Skip to Navigation

Breast Cancer (transcript)
Share This:

DR. SALGO:  BREAST CANCER MIGHT BE THE TWO MOST FRIGHTENING WORDS IN THE ENGLISH LANGUAGE. THERE'S NO SHORTAGE OF ADVICE FOR PROTECTION, DETECTION AND TREATMENT OPTIONS. BUT THERE'S ALSO NO GUARANTEE THAT YOU WON'T GET BREAST CANCER EVEN IF YOU DO EVERYTHING RIGHT. DOES ALL THE AWARENESS, THE EDUCATION, THE PREVENTION INFORMATION REALLY HELP ONCE YOU HAVE IT. HOW DO YOU MAKE TREATMENT DECISIONS? AND IS THERE SUCH A THING AS A SURVIVOR? OUR HEALTHCARE TEAM TACKLES THE CASE NEXT ON SECOND OPINION.

MAJOR FUNDING FOR SECOND OPINION IS PROVIDED BY THE GUIDANT FOUNDATION.  THROUGH PHILANTHROPIC PARTNERSHIPS, THE GUIDANT FOUNDATION IS COMMITTED TO INCREASING PATIENT AWARENESS AND ACCESS TO ADVANCEMENTS IN CARDIOVASULAR CARE. WITH ADDITIONAL SUPPORT FROM THE FOLLOWING:  THE JOSIAH MACY JR. FOUNDATION AND THE PARK FOUNDATION.

DR. SALGO: WELCOME TO SECOND OPINION, WHERE EACH WEEK WE SOLVE A REAL MEDICAL MYSTERY. WHEN WE CLOSE THIS CASE FILE A HALF AN HOUR FROM NOW, YOU'LL NOT ONLY KNOW THE OUTCOME OF THIS WEEK'S CASE, YOU'LL BE BETTER ABLE TO TAKE CHARGE OF YOUR OWN HEALTHCARE. I'M YOUR HOST, DR. PETER SALGO. TODAY OUR CASE FILE CONTAINS THE STORY OF LAURA. AS ALWAYS, WE'VE ASSEMBLED A HEALTH CARE TEAM TO TACKLE THE CASE. SOME ARE DOCTORS, SOME ARE NOT.  NO ONE ON THE PANEL KNOWS THE CASE EXCEPT FOR ELISSA ORLANDO, OUR RESIDENT CIVILIAN HERE, WHOSE JOB IT IS TO GIVE US ALL A REALITY CHECK. HOW ARE YOU DOING, ELISSA?

ORLANDO: I'M GREAT, THANKS PETER.

DR. SALGO: GOOD TO SEE YOU AGAIN. AND NOW IT'S TIME TO LOOK INTO THE CASE OF LAURA. I CAN TELL YOU THAT LAURA IS A YOUNG, FIT 49-YEAR-OLD WOMAN. SHE EATS RIGHT SHE THINKS, SHE DOESN'T SMOKE. SHE WORKS IN A VERY STRESSFUL CAREER. SHE GETS A YEARLY MAMMOGRAM. SHE HAS NO IMMEDIATE FAMILY HISTORY OF CANCER. SHE DID NOT PRACTICE REGULAR SELF-BREAST EXAMS. SHE THINKS SHE IS DOING EVERYTHING RIGHT, BUT IN THE COURSE OF DAILY LIVING, SHE FOUND A LUMP IN HER RIGHT BREAST. CAN A WOMAN HAVE A CLEAN MAMMOGRAM AND HAVE SOMETHING BREWING IN THERE ANYWAY?

DR. BERG: ABSOLUTELY.

DALGO: HOW DOES IT HAPPEN?

DR. BERG: WELL ESPECIALLY IF HER TISSUE IS RELATIVELY DENSE AND BREASTS CAN BE ANYTHING FROM COMPLETELY FATTY, WHICH IS EASY TO READ ON A MAMMOGRAM, UP TO ALMOST A SNOW STORM--VERY DENSE TISSUE.  AND THE DENSER HER TISSUE IS, THE HARDER IT IS TO SEE THINGS AND MANY LUMPS, AS MANY AS HALF OF THEM, DON'T SHOW UP IN DENSE BREASTS.

DR. SALGO: AS MANY AS HALF THE LUMPS. WHY BOTHER GETTING A MAMMOGRAM IN THE FIRST PLACE?  DOES THAT MAKE ANY SENSE?

DR. AHRENDT: OH SURE.

DR. SALGO: WHY?

