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Breast Cancer

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SARA LOMAX-REESE:     And we're back. You are listening to Healthquest Live on 900 AM WURD. I am Sara Lomax-Reese and we are into the second segment of today's edition of Healthquest Live and right now we are joined by our Einstein docs, Dr. Donee Patterson, who is a family medicine physician and Dr. Lisa Jablon, who is a breast surgeon at Einstein. Welcome.

DONEE PATTERSON, MD: Thank you for having us. 

LISA JABLON, MD: Thank you.

LOMAX-REESE: Thank you both for being here. So Dr. Donee, you usually kind of get us set-up and lay the foundation for our conversation. We know that breast cancer is the most common cancer in women in the United States, aside from skin cancer. That's an interesting fact and we know that there's a peculiar kind of situation with African American women in particular that we don’t necessarily get it as much, but it is more deadly. We sometimes get it at an earlier age and a more lethal stage. So just lay the foundation for us. 

PATTERSON: Exactly. Thank you, Sara. So we always want to talk about medical conditions that we feel we can educate people about and help the WURD listeners to be healthier. That's always our goal. Because breast cancer is so common, in fact, one in eight women in their lifetime have a risk of getting breast cancer, we thought it was really important to talk about it today. So you are right that breast cancer is the second leading cause of cancer in the U.S. Skin cancer is first, but it is the second leading cause of death, as well, with lung cancer being the first. We really want people - the things that Dr. Jablon and I really want to emphasize today are that there are things that you can do, and just like almost every medical condition, early detection is key. So we want to emphasize to people to make sure that they get mammograms. We want them to know what age they should be getting mammograms and we want them to understand the exceptions and we want them not to be afraid. Those are the things we want to emphasize today. 

LOMAX-REESE: So Dr. Jablon, I want to know - because we hear a lot, of all the cancers we hear a lot about breast cancer. We see the pink ribbons. We see the walks. We have the breast cancer awareness month. I think sometimes people numb out to breast cancer and health information probably in general, but what is new? Is there anything that we don’t hear about all the time that we need to know? We know that we are supposed to get mammograms. We know we should probably do breast self-exams. We know that your risk increases over 40. What don’t we know. 

JABLON: Well, I guess, some things that are new are that we are doing a lot more in targeted therapy. So what I get from a lot of my patients is they ask me, why is it that I had a certain treatment and someone else did not and what we do nowadays is, we not only diagnose breast cancer in terms of what type it is, we also do a lot of different markers of cancer, things called hormone receptors or something else called HER-2 NEU and then we target our therapies for an individual based on those results, so it is not just everybody gets treated the same. 

LOMAX-REESE: So the treatment regimens have improved significantly over the years. 

JABLON: Absolutely.

LOMAX-REESE: I think that another message is, I guess, that breast cancer is not a death sentence.  

PATTERSON: Absolutely.

LOMAX-REESE: It's the early detection - because I actually was, I don’t know if I was watching or if I was just reading something about Minnie Riperton, who died at a very early age of breast cancer and back then it must've been, I don’t know, the 70's and it was like breast cancer was, you know, it seemed like it was a death sentence back then. 


LOMAX-REESE: It's evolved tremendously with, I guess, the awareness and the additional research and those kinds of things.  

PATTERSON: We are excited that there are 2.5 million breast cancer survivors in the U.S. We are excited about that. That's why we want people to know not to be afraid to get mammograms. I think you are absolutely right that people are kind of desensitized about diabetes. Sometimes they hear the education and they're like, yeah, I already know that, and the same with breast cancer, but I recently was doing some breast cancer talks and I was telling people don’t forget to get your mammogram, etcetera, etcetera. A woman recently came back to me and said, actually it was just this Saturday, she said to my husband, she said, you know I went to that talk and it reminded me to get my mammogram done and it had been about 13 months. I was late on my mammogram and I had breast cancer and now I am in treatment and that saved my life because if I hadn’t kept going it would have been spread and my doctors told me that they were really glad that I came in when I did.  

