FAQ

1. My doctor is sending me to a breast surgeon. Does this mean that I have cancer?

Not necessarily. Your physician is concerned about your breast health, or is encountering something outside of his or her “comfort zone.” Or, it could mean simply that your physician feels that you deserve the care of a specialist.

2.  What is Breast Cancer?

Breast cancer, plainly defined, is breast cells which grow out of control.

Normally, there are genes in every cell of every organ which regulate cell growth, as well as keeping the cells healthy.  There are also genes that specifically “tell” cells when they have lived their life and should die.  Abnormal changes (aka mutations) in these genes can cause uncontrolled division and growth of the cells.  This leads to a growth or mass.

Not all masses are cancerous.  We call them benign when the cells divide rather slowly, or when the mass is not invasive, does not spread to other parts of the body, and the cells look close to the normal appearance.  When the mass contains cells that look abnormal, which divide rapidly or invade other tissues, we call the mass malignant, or cancerous.  If these malignant masses are not controlled, the cells can spread to other parts of the body.

In the breast, cancer can occur in one of three places.
1.  the lobules = glands which produce milk
2.  the ducts = the structures which drain milk from the glands to the nipple
3.  the stroma = the fatty/ fibrous connective tissue of the breast (this is not as common)

Breast cancer is always due to a mutation in the cell’s genes.  The majority of breast cancer (more than 90%) is due to wear and tear due to aging, smoking, hormones, alcohol, stress, or simply a mistake that the cell made in making new genetic material.  The other 5-10% of breast cancers happen as a result of genetic mutations passed down by your mother or father.

Unfortunately, even when we try to stay as healthy as possible, breast cancer can still occur.  It is not helpful or worthwhile to blame yourself or those around you.  Cancer (of any kind) is under no circumstances anyone’s wrongdoing.  Please remove those thoughts from your head, and those words from your vocabulary.  We are here to help you move forward.

3.  What are the stages of breast cancer?

Staging of a cancer takes into account the size of the tumor, whether the tumor is invasive or not, if lymph nodes are involved, and if the cancer has spread (or metastasized) outside of the original organ (the breast, in this case).  The stage of a cancer helps your physicians to guide your care.

Stage 0:  the cancer cells are still inside the original location, with no invasion

Stage I:  the cancer is less than or equal to 2 centimeters (cm) and has not gone outside of the breast (the lymph nodes do not have cancer in them)

Stage IIA:  the cancer is 2-5 cm in size and has not spread to the lymph nodes
OR
the cancer is  less than or equal to 2cm, but has spread to the lymph nodes
OR
there is no cancer found in the breast itself, but there are cancer cells found in the lymph nodes

Stage IIB:  the cancer is 2-5 cm and in the lymph nodes
OR
the cancer is > 5cm, but is not in the lymph nodes

Stage IIIA
:  cancer is not found in the breast, but is found in the lymph nodes in the underarm.  These nodes are stuck together or to other structures (artery, vein, nerve).  Alternately, there is cancer found in the lymph nodes at the sternum (breastbone).
OR
cancer is any size and has spread to lymph nodes in the underarm, and those nodes are stuck together or to other structures, or cancer is in the lymph nodes near the sternum.

Stage IIIB
:  The cancer is any size and is found to have spread to the skin and/ or the chest wall.  There may be spread to the lymph nodes as in Stage IIIA.

Stage IIIC:  No cancer, or any size cancer, is found in the breast which has spread to the skin and/ or chest wall
AND
there is spread to the lymph nodes around the collarbone
AND
there may be cancer in the underarm lymph nodes or those near the sternum

Stage IV:  the cancer has spread to other body parts.  This is called metastasis.

With these explanations, you can see that sometimes it may be difficult to tell a patient what stage they are on initial assessment.  Often, we will give you a clinical stage, and later a pathological stage.  The two may be different.  This happens most often if your physician believes that there has been no spread of cancer outside of the breast, and upon surgical evaluation, it is found that the patient has lymph node involvement.

4.  What are breast cancer risks?  Is there anything I can do to decrease my risk?

Simply put, breast cancer risks are those things that can put you at risk of developing breast cancer.

The two biggest factors for developing breast cancer are gender (simply being a woman) and age.  As we age, our risk of developing breast cancer increases.