DR. AHRENDT: A MAMMOGRAM MAY SHOW SOMETHING THAT YOU WON'T FEEL ON YOUR OWN EXAM, PARTICULARLY SOMETHING CALLED CALCIFICATIONS, AND SO EVEN IN A VERY DENSE BREAST, A MAMMOGRAM MAY REVEAL SOMETHING THAT IS ABNORMAL.

DR. SALGO: NOW, IT'S TRUE THAT SHE FOUND THIS LUMP ON HER OWN. AND I KNOW THAT FOR A LONG TIME THERE WAS A BIG PUSH TO GET WOMEN TO DO BREAST SELF-EXAMS. WHERE ARE WE WITH THAT? IS THAT A GOOD IDEA, ARE WE STILL ADVOCATING THAT?

DR. GRIGGS: IT'S SORT OF ANTI-AMERICAN TO SAY THAT IT ISN'T...

DR. SALGO: OH, BE MY GUEST!

ORLANDO: ANTI-AMERICAN?

 DR. SALGO: WHAT DO YOU MEAN ANTI-AMERICAN?

DR. GRIGGS: WELL WE ALL GREW UP SINCE THE 1970'S HEARING, SELF-BREAST EXAM, YOU DO YOUR SELF-BREAST EXAM, YOU'RE GOING TO HAVE A GOOD BREAST CANCER OUTCOME.

DR. SALGO: FOR HUNDREDS OF YEARS PEOPLE BELIEVED THE EARTH WAS FLAT.

DR. GRIGGS: THAT'S RIGHT, THAT'S RIGHT.  AND I THINK IT MAKES US AS AMERICANS FEEL MUCH MORE IN CONTROL, THAT WE CAN SOMEHOW CHANGE THE COURSE OF OUR OWN HEALTH.

DR. SALGO: I HEAR A COMMA AND A "BUT".

DR. GRIGGS: THE COMMA AND THE "BUT" IS THAT WE HAVE NO DATA SHOWING THAT WOMEN WHO DETECT, WHO PERFORM SELF-BREAST EXAMS ACTUALLY HAVE BETTER CANCER OUTCOME.

DR. AHRENDT: IN FACT, WHAT'S WORSE IS THERE ARE DATA TO SHOW THAT WOMEN WHO DETECT A MASS DO NOT IMPROVE THEIR MORTALITY FROM BREAST CANCER IN THE COURSE OF DETECTING THAT MASS.

DR. GRIGGS: AND THEY'RE TWICE AS LIKELY TO NEED A BIOPSY.

DR. AHRENDT: CORRECT.

DR. GRIGGS: AND IT'S BENIGN.

DR. SALGO: WHAT'S GOING ON HERE? YOU FIND A MASS, YOU GET IT BIOPSIED, IS IT JUST THAT IT'S MORE LIKELY BENIGN?  YOU WANTED TO CHIME IN.

DR. BERG: WELL AT THE SAME TIME, I MEAN WE STILL WANT TO DETECT...IF THERE IS CANCER, GOD FORBID, WE STILL WANT TO DETECT IT AS EARLY AS POSSIBLE SO THE LAST THING YOU WANT TO DO IS IGNORE A LUMP ONCE SHE'S FELT IT.  AND IT'S STILL...

DR. GRIGGS: THAT'S A DIFFERENT STORY, THOUGH.

DR. AHRENDT: SO THE STUDIES LOOK AT CANCER MORTALITY AS AN ENDPOINT, BUT THAT MAY NOT BE THE ONLY ENDPOINT. IF YOU LOOK AT THE ENDPOINT OF HOW MANY MASSES ARE FOUND BY BREAST SELF-EXAM AND NOT SEEN ON MAMMOGRAPHY, THAT MIGHT BE A BETTER ENDPOINT. SO IT'S STILL IMPORTANT FOR WOMEN TO CONDUCT THEIR OWN BREAST SELF-EXAM.

DR. SALGO: IS IT CLEAR THAT WOMEN CAN BE CONFUSED ABOUT THIS?

DR. GRIGGS: ABSOLUTELY!

DR. SALGO: THAT HERE'S...YOU'RE TELLING THEM TO DO...DOCTORS ARE CONFUSED.

ORLANDO: WE DO HEAR MIXED MESSAGES AND WE READ ABOUT THIS AND WE HEAR IT IN THE NEWS AND I'M VERY CONFUSED ABOUT THE SORT OF EARLY DETECTION AND PREVENTION TYPE ACTIVITY.  AND I'M REALLY, FRANKLY, I'M SO CONFUSED, I'M NOT DOING ANYTHING!

DR. AHRENDT: WELL, THE PROBLEM IS IT'S NOT EARLY DETECTION BY THE TIME YOU FEEL A LUMP. EARLY DETECTION WOULD BE FINDING IT BEFORE IT FORMS A LUMP, AND MAMMOGRAPHY IS THE BEST WAY TO DO THAT.

