but some women still have dense breast tissue even as they get older. Hormone therapy will maintain the dense breast appearance on mammogram.
Women with dense breast tissue on imaging are at higher risk for the future development of breast cancer, and as mammograms may miss more cancers in women with dense breast tissue, additional imaging such as ultrasound or MRI may be helpful.
Women with dense breast tissue on imaging are at higher risk for the future development of breast cancer, and as mammograms may miss more cancers in women with dense breast tissue, additional imaging such as ultrasound or MRI may be helpful. No - many women have "lumpy" breasts which is usually related to the combination of glandular tissue and fatty tissue in the breast, but lumpy is not the same as dense. Breast density refers to the appearance of the breast tissue on imaging, usually mammogram. Dense breast tissue appears more "white" on mammogram, which makes it harder to detect cancer, also usually "white" on mammogram. Younger women naturally have dense breast tissue, but some women still have dense breast tissue even as they get older. Hormone therapy will maintain the dense breast appearance on mammogram.
Women with dense breast tissue on imaging are at higher risk for the future development of breast cancer, and as mammograms may miss more cancers in women with dense breast tissue, additional imaging such as ultrasound or MRI may be helpful.
New answer by DrAttai (Physician - Surgery - Breast (Verified)) in topic(s) Breast Cancer, Breast Cancer Risk Factors, Cancer Risk Factors, Breast Density, Lumpy Breasts, Breasts
1
Answer |
1 month ago
Metastatic breast cancer means that the breast cancer has spread outside of the breast and outside of the underarm (axillary) lymph nodes. The most common sites of spread are to lymph nodes above the clavicle, in the chest, and to the lung, liver, bones, and brain. Metastatic breast cancer, or Stage IV breast cancer, is not considered curable, but modern treatments do allow for much longer survival with a better quality of life than older treatment regimens.
Metastatic breast cancer means that the breast cancer has spread outside of the breast and outside of the underarm (axillary) lymph nodes. The most common sites of spread are to lymph nodes above the clavicle, in the chest, and to the lung, liver, bones, and brain. Metastatic breast cancer, or Stage IV breast cancer, is not considered curable, but modern treatments do allow for much longer survival with a better quality of life than older treatment regimens.
New answer by DrAttai (Physician - Surgery - Breast (Verified)) in topic(s) Breast Cancer, Metastatic Breast Cancer, Breast Cancer Types, Metastatic Cancer
1
Answer |
1 month ago
Stage 0 Breast cancer is also known as Ductal Carcinoma In-Situ, or DCIS. This means that the cancer cells are filling the milk ducts, but have not broken through the lining or wall of the milk duct. This means that the cancer generally does not have the potential to spread to other areas of the body. DCIS can be quite extensive throughout the breast however and sometimes mastectomy is needed. In addition, DCIS can be harder to detect on mammogram, ultrasound, or MRI, and often the extent of disease is underestimated by imaging.
Stage 0 Breast cancer is also known as Ductal Carcinoma In-Situ, or DCIS. This means that the cancer cells are filling the milk ducts, but have not broken through the lining or wall of the milk duct. This means that the cancer generally does not have the potential to spread to other areas of the body. DCIS can be quite extensive throughout the breast however and sometimes mastectomy is needed. In addition, DCIS can be harder to detect on mammogram, ultrasound, or MRI, and often the extent of disease is underestimated by imaging.
New answer by DrAttai (Physician - Surgery - Breast (Verified)) in topic(s) Breast Cancer, Breast Cancer Stage, Cancer Stage, Stage 0 Breast Cancer, Cancer
1
Answer |
1 month ago
Breast cysts are completely benign, in other words, not related to breast cancer. Think of them like little "water balloons" in the breast - they develop due to enlargement of an area of the milk duct that fills with fluid. They will often enlarge and may become painful right before the menstrual period, and then often decrease without any intervention. An ultrasound can be used to ensure that a lump is indeed a fluid filled cyst and not a solid tumor. "Simple" cysts, which have a thin wall and no solid growth associated with them can safely be observed, but sometimes fine needle aspiration is recommended if a cyst is large or painful.