A few words about breast biology:

Our breasts are more inclined to cancer than any other organ because of their unique way of development. The breasts begin to develop while a fetus is still in the womb. Adolescence continues breast development, and breasts reach their final size when a woman is in her early twenties.

The part you may not realize is that although the breast shape may look mature, the CELLS inside the breast are not! They stay immature, and continue to develop and the cells divide until we carry through a pregnancy. It is only then that the breast cells actually mature and make milk.

Other risk factors that you cannot control:

your genetic makeup–if you have “the breast cancer gene” (BRCA 1 or 2)

personal history of breast cancer:  if your body knows how to make breast cancer once, it has a higher risk of making it another time than a woman who has never had breast cancer

family history of breast cancer:  even if you do not carry the BRCA gene, if a first degree relative has breast cancer, you may be at higher risk

radiation therapy to the chest:  ie: mantle radiation for Hodgkin’s lymphoma–specifically between the ages of 10 and 30

race:  we do not yet know why, but Caucasian women are slightly more likely than African Americans to develop breast cancer.  It also appears that Native Americans, Asians and Hispanics have a smaller risk of developing breast cancer.

breast findings:  if you have developed hyperplasia or atypical cells that were found on biopsy, you may have an increased risk of breast cancer

estrogen exposure:  menarche before age 12 and menopause after age 55 increases your body’s exposure to estrogen and your risk

pregnancy and breastfeeding:  this again has to do with exposure to estrogen, as these two entities decrease the number of menstrual cycles in one’s lifetime.  A woman who has never had a child, or had her first live birth older than age 30 has a higher risk of developing breast cancer.  There has been supporting information that breastfeeding decreases risk of breast cancer.

diethylstilbestrol (DES) exposure:  Women to whom this was administered (to prevent miscarriage) have a higher risk of breast cancer, as do the daughters of women who took DES while pregnant.

Risk factors that you can change:  keeping an active lifestyle (at least 3.5 hours of moderate exercise/ week), getting your BMI (body mass index) to between 18-25, STOP SMOKING!!, keep alcohol intake to no more than 5 drinks/ week, decrease your estrogen exposure (either by losing weight or by not taking hormone replacement therapy).

5. I have been diagnosed with breast cancer. Will I live to see my kids grow up… my grandchildren… my child’s high school graduation… next week?

Please be aware that, although this is a very general statement, and your individual case will be considered, but breast cancer is currently a very controllable disease. We have come a long way with detection, diagnosis and clearance.  In fact, because of our advances in breast cancer diagnosis and treatment, as well as increased awareness, death rates due to breast cancer have been declining since 1990.

At the same time, we need to understand that breast cancer is the cause of more cancer deaths in women in the U.S. than any other, except lung cancer.

Breast cancer is also the second most diagnosed cancer in women in the United States (skin cancer is first).  The most recent statistics state that 1 in 8 women will develop invasive breast carcinoma in their lifetime–this makes about 12% of women in the United States.

6. I have been diagnosed with breast cancer. Will I need chemotherapy?

This is a question that does not have a simple answer at this time. This is a great portion of research being done. When regarding our patients for therapy in addition to surgery, we look at the patient (age, risk factors, etc), as well as the cancer’s biology (aggressivity, size, lymph node spread, etc). Also, please be aware that medical therapies for breast cancer include pills such as Tamoxifen, Arimidex and others, as well as injectables.

Dr Bednarski and your medical oncologist will be happy to discuss this with you.

7. I have been diagnosed with breast cancer. Will I need radiation therapy?

Again, this depends on several factors. The type of surgery which you undergo is a big determinant here. (If you have a partial mastectomy=lumpectomy, you will likely need radiation therapy.) However, even those patients that undergo mastectomies sometimes will also need radiation therapy.

Dr Bednarski and your radiation oncologist will be happy to discuss this with you.

8. What does Dr. Bednarski think of “the mammogram controversy?”

In late 2009, there was a lot of talk about whether women under 50 really needed mammography, and how often mammography should be done. Dr. Bednarski believes that mammography is the best, easiest, and most cost-effective tool that we currently have for early breast cancer detection. Women less than 50 years old who get breast cancer tend to get a more aggressive variant of the disease. With that in mind, Dr. Bednarski agrees wholeheartedly with the American Society of Breast Disease, the American Society of Breast Surgeons, the American College of Surgeons, the American Cancer Society, and the American College of Radiologists guidelines: mammograms every year starting at age 40. Also recommended are self breast exams monthly starting at age 20. Finally, clinical breast exams (by your doctor or breast surgeon) are to be done every 3 years at age 20-39 and every year starting at 40 years of age.