 HUNT: WELL, I MEAN, I FOUND A LUMP.  THAT'S WHY I'M HERE.  AND I FOUND IT AND DIDN'T DO ANYTHING ABOUT IT FOR FOUR MONTHS BECAUSE I ASSUMED IT WAS SOMETHING ELSE.  AND SO I DIDN'T...I IGNORED IT.  I WAS BUSY TAKING CARE OF FAMILY AND THINGS, AND VERY BUSY IN MY CAREER.  AND WHEN I FINALLY WENT IN...BOOM.   

ORLANDO: DID YOU HAVE A FEELING THOUGH? I MEAN, UNDERLYING THAT IT MIGHT BE SOMETHING SO THERE MIGHT'VE BEEN SOME FEAR, TOO?

HUNT: YEAH, BUT I STILL THINK...AND IT'S VERY STRANGE. I FEEL I'M INTELLIGENT, I FEEL I'M WELL READ, BUT FOR SOME REASON I DIDN'T MOVE ON IT.

DR. SALGO: WE'RE GOING TO GET TO WHAT HAPPENS TO LAURA IN A MOMENT, BECAUSE SHE DOES GO TO SEE HER DOCTOR, AND AT THAT TIME, IT'S NOW SEVERAL MONTHS LATER, SHE SAYS, "YOU KNOW, I HAVE THIS LUMP." AND HER DOC SENDS HER FOR SOMETHING CALLED A DIAGNOSTIC MAMMOGRAM, AS OPPOSED TO A NORMAL MAMMOGRAM. WHAT THE HECK IS THAT? 

DR. BERG: RIGHT, SO ANY WOMAN WHO COMES IN WITH A SYMPTOM OF ANY KIND, A LUMP OR NIPPLE DISCHARGE, A CHANGE IN THEIR SKIN, A CHANGE IN THEIR BREAST, THEY WOULD HAVE THEIR MAMMOGRAMS REVIEWED BY THE RADIOLOGIST AT THE TIME THEY'RE IN FOR THEIR APPOINTMENT AND THAT WOULD BE A DIAGNOSTIC EXAM. WE LOOK AT THE FILMS WHILE THEY'RE THERE. IF THERE'S A NEED FOR ADDITIONAL VIEWS, EXTRA PICTURES, MAGNIFICATION VIEWS, IF THERE ARE CALCIFICATIONS, WE'LL DO THEM ON THE SPOT. AND THEN IF THERE IS A LUMP OR IF NOTHING SHOWS UP ON THE MAMMOGRAM, WE'LL OFTEN PROCEED STRAIGHT TO ULTRASOUND AS THE NEXT STEP ON THE SAME VISIT.

DR. SALGO: WELL THAT'S EXACTLY WHAT HAPPENED TO LAURA. THEY DIDN'T FIND ANYTHING ON THE MAMMOGRAM, SO THEY WENT AHEAD TO AN ULTRASOUND. NOW, WHAT DOES THE ULTRASOUND DO THAT THE MAMMOGRAM DOESN'T?

DR. BERG: SO ULTRASOUND IS A COMPLETELY DIFFERENT WAY TO PENETRATE THE BREAST TISSUE. IT USES SOUND WAVES AND THERE'S NO RADIATION INVOLVED TO THE BREAST AND WE SEE THINGS VERY DIFFERENTLY, SO ACTUALLY IT DOES BETTER IN DENSE BREAST TISSUE. IT'S VERY GOOD AT SEEING MASSES, IT'S NOT VERY GOOD AT SEEING CALCIFICATIONS. SO ULTRASOUND AND MAMMOGRAPHY ARE QUITE COMPLEMENTARY.

DR. SALGO: ALL RIGHT, WELL I'LL TELL YOU WHAT LAURA FOUND...
NOTHING! SHE'S FEELING THIS MASS AND THEY FOUND NOTHING ON MAMMOGRAM, NOTHING ON ULTRASOUND. SO WHAT DOES SHE DO NOW? DOES SHE GO HOME?

DR. AHRENDT: AT THIS POINT I WOULD ADVISE THAT SHE HAVE A NEEDLE BIOPSY DONE. 

DR. SALGO: WHY A NEEDLE BIOPSY? WHAT IS THAT, ACTUALLY?