LOMAX-REESE: Well, I think that speaks to, there are definitely misconceptions about mammograms and maybe, Dr. Jablon, you can speak to that. Well, I don’t know if they're misconceptions or not, but there are beliefs around mammograms. One that it can actually increase, that getting the radiation can be harmful to the body and so some women say I don’t need that and I know that there are alternatives. They're more expensive and you probably have to pay out of pocket, but there are alternatives to the radiation of mammograms. Can you speak to some of those thoughts?

JABLON: Sure. Mammogram is still the best tool that we have in early detection and one of the things that you had mentioned earlier about a disparity that exists among African American women compared to Caucasian women is that Caucasian women are more apt to pick up their cancer in an earlier stage because they more often are getting their screening mammograms. If you pick up a cancer on a mammogram before it is palpable or feelable in the breast, then there is a much higher cure rate. Some of the disparities that exist among different populations have to do with just coming in for your mammogram. There are different kinds of mammograms. There's something called a digital mammogram, which is a little bit better, so if you have a choice of a place to go, I would go to a place that has a digital mammogram.  

LOMAX-REESE: Now why is it better? Why is the digital better? 

JABLON: Well, the digital is a different technique, in that it stores the films on a computer, rather then on a screen and they can manipulate the picture and for women who have dense breasts can manipulate the x-ray so that you can see through the tissue better. 

PATTERSON: Let me just be careful about the word manipulation. So we are not changing the image. We are just zeroing in, looking closer, so women with more dense breasts, so that we can see behind the shadows. 

LOMAX-REESE: Okay, so digital, request digital if they have it.

JABLON: Exactly and then there are other things that we do, other tests that we can order for women who are high risk, such as MRI or ultrasounds, but the problem with those other tests, it's not just the expense, even if you had all the money in the world, I am not sure it makes sense for a person to go out and have an MRI and the reason is they tend to be oversensitive. They fins a lot of things that aren’t cancer that look abnormal on the study and then that person ends up having a fair amount of anxiety as you work through figuring out what things are by doing biopsies, etcetera. We reserve those kinds of studies for specific problems or for women who are in a very, very high risk group, like somebody who carries a genetic mutation for breast cancer. That's the person we would probably send for an MRI.  

LOMAX-REESE: So what are the risk factors for breast cancer? Want to take that? Who wants to take that? Dr. Donee? 

PATTERSON: Sure. One of the major risk factors is just getting older. We know that the older you get the more likely you will be to have the instance of breast cancer, but also smoking. So if you smoke, you really need to stop smoking, need to find help some way, talk to your doctor, because it also increases your risk of breast cancer. There's high fat diets have been indicated, obesity because you have more estrogen when you are a higher weight. Dr. Jablon and I were just talking about many of the myths behind breast cancer, but some of them really don’t pan out, but those are some of the major ones.

LOMAX-REESE: What about breast feeding? Does that have any impact on your propensity for breast cancer? Dr. Jablon?

JABLON: Not really. There have been a few studies that maybe show that breast feeding is protective and then there are some other studies that didn’t really pan out in terms of showing that. I don’t think it is harmful to breast feed. It is certainly good for the baby, but I don’t think that will really offer you much protection. 

LOMAX-REESE: What about - and I want to invite callers. If you have a question about breast cancer or breast health for Dr. Lisa Jablon or Dr. Donee Patterson the number is 215-634-8065, toll free 866-361-0900. This whole issue of fibrocystic breasts, which I think a lot of women have and it can create some anxiety because if you feel, if you do the breast self-exam, it may feel kind of lumpy or what have you, and then you might get a mammogram and they say, well, you need to get an ultrasound or we need to do x, y, and z. What's going on with fibrocystic breasts? 