Breast cysts are completely benign, in other words, not related to breast cancer. Think of them like little "water balloons" in the breast - they develop due to enlargement of an area of the milk duct that fills with fluid. They will often enlarge and may become painful right before the menstrual period, and then often decrease without any intervention. An ultrasound can be used to ensure that a lump is indeed a fluid filled cyst and not a solid tumor. "Simple" cysts, which have a thin wall and no solid growth associated with them can safely be observed, but sometimes fine needle aspiration is recommended if a cyst is large or painful.
New answer by DrAttai (Physician - Surgery - Breast (Verified)) in topic(s) Breast Cancer, Breast Cysts, Breast Cancer Risk Factors, Cancer Risk Factors, Breast Cancer Risk, Cysts, Cancer
1
Answer |
1 month ago
It depends on the patient and if reconstruction is performed, and what type of reconstruction. If a mastectomy without reconstruction is performed, usually a 24-48 hour hospital stay is required, and a patient is discharged with drainage tubes in place. The drains are usually removed after about 7-10 days, but may stay in place longer depending on the amount of fluid that is being produced. Overall recovery in terms of return to work and other normal activities can take anywhere from 2-3 weeks up to 6-8 weeks.
If reconstruction is performed using tissue expanders or implants, the recovery is similar to that of a mastectomy without reconstruction but the initial pain is usually more as the tissue expanders or implants are placed underneath the pectoralis muscle. If reconstruction using muscle or fatty tissue is performed, the hospital stay is usually 3-5 days, and may include an intensive care unit stay; overall recovery is typically 6-8 weeks and sometimes longer. It depends on the patient and if reconstruction is performed, and what type of reconstruction. If a mastectomy without reconstruction is performed, usually a 24-48 hour hospital stay is required, and a patient is discharged with drainage tubes in place. The drains are usually removed after about 7-10 days, but may stay in place longer depending on the amount of fluid that is being produced. Overall recovery in terms of return to work and other normal activities can take anywhere from 2-3 weeks up to 6-8 weeks.
If reconstruction is performed using tissue expanders or implants, the recovery is similar to that of a mastectomy without reconstruction but the initial pain is usually more as the tissue expanders or implants are placed underneath the pectoralis muscle. If reconstruction using muscle or fatty tissue is performed, the hospital stay is usually 3-5 days, and may include an intensive care unit stay; overall recovery is typically 6-8 weeks and sometimes longer.
If reconstruction is performed using tissue expanders or implants, the recovery is similar to that of a mastectomy without reconstruction but the initial pain is usually more as the tissue expanders or implants are placed underneath the pectoralis muscle. If reconstruction using muscle or fatty tissue is performed, the hospital stay is usually 3-5 days, and may include an intensive care unit stay; overall recovery is typically 6-8 weeks and sometimes longer. It depends on the patient and if reconstruction is performed, and what type of reconstruction. If a mastectomy without reconstruction is performed, usually a 24-48 hour hospital stay is required, and a patient is discharged with drainage tubes in place. The drains are usually removed after about 7-10 days, but may stay in place longer depending on the amount of fluid that is being produced. Overall recovery in terms of return to work and other normal activities can take anywhere from 2-3 weeks up to 6-8 weeks.
If reconstruction is performed using tissue expanders or implants, the recovery is similar to that of a mastectomy without reconstruction but the initial pain is usually more as the tissue expanders or implants are placed underneath the pectoralis muscle. If reconstruction using muscle or fatty tissue is performed, the hospital stay is usually 3-5 days, and may include an intensive care unit stay; overall recovery is typically 6-8 weeks and sometimes longer.