DR. SCHNITT: WELL, THERE ARE A VARIETY OF WAYS OF DOING NEEDLE BIOPSIES; ONE IS WITH A VERY, VERY THIN NEEDLE, WHICH CAN BE PUT INTO A MASS TO JUST TO TAKE OUT SOME CELLS.  OTHERS ARE CUTTING NEEDLES, IN WHICH YOU ACTUALLY PUT A NEEDLE IN WITH A LARGER BORE THAT TAKES OUT A CORE OF TISSUE. NOWADAYS, I THINK IN GENERAL IF THERE'S A MASS, AND YOU'RE NOT SURE WHETHER IT'S A CYST OR A SOLID TUMOR, PUTTING A FINE NEEDLE IN IS A GOOD WAY TO TRY TO SEPARATE THAT OUT.

ORLANDO: WHEN WE TALK ABOUT ALL THESE DIFFERENT KINDS OF TESTS THAT WE'RE HAVING, MAMMOGRAMS, DIAGNOSTIC MAMMOGRAMS, ULTRASOUNDS, SOME ARE CLEAN, SOME ARE SHOWING SOMETHING. WHEN YOU FEEL IT, IT'S THERE. I MEAN, IT'S SOUNDS TO ME LIKE YOU REALLY CAN'T GET AN ANSWER UNLESS YOU'RE LOOKING AT IT WITH A BIOPSY. IS THAT THE CASE?

DR. AHRENDT: THAT'S NOT ALWAYS THE CASE.  I MEAN, THERE WILL BE THINGS ON A MAMMOGRAM THAT ARE DISTINCTLY ABNORMAL AND VERY SUSPICIOUS FOR MALIGNANCY, AND THEN, THAT ABSOLUTELY REQUIRES A BIOPSY, BUT

ORLANDO: SO, SOME WAY OR ANOTHER WE'RE GOING TO GET TO A BIOPSY?

DR. AHRENDT: ESSENTIALLY THERE'S A RULE OF 3'S THAT MOST BREAST SPECIALISTS FOLLOW, WHICH IS THAT THE PHYSICAL EXAMINATION, THE BREAST IMAGING AND THE PATHOLOGY ALL HAVE TO AGREE. SO IN THIS PARTICULAR CASE OF LAURA, HER PHYSICAL EXAM DOES NOT GO WITH THE BREAST IMAGING. SHE'S GOT A LUMP BUT THE IMAGING'S NEGATIVE, SO YOU NEED MORE INFORMATION, SO THE NEXT STEP IS PATHOLOGY.

ORLANDO: BUT I THINK, I'M NOT LAURA, BUT I THINK IF I HAD A CLEAN MAMMOGRAM BUT I FELT A LUMP I WOULD WALK RIGHT IN TO YOU AND WOULD SAY, "BIOPSY ME". IS THAT SO UNREASONABLE?

DR. AHRENDT: IN FACT YOU SHOULD. YOU SHOULD ADVOCATE FOR YOURSELF.

DR. SALGO:  SO LET ME JUST TAKE A MOMENT OVER HERE TO SUM UP THE KEY THINGS TO REMEMBER BEFORE WE MOVE ON. EVALUATION OF A SUSPICIOUS BREAST SHOULD BE PROCEEDING UNTIL BOTH THE DOCTOR AND THE PATIENT ARE CONVINCED THAT THERE IS NO REASONABLE CHANCE THAT ANY CANCER EXISTS. LET ME SAY THAT A DIFFERENT WAY. UNTIL BOTH PEOPLE ARE HAPPY THAT THERE IS NO CANCER THERE, OR THAT THEY NEED TO DO SOMETHING, YOU CONTINUE GOING ON. YOU CONTINUE LOOKING UNTIL EVERYBODY IS COMFORTABLE WITH WHERE YOU ARE. THAT'S A VERY IMPORTANT POINT. LAURA DID GO SEE HER SURGEON, AND LAURA GOT A LUMPECTOMY. THE SURGEON DECIDED, RATHER THAN PUT A NEEDLE IN THIS, RATHER THAN DO ANYTHING ELSE, THE SURGEON WAS GOING TO TAKE THIS THING OUT. IT WAS CANCER IN THIS LUMP, WHICH WAS REMOVED BY LUMPECTOMY.  IT WAS AN INVASIVE DUCTAL CARCINOMA. THE TUMOR WAS ESTROGEN POSITIVE. WHAT ON EARTH DOES ALL OF THIS MEAN, JENNIFER?

DR. GRIGGS: WELL WE DON'T REALLY KNOW WITHOUT KNOWING HER LYMPH NODES STATUS WHAT STAGE THIS TRULY IS.

DR. SALGO: WELL WE GOT THIS MUCH. CAN'T YOU SAY ANYTHING?