PATTERSON: Well, the breast tissue by nature is lumpy. They're the breast glands. They are the ducts that are present so that a woman can breastfeed later in life. Some breasts tend to be more lumpy then others and there's a genetic component where it runs in the family, just breasts are lumpier then others, but it doesn’t mean that every lump is breast cancer, but we do want women to take those lumps seriously and understand their breasts and then come to their doctor with their questions and then the doctor and the patient, we can work it out. Some women just know that they have lumpy breasts and they've talked to their doctor about it and they have had thorough exams and then if they find anything different then we want them to come back to us. Right, Dr. Jablon? 

LOMAX-REESE: And I was told that caffeine can sometimes exacerbate or make fibrocystic breasts more lumpy or whatever you want to call it. 

JABLON: I think that's more of a myth…

LOMAX-REESE: That's a myth?

JABLON: …then a reality. Yes. 


JABLON: It used to be we thought there was something in caffeine, methylxanthine, that would cause different problems with breakdown of your estrogen, but there haven’t been a lot of good studies that show that caffeine has anything to do with your breasts and certainly not a risk for cancer. 

LOMAX-REESE: Okay, so all you coffee drinkers, drink up. We are going to take a quick break and when we come back we'll go to the phones. We will go to Viola and Michael in just a minute. If there are others who have questions give us a call 215-634-8065, toll-free 866-361-0900. And we are back. A little Minnie Riperton. Thanks, Tiff. Just since we called her name I want to acknowledge her. We are going to go back to the phones. We are going to go to the phones. We are talking today about breast cancer, breast health, with Dr. Lisa Jablon and Dr. Donee Patterson, both physicians at Einstein Healthcare Network. We've got Viola from Delaware. Welcome to the program, Viola.

VIOLA: Hi, thank you, and hello to everyone. I just wanted to, you know, call because of the fact that I am a breast cancer survivor and I celebrated 29 years on April 13, which was ... 

LOMAX-REESE: Wow. Congratulations.

PATTERSON: Thank you so much for calling. 

VIOLA: I've called quite a number of times. Whenever you have a breast cancer show I try to call if I can because it is so important for women and men to know about breast cancer. I have four daughters and my mother died from breast cancer at the age of 49, three years before I got it. She died in 1980 and I do believe that genetics is one thing, but I think stress plays a major part, because I did go through a lot of stress after her death, but I found my lump one evening undressing and it was high up on my chest and I went to the doctor the next day. Now I don’t know exactly how many of us are in the record book for having breast cancer, having a mastectomy, and not having any treatment. I took no chemotherapy and no radiation. 

LOMAX-REESE: Was that your choice or was that what was recommended? 

VIOLA: Dr. Robert Somers, I am quite sure the ladies know who he is. 

JABLON: He's my partner. 

VIOLA: Yes, Dr. Robert Somers, he was just fantastic. I had four opinions. He was my first opinion and I went back to him. When he was doing my biopsy, we were talking about my profession as a hairdresser and he was talking about him and his wife that they had went to the casino and something happened and they were stuck there for the weekend. So his personality and the mannerisms that he had made me say, you know, that I felt as though he was the one to make the choice in giving me my operation, but also Dr. Somers, he also operated on someone in my family back in the 50's that I had no idea about and, you know, I didn’t have to take any treatment because I had no positive lymph nodes. Within the time that I found my lump on March 29, I was operated on April 13, and I didn’t mess around, waiting, thinking it was going to go away, and I think that was part of the death of my mother because she thought that it was going to go away and it was the big C at that time and they were more fearful of having cancer then living. You die from more so the fear of having cancer or thinking that you are going to get it, but I belong to a group of women here in the lower Sussex County of Delaware because I am two hours form Philadelphia. One of the nurses with the BB Health Medical Center called me and wanted to know why was it that so many African Americans die from breast cancer. She said because most of them, the stories that they tell, that God is going to heal them and God is going to do this. She thought that faith - I said but faith can play a major part in it, but it is all in how you look at it because you can't just sit around, and it's not so much as just breast cancer, it is even with diabetes or whatever.

LOMAX-REESE:  It's everything, sure. 