New answer by DrAttai (Physician - Surgery - Breast (Verified)) in topic(s) Surgery Recovery, Breast Cancer, Recovery, Breast Surgery, Surgery, Mastectomy, Breast Surgery Recovery, Cancer
1
Answer |
1 month ago
The HALO test is a way to obtain fluid from the nipple which then can be analyzed to see if there are any abnormal, or atypical cells. Cellular atypia is a risk factor for the future development of breast cancer, and patients who have atypia usually are followed more closely. The HALO test is not a substitute for mammogram or other imaging as it is not meant to diagnose breast cancer - it is a way to determine if a woman might be at increased risk and therefore might need additional imaging. The HALO test is typically used in women under the age of 40, who are not yet undergoing routine screening with mammography.
The HALO test is a way to obtain fluid from the nipple which then can be analyzed to see if there are any abnormal, or atypical cells. Cellular atypia is a risk factor for the future development of breast cancer, and patients who have atypia usually are followed more closely. The HALO test is not a substitute for mammogram or other imaging as it is not meant to diagnose breast cancer - it is a way to determine if a woman might be at increased risk and therefore might need additional imaging. The HALO test is typically used in women under the age of 40, who are not yet undergoing routine screening with mammography.
The HALO test is a way to obtain fluid from the nipple which then can be analyzed to see if there are any abnormal, or atypical cells. Cellular atypia is a risk factor for the future development of breast cancer, and patients who have atypia usually are followed more closely. The HALO test is not a substitute for mammogram or other imaging as it is not meant to diagnose breast cancer - it is a way to determine if a woman might be at increased risk and therefore might need additional imaging. The HALO test is typically used in women under the age of 40, who are not yet undergoing routine screening with mammography.
New answer by DrAttai (Physician - Surgery - Breast (Verified)) in topic(s) Breast Cancer Tests, HALO, Breast Cancer, Breast Cancer Risk, Cancer Tests, HALO Test
1
Answer |
1 month ago
Most often a woman will see a breast surgeon early in the process - either before diagnosis as many breast surgeons perform their own minimally invasive biopsies, or shortly after diagnosis. The breast surgeon will usually consult with the medical oncologist, radiation oncologist and plastic surgeon and the specialists will all work as a team to determine the breast treatment approach for a patient.
Most often a woman will see a breast surgeon early in the process - either before diagnosis as many breast surgeons perform their own minimally invasive biopsies, or shortly after diagnosis. The breast surgeon will usually consult with the medical oncologist, radiation oncologist and plastic surgeon and the specialists will all work as a team to determine the breast treatment approach for a patient.
New answer by DrAttai (Physician - Surgery - Breast (Verified)) in topic(s) Cancer Treatment Process, Breast Surgeon, Breast Cancer Treatment Process, Treatment Process, Breast Cancer Surgeon, Breast Cancer Process
1
Answer |
1 month ago
How often do women undergo immediate breast reconstruction versus waiting for a while after surgery?
This may be a woman's individual choice - if a woman is a candidate for immediate reconstruction, she may have a preference regarding the timing of the surgery. Some prefer to undergo the mastectomy and other treatment first, delaying the reconstruction, while some women like the idea of having a large part of the reconstruction performed at the time of the mastectomy. Some patients with more aggressive tumors are not candidates for immediate reconstruction, but if the woman has a choice, it is really an individual decision.
This may be a woman's individual choice - if a woman is a candidate for immediate reconstruction, she may have a preference regarding the timing of the surgery. Some prefer to undergo the mastectomy and other treatment first, delaying the reconstruction, while some women like the idea of having a large part of the reconstruction performed at the time of the mastectomy. Some patients with more aggressive tumors are not candidates for immediate reconstruction, but if the woman has a choice, it is really an individual decision.
New answer by DrAttai (Physician - Surgery - Breast (Verified)) in topic(s) Cancer Treatment Process, Breast Cancer, Breast Surgery, Breast Reconstruction Process, Breast Cancer Treatment Process, Breast Reconstruction
1
Answer |
1 month ago
Full preparation includes review of all imaging studies such as mammogram, ultrasound, and MRI, as well as consultation with appropriate specialists such as the medical oncologist, radiation oncologist, and plastic surgeon. Of course reviewing all options with the patient and making sure she is understands her treatment options and is comfortable with her decision is of utmost importance.