DR. GRIGGS: THAT'S WHAT THE PATHOLOGISTS TELL US, AND WE NEED THEM SO BADLY! YOU KNOW, THEY TELL US WHAT THEY SEE UNDER THE MICROSCOPE...

DR. SALGO: JUST DUMP IT OFF ON THE PATHOLOGIST!  I'LL ASK YOU, WHAT DOES THIS MEAN?

SCHNIITT: WELL, FIRST OF ALL THERE'S A BIT OF INFORMATION THAT'S MISSING. WE NEED TO KNOW THE SIZE OF THE TUMOR, WHICH IS ABSOLUTELY CRITICAL IN DETERMINING THE MANAGEMENT OF THE PATIENT AND ASSESSING THE PROGNOSIS.   

DR. SALGO: WHAT ARE YOU GOING TO TELL THE PATIENT HERE? DO YOU TELL HER SHE HAS CANCER IN THE PRESENT TENSE?

DR. AHRENDT: ABSOLUTELY.

DR. SALGO: HOW ARE YOU GOING TO TELL HER?

DR. AHRENDT: IF YOU HAVE AN ESTABLISHED RELATIONSHIP WITH A WOMAN AND YOU'VE DISCUSSED WITH HER YOUR FEELING THAT THIS IS VERY LIKELY TO BE BREAST CANCER AND WE NEED TO MAKE A DIAGNOSIS, IT'S REASONABLE TO GIVE HER THAT DIAGNOSIS OVER THE PHONE SO THAT SHE'S NOT WAITING FOR AN OFFICE VISIT TO COME BACK. AND IN THE REALITY OF A SURGEON'S PRACTICE, THEY'RE NOT IN THE OFFICE EVERY DAY AND THEY MAY NEED TO DISCUSS SOME THINGS BY PHONE THAT THEY, THAT CAN BE DONE AGAIN IN PERSON WITH SOME MORE DETAIL.

DR. SALGO: HOW DID THEY TELL YOU, SUSAN?

HUNT: SHE WAS PRETTY MATTER-OF-FACT ABOUT IT AND TOLD ME ON THE PHONE. SHE TOLD ME ON THE PHONE.

ORLANDO: IT CAME FROM YOUR SURGEON? THE NEWS CAME FROM YOUR SURGEON?

HUNT: YEP, YEP. AND IT WAS VERY STRANGE BECAUSE I HAD THE LUMPECTOMY ON A THURSDAY, HAD TO FLY ACROSS THE COUNTRY THE NEXT DAY, NOT KNOWING WHAT WAS GOING ON, TO MAKE AN APPEARANCE SOMEWHERE AND I WAS REALLY NERVOUS BUT NOBODY REALLY KNEW WHY AND THEN MONDAY THE PHONE RANG AND I REMEMBER SITTING THERE AND IT WAS A REALLY RAINY DAY AND I WAS WAITING AND WAITING AND FINALLY SHE SAID IT JUST LIKE THIS, "IT'S CANCER." BOOM. THAT WAS ALL THERE WAS. "I'M SORRY, IT'S CANCER." NOW, NEXT STEP. I THINK THAT'S HOW SHE WANTED TO MOVE. "LET'S GET TOGETHER, I WANT YOU BACK HERE," YOU KNOW, "GET BACK HERE AS SOON AS YOU CAN" AND I NEEDED SOME TIME, I NEEDED A WEEK OR SO TO JUST LET IT ALL DIGEST.

DR. SALGO: WHAT DO YOU MEAN BY THAT? WHAT HAPPENED TO YOU WHEN YOU HEARD THE WORDS "IT'S CANCER"?

HUNT:  LIFE. WHERE IS IT? WHO AM I? WHAT'S HAPPENING? I THINK IT'S THE MOST FRIGHTENING DIAGNOSIS ANYBODY CAN EVER HEAR. SO, I DID A LOT OF CRYING AND I TALKED TO FAMILY AND FRIENDS AND THEN BY WEDNESDAY I WAS READY TO, "OK, LET'S GET SOME OPINIONS. LET ME LEARN ABOUT IT." I THINK ONCE YOU HAVE IT, YOU HAVE IT.

DR. SALGO: APPARENTLY, I CAN TELL YOU NOW TO ADVANCE THE CASE HERE A LITTLE BIT, THAT LAURA'S PHYSICIANS WERE CONCERNED BECAUSE WHAT THEY DID WAS THEY WANTED TO MAKE SURE THAT LAURA'S NODES WERE NOT INVOLVED WITH CANCER, AND THEY WANTED TO BE SURE THAT THEY GOT IN THIS EXCISIONAL BIOPSY, THIS LUMPECTOMY, ALL THE CANCER THERE WAS TO GET. SO THEY ASKED LAURA TO COME BACK FOR ANOTHER PROCEDURE.