VIOLA: But you have to be willing to go and see about and care about yourself and then this meeting that I went to the other day, I met a young girl who is 21 years old. I am meeting a lot more younger women in places that I go and I am there for all of the support that I can give to anyone, even on down to the fear of going to get a mammogram. I have offered myself that I would go with you because sometimes that extra support, and sometimes not even a family member can be your best support. Sometimes a total stranger can be your best support. 

LOMAX-REESE: Well, Viola, I wanna thank you so much for calling in and you have said so many important things in terms of being proactive. You immediately went and had your lump looked into. You got four opinions that you recognize that the stress that you were under played a contributing role in your illness and the fact that you are a champion. You are someone who is going to stand up and speak out about the importance of all of these things and being proactive. Thank you so much for calling and congratulations and we wish you continued good health. 

VIOLA: Can I say just one more thing?

LOMAX-REESE: Sure, but we've got two other callers waiting. 

VIOLA: Okay, it is just that I had a baby two years later. 


VIOLA: So there is still hope and there's still life after anything that you have. 

LOMAX-REESE: Absolutely. Thank you so much for your call. I don’t know, Dr. Donee, do you want to say anything? 

PATTERSON: She said so many important things. Viola, we are so happy that you are doing well. One statement that Dr. Jablon mentioned before is that treatment is so different, so glad that you didn’t have to go through the chemotherapy and the radiation, but there are different types of breast cancer and people need to understand that and so there's going to be different treatments. Another important thing she said was that she talked to her family and that's very important because we know that about 97% of the breast cancer deaths, they occur in women that don’t have some family history. So people do need to know their family history, but they can't use the excuse that I don’t have it in my family so you still have to go and then, lastly, I do want to say that if your mother, your father, your brother, your sister has had breast cancer, then you may need to be screened earlier. You need to go to your doctor right away. You need to know what age that person had breast cancer and you need to tell your doctor because you may need to get a mammogram earlier. She also said that men need to know. Men can get breast cancer. There's about 1,900 men a year that get breast cancer and about 450 men each year die of breast cancer. So men do need to check their breasts and pay attention to lumps as well. 

LOMAX-REESE: Excellent. Excellent information. We are going to go to Michael from Norristown. Hi, Michael, are you there?

MIKE: Yes, I am here. 

LOMAX-REESE: Welcome to the program. 

MIKE: Thank you so much and good afternoon to everyone and a special good afternoon to our very own Dr. Donee Patterson. This is Minister Mike. How are you?

PATTERSON: Oh, I am great. Thank you. 

MIKE: Good. I do have a question. I know it is a segment on breast cancer. I do have a question though. How can I, as a husband, a brother, and a son, to the women in my life, how can I encourage the women in my life to get their mammograms and also to be a support to them? 

LOMAX-REESE: That's a great question. Dr. Jablon, do you want to answer that? 

JABLON: Well, I think just the fact that you called today shows that you are very interested in just encouraging them to do so. I think it is the number one thing that a woman can do to help find a cancer early and at a stage which it can be cured and so I think just being encouraging to your family members. You can take them. You can offer a ride. You can stay with them. 

PATTERSON: That's exactly right. 

JABLON: The other thing I should mention is people always find an excuse not to do it. It hurts or they don’t have insurance or they can't afford it, but we have a number of programs in the city. We have one at Einstein. There are a number of different programs in the city that offer mammograms free for women who don't have insurance and so calls should not be prohibitive. 

PATTERSON: And it doesn’t take long. It's really, the actual exam is probably like ten, fifteen minutes. 

JABLON: It's probably less. It really is maybe more like four minutes actually, of getting squeezed. 

PATTERSON: Right. I mean, it's uncomfortable but it is not like crazy… 

LOMAX-REESE: Devasting.

PATTERSON: Yeah, it is not painful. 

JABLON: Right. We should also mention that the radiation that you get with a mammogram is extremely low dose so that should not be a reason to not get a mammogram. 