Full preparation includes review of all imaging studies such as mammogram, ultrasound, and MRI, as well as consultation with appropriate specialists such as the medical oncologist, radiation oncologist, and plastic surgeon. Of course reviewing all options with the patient and making sure she is understands her treatment options and is comfortable with her decision is of utmost importance.
New answer by DrAttai (Physician - Surgery - Breast (Verified)) in topic(s) Breast Surgeon, Breast Cancer, Surgeon, Breast Surgery, Surgery
1
Answer |
1 month ago
I would reinforce Dr. Moore's answer that not all breast findings need an MRI. There is no way that any of us can tell based on the information provided whether or not an MRI or other imaging will be helpful or necessary in this case - an understanding of the patient's clinical situation as well as review of the mammograms and any available pathology reports is necessary. In general, calcifications do not show up on MRI. There is no question that there are cancers that will show up on MRI that are missed by other imaging, but again each case needs to be properly evaluated before a blanket recommendation for MRI is made. There is no best imaging test for the breast, but that also does not mean that every test should be done in every person.
Calcifications are very commonly seen in the breast. More than 50% of all mammograms performed have calcifications. The vast majority of them are related to benign or "normal" things. Surgery is one of the things that can produce calcifications. According to a recent Medscape article "high quality mammography is the best diagnostic tool for the identification of breast calcifications." When we interpret mammograms we characterize calcifications in terms of their their shape, number, distribution and size. We then categorize them as normal, benign, probably benign, or suspicious. Suspicious calcifications are biopsied, even though there is no palpable lump, or breast pain, or any other findings.
In one study 300 biopsies were performed on suspicious calcifications and only 100 of them were cancers. So even those that look suspicious are not always related to cancer.
MRI of the breast is a very sensitive test that is not always specific. If you have a lump that is palpable, or is seen on mammography or ultrasound, MRI may help. It can also find unsuspected small lesions as part of preoperative planning. MRI is not good at looking at calcification. Could MRI show you something really small that is in the area of the calcifications that is not seen on other tests? Possibly, but if the calcifications are in the area of the surgery MRI might be abnormal anyway, and more difficult to interpret.
Every case is different and every medical decision is made in the context of that patient's personal and family history, physical findings,and all imaging results. Patients are best served when they have a doctor who listens to them and whom they trust. Decisions are then made together. Unfortunately medicine is not an exact science, and our knowledge is still incomplete, in spite of the advances we have made.
In one study 300 biopsies were performed on suspicious calcifications and only 100 of them were cancers. So even those that look suspicious are not always related to cancer.
MRI of the breast is a very sensitive test that is not always specific. If you have a lump that is palpable, or is seen on mammography or ultrasound, MRI may help. It can also find unsuspected small lesions as part of preoperative planning. MRI is not good at looking at calcification. Could MRI show you something really small that is in the area of the calcifications that is not seen on other tests? Possibly, but if the calcifications are in the area of the surgery MRI might be abnormal anyway, and more difficult to interpret.
Every case is different and every medical decision is made in the context of that patient's personal and family history, physical findings,and all imaging results. Patients are best served when they have a doctor who listens to them and whom they trust. Decisions are then made together. Unfortunately medicine is not an exact science, and our knowledge is still incomplete, in spite of the advances we have made.
New answer by DrAttai (Physician - Surgery - Breast (Verified)) in topic(s) Calcifications, Breast Cancer Screening, PET Scan (Positron Emission Tomography), Breast Calcifications, Breast Cancer Risk, Mammogram, Breast Imaging
5
Answers |
2 months ago
Recurrence and survival statistics are based on historical studies as well as more current clinical trial results. It is important for an individual patient to realize that they are not a statistic, and that recurrence and survival rates can never be predicted with complete accuracy in a given patient. My recommendation is to be aware of the statistics as they pertain to your individual case, but do not hang all your hopes and fears on those numbers.