DR. AHRENDT: ACTUALLY YOU JUST USED TWO TERMS IN THE SAME SENTENCE. EXCISIONAL BIOPSY AND LUMPECTOMY AS IF THEY WERE THE SAME THING, AND I WOULD DISAGREE. I THINK AN EXCISIONAL BIOPSY IS A DIAGNOSTIC PROCEDURE. YOU DON'T KNOW WHAT YOU'RE DEALING WITH. YOU'RE TAKING A LUMP OR A TUMOR OUT TO MAKE A DIAGNOSIS.

DR. SALGO: SO IS THAT WHAT WE THINK LAURA HAD THE FIRST TIME?

DR. AHRENDT: WELL I DON'T KNOW WHAT SHE HAD BECAUSE THE SURGEON DIDN'T KNOW WHAT SHE HAD EITHER. BUT IF YOU'RE DOING A LUMPECTOMY, THAT REALLY SAYS THAT YOU KNOW THIS IS A CANCER AND YOUR GOAL IS YOU'RE GOING TO GET THAT LUMP OUT AND YOU'RE GOING TO GET A RIM OF NORMAL TISSUE AROUND IT. THAT'S THE MARGIN.

DR. SALGO: WELL SHE WENT BACK. AND THEY WENT BACK IN AND THEY GOT SOME MORE TISSUE AND THEY GOT SOME NODES. SO HERE IT IS, THEY GOT THE NODES, AND THE NODES WERE REPORTED BACK BY YOUR COLLEAGUES, THE PATHOLOGISTS AS QUOTE "CLEAN".   IN ADDITION, THEY FOUND THAT UPON FURTHER SURGERY, THERE WAS NO MORE TUMOR TO EXCISE. THEY GOT SOME MORE TISSUE. THERE WAS NO TUMOR SEEN IN IT. SO THE ASSUMPTION I'M ASSUMING FROM THEIR FIRST PROCEDURE WAS THEY GOT PRETTY GOOD MARGINS. THAT CLINICALLY THEY HAD GOTTEN THE TUMOR OUT IN THE FIRST PLACE. SO NOW IN LAYMEN'S TERMS, WHICH I SUSPECT IS WHAT WE NEED TO TALK ABOUT FOR A MOMENT, LAURA HAS CANCER. DOES SHE HAVE CANCER OR DID SHE HAVE CANCER?

DR. GRIGGS: WE DON'T REALLY KNOW.

DR. BERG: WE DON'T KNOW.

DR. SALGO: HERE'S THAT "WE DON'T KNOW" AGAIN. IS IT DRIVING YOU CRAZY?

HUNT: YES, IT SURE IS. IT SURE IS. WHY DON'T YOU KNOW?

DR. GRIGGS: BECAUSE EVEN THE SMALLEST TUMORS CAN, UNFORTUNATELY IN THE FUTURE COME BACK THROUGHOUT THE BODY. BREAST CANCER CAUSES TROUBLE IN THE BREAST, CLEARLY.  BUT BREAST CANCER REALLY CAUSES PROBLEMS WHEN IT RECURS ELSEWHERE IN THE BODY.

DR. SALGO:  THERE ARE SOME KEY THINGS TO REMEMBER HERE THAT ARE VERY, VERY IMPORTANT. THE POWERFUL PROGNOSTIC FACTORS THAT INFLUENCE THE TREATMENT OF BREAST CANCER ARE THE SIZE OF THE TUMOR, WHETHER IT'S INVASIVE OR NOT, IF IT'S METASTATIC--THAT IT IS IN THE NODES OR ELSEWHERE AT THE TIME OF DIAGNOSIS--IF IT'S HORMONALLY SENSITIVE, BUT ONCE AGAIN YOU HAVE GOT TO GET THE INFORMATION. THIS INFORMATION IMPACTS THE OPTIONS THAT YOU'RE GOING TO BE PRESENTED. SO IT BEHOOVES YOU TO GET THE INFORMATION YOU CAN, BE PROACTIVE AND THEN GO FORWARD. ALL RIGHT? WE'RE GOING TO GO FORWARD. LAURA IS TOLD THAT THE LUMP IS OUT. OR AS I WAS TOLD IN MEDICAL SCHOOL, THE LUMP'S IN A BOTTLE. THIS IS A GOOD THING, SHE'S TOLD. AND WHAT SHE REALLY NEEDS IS SIX WEEKS OF RADIATION THERAPY AND THAT WOULD BE AS EFFECTIVE AS HAVING A MASTECTOMY. THAT IS THE LUMPECTOMY PLUS RADIATION EQUAL STATISTICALLY A MASTECTOMY. AND I READ ON THE CHART THAT SHE HAD AN 85% CHANCE THE CANCER WOULD NOT COME BACK.