On a related note, there is no such thing as an “unnecessary biopsy.” A breast biopsy is the only reliable way to rule out breast cancer.

9.  If I choose to undergo reconstruction for my breast cancer, will my insurance company pay?

In 1998, the Federal Breast Reconstruction Law was put into practice.  It is also called the “Women’s Health and Cancer Rights Act of 1998.”  Accordingly, per Illinois law (215 ILCS 5/356g) (from Ch. 73, par. 968g),

“Coverage for breast reconstruction in connection with a mastectomy shall include:
(1) reconstruction of the breast upon which the mastectomy has been performed;
(2) surgery and reconstruction of the other breast to produce a symmetrical appearance; and
(3) prostheses and treatment for physical complications at all stages of mastectomy, including lymphedemas.

Care shall be determined in consultation with the attending physician and the patient. The offered coverage for prosthetic devices and reconstructive surgery shall be subject to the deductible and coinsurance conditions applied to the mastectomy, and all other terms and conditions applicable to other benefits… As used in this Section, “mastectomy” means the removal of all or part of the breast for medically necessary reasons, as determined by a licensed physician.”

www.ilga.gov

10.  There seems to be a lot of hype about Vitamin D lately.  Is it worth it?

in a word:  YES!!

Vitamin D is actually a hormone, and it helps us in so many ways:

Cancer

Vitamin D works to regulate cell growth and differentiation:  if a cell becomes abnormal, vitamin D tries to normalize it.  If not, it kills the cell by blocking off its blood supply. If the body does not have enough Vitamin D, it cannot stop suspicious activity fast enough, and cancer can take over. Studies show a high level of Vitamin D may decrease the risk of breast, colorectal, prostate, lung and pancreatic cancers, and possibly lymphomas.  The jury is still out in ovarian, endometrial, or esophageal cancers. We do know that people with higher D levels have lower death rates in general.

Auto-Immune Diseases

Illnesses of the immune system (rheumatoid arthritis, lupus) could be reduced by vitamin D which appears to strengthen the immune system.  A strong immune system helps us to ward off infections, too.

Bone Disease

Vitamin D is super important for bone health!  It helps the intestinal absorption of calcium, as well as phosphate and magnesium.  Without Vitamin D, we cannot absorb dietary calcium.  So, it is a key mineral in staving off osteoporosis.  It is also great support for your muscles, and may help if you feel fatigued.

Depression

Still in debate, but it seems that your intake of Vitamin D helps to control mood disorders. We still are not sure how this works.  At least, there have been studies to show that low Vitamin D levels are associated with seasonal affective disorder and depression.

Heart Disease

There have been some small studies to show that low Vitamin D levels put you at a higher risk for coronary problems. Vitamin D has also been shown to help regulate blood pressure.

The dosage needed is still not firm, though most experts recommend a Vitamin D3 blood level between 30 to 100 ng/mL. We can check the level for you when you come to visit us.  If you have not yet had your level checked, and would like to start taking Vitamin D, we recommend you start with Vitamin D3 1000mg/day until you get your level checked–then we can adjust as necessary.

11. How can I get ready for my appointment with Dr Bednarski?

If you have undergone breast imaging (mammogram, ultrasound, MRI, etc), please obtain the two (2) most recent studies (original films and reports) and bring them with you to your appointment. **Please note: Your breast health cannot be evaluated without these materials, and your appointment may be rescheduled if necessary films are not brought to your consultation. With prior notice, Dr. Bednarski may make exceptions on an individual basis.**

If you had any other studies (ie: biopsy) at another facility, or with another provider other than Dr Bednarski, please bring those reports with you, as well.

12. Do I need a referral to see Dr Bednarski?

If you are unsure whether you need a referral, please contact your insurance company.

If your insurance company does require a physician referral, please obtain this and bring it with you, or have your doctor’s office fax it to us before your visit.

13. What should I do if I need to cancel my appointment?

Should you need to cancel or reschedule your appointment, kindly give us 24 hours advance notice, and we would be happy to help you.