Recurrence and survival statistics are based on historical studies as well as more current clinical trial results. It is important for an individual patient to realize that they are not a statistic, and that recurrence and survival rates can never be predicted with complete accuracy in a given patient. My recommendation is to be aware of the statistics as they pertain to your individual case, but do not hang all your hopes and fears on those numbers.
New answer by DrAttai (Physician - Surgery - Breast (Verified)) in topic(s) Breast Cancer Survival Rates, Breast Cancer Recurrence, Cancer Survival, Breast Cancer Survival Statistics, Survival Rates, Breast Cancer Survival, Breast Cancer Recurrence Rates, Cancer Statistics, Cancer, Breast Cancer Recurrence Statistics, Breast Cancer Statistics, Recurrence Rates, Breast Cancer, Cancer Survival Rates, Statistics, Cancer Recurrence Rates
1
Answer |
2 months ago
In general, the earlier the stage of diagnosis, the lower the risk of recurrence. However, with breast cancer or any cancer, we can never really say that a patient is truly “cured” – sometimes “NED” – no evidence of disease – is the best we can do. We do not yet have the ability to detect individual metastatic cells which may be slowly growing, only to show up on a scan years later. We are also learning more about breast cancer and while the stage at initial diagnosis is important, the biologic behavior, or aggressiveness of the cancer, may be even more important in terms of assessing an individual patient’s risk of recurrence.
In general, the earlier the stage of diagnosis, the lower the risk of recurrence. However, with breast cancer or any cancer, we can never really say that a patient is truly “cured” – sometimes “NED” – no evidence of disease – is the best we can do. We do not yet have the ability to detect individual metastatic cells which may be slowly growing, only to show up on a scan years later. We are also learning more about breast cancer and while the stage at initial diagnosis is important, the biologic behavior, or aggressiveness of the cancer, may be even more important in terms of assessing an individual patient’s risk of recurrence.
New answer by DrAttai (Physician - Surgery - Breast (Verified)) in topic(s) Cancer Cure, Cure, Survivorship, Breast Cancer, Breast Cancer Cure, Cancer
1
Answer |
2 months ago
The duration of treatment is very variable, depending on the exact type of cancer, the biologic behavior of the cancer (how aggressive it is), and the stage of diagnosis. Some cases of breast cancer, especially low-grade DCIS, may be treated by surgery alone; some cases of breast cancer are treated with a combination of surgery, chemotherapy, radiation therapy, and anti-estrogen therapy. Radiation therapy, if needed is now able to be administered in several ways, including intraoperative therapy, accelerated partial-breast irradiation, accelerated whole-breast irradiation, and standard whole breast therapy – with the newer forms of more concentrated therapy, the duration of treatment is often significantly reduced. There are multiple chemotherapy and targeted therapy regimens, which may range in duration from several months to years. In some cases of metastatic disease, continued maintenance chemotherapy is required.
The duration of treatment is very variable, depending on the exact type of cancer, the biologic behavior of the cancer (how aggressive it is), and the stage of diagnosis. Some cases of breast cancer, especially low-grade DCIS, may be treated by surgery alone; some cases of breast cancer are treated with a combination of surgery, chemotherapy, radiation therapy, and anti-estrogen therapy. Radiation therapy, if needed is now able to be administered in several ways, including intraoperative therapy, accelerated partial-breast irradiation, accelerated whole-breast irradiation, and standard whole breast therapy – with the newer forms of more concentrated therapy, the duration of treatment is often significantly reduced. There are multiple chemotherapy and targeted therapy regimens, which may range in duration from several months to years. In some cases of metastatic disease, continued maintenance chemotherapy is required.
New answer by DrAttai (Physician - Surgery - Breast (Verified)) in topic(s) What To Expect, Cancer Treatment Process, Breast Cancer, Cancer Process, Breast Cancer Treatment, Breast Cancer Treatment Process, Treatment, Cancer Treatment, Breast Cancer Process
1
Answer |
2 months ago
Noninvasive means that the cancer cells have not spread or penetrated through the basement membrane - the thin layer that lines the milk ducts and lobules. An invasive cancer occurs when the basement membrane is disrupted by the invading cancer cells; those cancer cells then have the potential to invade blood vessels or lymphatic vessels.