DR. AHRENDT: WHERE? IN HER BREAST OR ELSEWHERE IN HER BODY?

DR. SALGO: IT SOUNDS TO ME AS IF IT WAS AN 85% CHANCE OF CANCER NEVER COMING BACK ANYWHERE. IS THAT AN ACCURATE NUMBER?

DR. SCHNITT: WELL I THINK YOU'RE RAISING TWO DIFFERENT, BUT RELATED ISSUES. ONE IS LOCAL CONTROL AND ONE IS SYSTEMIC CONTROL. THE RADIATION THERAPY WILL HELP WITH THE LOCAL CONTROL. AND CLEARLY THERE HAVE BEEN STUDIES FROM THE UNITED STATES AND EUROPE THAT HAVE SHOWN THAT THE COMBINATION OF LUMPECTOMY AND RADIATION IS EQUIVALENT TO MASTECTOMY IN TERMS OF LOCAL CONTROL, PREVENTING THE TUMOR FROM COMING BACK IN THE BREAST OR IN THE AREA OF THE CHEST. THE OTHER ISSUE IS WHAT'S THE LIKELIHOOD THAT IT'LL COME BACK ELSEWHERE IN THE BODY AS A METASTATIC LESION.

DR. SALGO: METASTATIC MEANS DISTANT?

DR. SCHNITT: DISTANT, RIGHT. AND THAT'S A COMPLETELY SEPARATE ISSUE.

DR. SALGO: LAURA DECIDED TO GO AHEAD AND HAVE RADIATION THERAPY, BUT SHE ALSO DECIDED THAT 85% WASN'T GOOD ENOUGH FOR HER. SO WHAT OTHER TREATMENTS CAN YOU OFFER LAURA AT THIS POINT?

DR. GRIGGS: YOUR BENEFIT FROM CHEMOTHERAPY DEPENDS ON YOUR BASELINE RISK OF THE CANCER COMING BACK. SO PEOPLE WHO HAVE A VERY SMALL RISK OF A SYSTEMIC RECURRENCE ARE GOING TO GAIN A VERY SMALL BENEFIT FROM CHEMOTHERAPY.

ORLANDO: YOU MEAN IF IT'S NOT LIKELY TO COME BACK IN YOUR BODY, YOU SHOULDN'T HAVE THE CHEMO OR IT MIGHT NOT HELP YOU AS MUCH?

DR. GRIGGS: THAT'S RIGHT. WELL IF IT'S A 6MM ER POSITIVE NODE NEGATIVE CANCER, THE LIKELIHOOD THAT CANCER'S GOING TO COME BACK IS WELL UNDER 10% OVER THE NEXT 10 YEARS. AND WITH CHEMO I CAN KIND OF WARM UP YOUR CUP OF COFFEE A TEENY BIT. IT'S THE SAME COFFEE, BUT IF YOUR CUPS HALF EMPTY, IF YOU HAVE BULKY POSITIVE NODES AND A LARGE TUMOR, YOU'RE GOING TO NEED THAT WARM-UP A LOT MORE. AGAIN IT'S THE SAME COFFEE IN THE POT.

DR. SALGO: HELP ME CLEAR THIS UP JUST A LITTLE BIT. WHAT EXACTLY IS THIS CHEMOTHERAPY DOING IN THE BODY THAT THE RADIATION THERAPY AND THE SURGERY DID NOT DO?

DR. GRIGGS: WELL RADIATION GOES WHERE WE ASK IT TO GO. IT'S LIKE A SHADOW. YOU SHINE A LIGHT AND IT GOES IN A SPECIFIC AREA AND THERE'S A LITTLE BIT OF FUZZINESS AROUND THE EDGES. CHEMOTHERAPY, IF IT GOES LIKE WE LIKE, IT GOES THROUGH YOUR WHOLE SYSTEM. IT GOES IN THROUGH A VEIN EITHER THROUGH YOUR ARM OR THROUGH A PORT, WHICH GOES UNDER THE SKIN, AND COURSES AROUND THE BODY AND GETS TO MOST PARTS OF THE BODY AND WE HOPE KILLS CELLS THAT HAVE THE POTENTIAL TO COME BACK LATER AND CAUSE TROUBLE.