LOMAX-REESE: Just to be clear, at what age, once you are 40 you should be getting an annual mammogram?



LOMAX-REESE: Okay. So we are going to go to the phones. Don from West Philly, welcome to the program, Don.

DON: Good afternoon ladies. 

LOMAX-REESE: Good afternoon.

DON: I am a man obviously and I have had two biopsies and three mammograms. 


DON: And it wasn’t because I felt the lump, but because I had a very painful nipple tightness that went on for years and when I saw an endocrinologist she suggested a mammogram. The mammogram showed some suspicious areas and went to Fox Chase and they did a biopsy one time. Then they said why don’t you come back again because we don't think we've biopsied it totally the area or something and a month later I was back again. Now they want me to have a third mammogram and possibly another biopsy and I am just concerned about the invasiveness of all this going on. No cancer was found in the two biopsies and I am hearing stuff from a lot of naturopathic physicians and individuals that they're concerned about all this cutting into the breast, especially since nothing was found the first two times. What are your thoughts on this? 

LOMAX-REESE: Dr. Jablon? 

JABLON: Well, if there is any question you can always get another opinion and get your mammogram looked at by a different physician just to get another opinion about it. Men usually present with a lump and it is usually something that is discreet and separate from the rest of the breast tissue and breast pain is usually more associated with something called gynecomastia, which is just an overgrowth of breast tissue in men that it can be quite normal or it can be related to medications. So it is not clear to me, it is unusual for a man to have several biopsies because there's not that much tissue in the breast to begin with, it would be hard not to remove the area of question, I would think. I would encourage you to consider perhaps getting a second opinion.  

LOMAX-REESE: I hope that's helpful. 

DON: There's a lot of tissue in my breasts all of my life since childhood. 


DON: And it's been very embarrassing and I am happy to know that now physicians are more sensitive to that and are removing that tissue from young boys.

LOMAX-REESE: Well, I think that the second opinion, you heard what Viola said earlier. She got four different opinions before she made a decision. You know, definitely, definitely, if you think that something is not - it doesn't sit well with you, get a second, a third, a fourth opinion and figure it - you've got to be the person who takes charge because it is your life. It is your body. So we wish you well and if you want to check back in next time we are talking about this, that would be great. 

DON: Thank you.

LOMAX-REESE: Okay. Go ahead, Dr. Donee. 

PATTERSON: Let me just say something about multiple opinions. I think it is awesome, especially if it is not sitting right with you, to get a second opinion. I would never tell anyone not to do that, but just don’t delay your care getting second, third, fourth, fifteenth opinion over two, three, five years, and kind of delaying your care. Get two or three sound opinions and then make a decision, but don’t let it delay for a long time. 

LOMAX-REESE: Well, we are just about out of time and we really appreciate these Einstein segments where we get to probe and explore and ask questions with experts on a variety of different issues and if you like this segment, if you like access to these physicians you should go to their Facebook page and post a comment and let people know. Let Einstein know that this is something that's valuable to you. It's facebook.com\einsteinhealth. You can go there and just post your comment and hopefully we can continue to bring this kind of information to you. I want to thank both Dr. Donee Patterson and Dr. Lisa Jablon for sharing their information about breast health, breast cancer today. Any final comments? Dr. Donee? 

PATTERSON: Sure. I just want to encourage people. I know that there's a lot of information out there, but there are 525,000 minutes in a year. Take four of those minutes to get a mammogram every year.

LOMAX-REESE: Dr. Jablon?

JABLON: No, I think we have covered a lot of information today. There's a lot more out there about breast cancer. There's a lot on the internet. Be careful where you get your sources of information because I think there's so much material that sometimes it is hard to sift through. You stay at very reputable sites when you go on the internet, American Cancer Society, etcetera, but, no, I think things are very positive. Cure rates are going up in breast cancer. I think things look quite good. 

LOMAX-REESE: Excellent. Well, thank you both for being here. We appreciate your information and your time. Thanks, Tiff, for all the work that you do. 

Communications Team

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