Ductal carcinoma in-situ (DCIS), is considered Stage 0 – the cancer cells have not invaded the basement membrane. Lobular carcinoma in-situ (LCIS) is not actually considered a cancer, despite the name, and many now refer to this condition as “lobular neoplasia” to avoid confusion. Patients with LCIS often do require surgical excision, but generally are not treated with additional therapy such as radiation therapy or chemotherapy. However patients with LCIS are at a significantly increased risk for the future development of breast cancer (in-situ or invasive) in either breast, so often anti-estrogen medication such as tamoxifen or an aromatase inhibitor may be recommended for risk reduction. In addition, increased surveillance may be indicated in these patients.
Noninvasive means that the cancer cells have not spread or penetrated through the basement membrane - the thin layer that lines the milk ducts and lobules. An invasive cancer occurs when the basement membrane is disrupted by the invading cancer cells; those cancer cells then have the potential to invade blood vessels or lymphatic vessels.
Ductal carcinoma in-situ (DCIS), is considered Stage 0 – the cancer cells have not invaded the basement membrane. Lobular carcinoma in-situ (LCIS) is not actually considered a cancer, despite the name, and many now refer to this condition as “lobular neoplasia” to avoid confusion. Patients with LCIS often do require surgical excision, but generally are not treated with additional therapy such as radiation therapy or chemotherapy. However patients with LCIS are at a significantly increased risk for the future development of breast cancer (in-situ or invasive) in either breast, so often anti-estrogen medication such as tamoxifen or an aromatase inhibitor may be recommended for risk reduction. In addition, increased surveillance may be indicated in these patients.
Ductal carcinoma in-situ (DCIS), is considered Stage 0 – the cancer cells have not invaded the basement membrane. Lobular carcinoma in-situ (LCIS) is not actually considered a cancer, despite the name, and many now refer to this condition as “lobular neoplasia” to avoid confusion. Patients with LCIS often do require surgical excision, but generally are not treated with additional therapy such as radiation therapy or chemotherapy. However patients with LCIS are at a significantly increased risk for the future development of breast cancer (in-situ or invasive) in either breast, so often anti-estrogen medication such as tamoxifen or an aromatase inhibitor may be recommended for risk reduction. In addition, increased surveillance may be indicated in these patients.
Noninvasive means that the cancer cells have not spread or penetrated through the basement membrane - the thin layer that lines the milk ducts and lobules. An invasive cancer occurs when the basement membrane is disrupted by the invading cancer cells; those cancer cells then have the potential to invade blood vessels or lymphatic vessels.
Ductal carcinoma in-situ (DCIS), is considered Stage 0 – the cancer cells have not invaded the basement membrane. Lobular carcinoma in-situ (LCIS) is not actually considered a cancer, despite the name, and many now refer to this condition as “lobular neoplasia” to avoid confusion. Patients with LCIS often do require surgical excision, but generally are not treated with additional therapy such as radiation therapy or chemotherapy. However patients with LCIS are at a significantly increased risk for the future development of breast cancer (in-situ or invasive) in either breast, so often anti-estrogen medication such as tamoxifen or an aromatase inhibitor may be recommended for risk reduction. In addition, increased surveillance may be indicated in these patients.
New answer by DrAttai (Physician - Surgery - Breast (Verified)) in topic(s) Breast Cancer, Non-invasive Breast Cancer, Stage 0 Breast Cancer, Cancer
1
Answer |
2 months ago
The type of breast cancer is generally determined by the microscopic appearance of the tumor. When the pathologist examines the tissue, either from a needle core biopsy or surgical excision, they make a determination if the cells are ductal or lobular in origin, and whether or not invasion is present. There are times when it is difficult to tell exactly what type of cancer is present – breast cancers can have a variable appearance and the diagnosis is not always obvious by the initial microscopic appearance. A variety of special stains may be used, and these additional tests can confirm if a tumor is ductal or lobular (some cancers are “mixed” , having features of both cell types), of if invasion is present or not.
The type of breast cancer is generally determined by the microscopic appearance of the tumor. When the pathologist examines the tissue, either from a needle core biopsy or surgical excision, they make a determination if the cells are ductal or lobular in origin, and whether or not invasion is present. There are times when it is difficult to tell exactly what type of cancer is present – breast cancers can have a variable appearance and the diagnosis is not always obvious by the initial microscopic appearance. A variety of special stains may be used, and these additional tests can confirm if a tumor is ductal or lobular (some cancers are “mixed” , having features of both cell types), of if invasion is present or not.
New answer by DrAttai (Physician - Surgery - Breast (Verified)) in topic(s) Cancer Type, Breast Cancer, Pathology, Breast Cancer Type, Breast Cancer Pathology, Cancer Pathology, Cancer
1
Answer |
2 months ago
I have certainly gotten an education on this one! "Gluten-Free" on the label does not necessarily mean healthy - you really need to read the labels carefully. When I was first transitioning my diet, I purchased many prepared gluten-free foods, only to find that many were full of fat, sodium, and preservatives; and many were severely lacking in taste! So I started cooking, of all things...I'm currently working on bread, and now have 2 recipes for hearty whole-grain breads that are gluten-free and with a little patients (and a stand mixer) have been relatively straightforward to prepare. And the taste is so much better than any of the prepared breads I've tried - and I've tried most of them. The mixes are easy, but as you've found, they're not cheap. Here's a link to a guest blog post from a few months ago detailing my transition : http://www.morrisonhealth.com/blog/health/dr-attais-gluten-free-diet
I don't think that a gluten-free diet is for everyone, but for me the health benefits have been amazing. However as I mentioned previously, I would not recommend it specifically to reduce the risk of developing cancer.
DrAttai (Physician - Surgery - Breast (Verified)) replied to answer by member8738 (High Risk Individual)
2
Answers |
2 months ago
Unfortunately, a lot of the studies are either looking at either DCIS or invasive cancer; many of the studies looking at invasive cancer do not necessarily differentiate between size of the cancer (except for T1 tumors <2cm or T2 tumors 2-5cm) and many of the older studies did not stratify for the biologic behavior of a cancer, such as ER/PR and Her2/neu status. In addition, you are correct that modern use of anti-estrogen medications such as tamoxifen and aromatase inhibitors will further reduce the risk of recurrence.
The NSABP B-06 trial, published in 1984, demonstrated no difference in survival in women who underwent modified radical mastectomy (removal of the breast and underarm lymph nodes but not the pectoralis muscle), lumpectomy, axillary dissection, and postoperative radiation, or lumpectomy without radiation therapy. However, the lumpectomy alone group did have a higher rate of local recurrence (39% compared to 14%), which gives the rational for our current practice of post-lumpectomy radiation (http://www.clinmedres.org/content/1/4/309.full). Some overview analyses have demonstrated that local recurrence does result in an increased mortality over a long period of follow up (http://www.ncbi.nlm.nih.gov/sites/entrez/16360786?dopt=Abstract&holding=f1000,f1000m,isrctn). The NCCN guidelines do discuss certain subsets of women that may be able to avoid radiation therapy (http://www.nccn.com/files/cancer-guidelines/breast/index.html#/68/).
There is no doubt that radiation therapy, surgery, and our other treatments cause harm and unfortunately, we are not always able to predict (in terms of radiation-related complications) who will develop a firm fibrotic painful breast, who will develop lymphedema as a result of the therapy, and other potential complications. As we learn more about the biology of an individual woman's specific cancer, we should be able to provide more detailed counseling to a woman regarding HER specific tumor, HER risk of recurrence, and then make decisions about what treatment will provide the best option for long-term disease free and overall survival with a minimal or acceptable risk of complications.
3
Answers |
3 months ago
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