DR. SALGO: YOU GOT THE ENTIRE TUMOR OUT. THE LYMPH NODES, WHICH I SUSPECT MOST PEOPLE THINK ARE THE WAY THE TUMOR LEAKS FROM THE LUMP INTO THE REST OF THE BODY--ALL THOSE LYMPH NODES WERE NEGATIVE.

DR. AHRENDT: UNFORTUNATELY THAT'S NOT THE ONLY WAY THAT BREAST CANCER CAN GET OUT OF THE BREAST.

DR. SALGO: OH REALLY?

DR. AHRENDT: AND IT CAN GET OUT THROUGH THE BLOODSTREAM.

DR. SALGO: SNEAKY.

DR. AHRENDT: CURRENTLY WE DON'T REALLY HAVE A GOOD WAY TO ASSESS WHETHER IT'S DISSEMINATED THROUGH THE BLOODSTREAM ALTHOUGH LOOKING AT BONE MARROW MAYBE ONE WAY OF DOING THAT. BUT THAT'S NOT CLINICALLY DONE ON A REGULAR BASIS RIGHT NOW.

DR. SALGO: WELL, HERE'S WHAT LAURA DID. SHE WENT AHEAD AND GOT CHEMO, IN ADDITION TO THE SURGERY, IN ADDITION TO THE RADIOTHERAPY.

ORLANDO: I HAVE A QUESTION ABOUT THE CHEMO, JUST TO GO BACK A LITTLE BIT, BECAUSE WHEN YOU WERE TALKING ABOUT PUTTING CHEMO THROUGH THE BODY, AND HOPING THAT IT HIT SOMETHING, THERE'S NO WAY--SO YOU'RE OPERATING WITH CHEMO IN THE DARK, RIGHT? THERE'S NO WAY THAT YOU KNOW, THERE MIGHT, YOU CAN'T DO ANY KIND OF A TEST THAT MIGHT SEE SOME CELLS SOMEWHERE IN THE BODY?

DR. GRIGGS: SO IF YOU TAKE 100 WOMEN WITH A TUMOR THAT HAS EACH OF THEM HAS A CHANCE THAT THEY, IT'S GOING TO...SO OUT OF 100 WOMEN, 15 ARE GOING TO HAVE A RECURRENCE AND I'M TREATING 100 WOMEN.  CAN YOU SEE WHAT WE'RE DOING? WE'RE TREATING EVERYBODY, BECAUSE WE DON'T YET KNOW AS A PROFESSION, AS A FIELD OF SCIENCE, WHICH WOMEN NEED CHEMOTHERAPY.

DR. SALGO: THERE'S THAT PHRASE AGAIN.  "WE DON'T KNOW."

DR. GRIGGS: WE DON'T KNOW.

HUNT:  THE POINT IS, IT JUST SEEMED THAT, IF IT MADE 1% OF A DIFFERENCE IN MY LIFE, I WAS GOING TO HAVE THE CHEMO.

DR. GRIGGS: THAT'S BEEN SHOWN, THAT ESPECIALLY YOUNG WOMEN LIKE YOU, THEY WILL DO ANYTHING, ALMOST ANYTHING FOR A 1% CHANCE OF CURE, AND THAT'S WHAT WE ARE TALKING ABOUT, IS CURE.

DR. SALGO: OTHER THAN THE DOWNSIDE WITH YOUR HAIR, WHAT WAS CHEMO LIKE?

HUNT: YOU DON'T LIKE MY HAIR? [LAUGHTER] CHEMO WAS SURPRISING. I WAS VERY PREPARED TO BE SICK ALL THE TIME, AND I WENT INTO IT WITH "I CAN DO THIS, AND THERE'S MY ARM", AND I NEVER, I KNOW A LOT OF PEOPLE HEAR ABOUT THROWING UP AND ALL OF THAT, NEVER DID THAT.  I WORKED THROUGH THE ENTIRE--I DID FOUR DOSES OF CHEMO THAT WAS MY CHOICE AND WORKED THROUGH THE WHOLE THING, AND I THINK I WAS ONLY DOWN A COUPLE OF DAYS EVERY TIME.

DR. SALGO: WELL LET ME TELL YOU WHAT LAURA DID.  SHE GOT THE CHEMO, BUT WHILE HAVING CHEMO, SHE DIDN'T STOP THINKING ABOUT THIS, AND SHE BECAME MORE AND MORE CONCERNED ABOUT WHETHER OR NOT SHE WAS GETTING ENOUGH PROTECTION AGAINST CANCER AND SO SHE DECIDED THAT SHE WANTED A MASTECTOMY BECAUSE SHE SIMPLY WANTED TO BE SURE THAT QUOTE, AND THIS IS A QUOTE FROM THE CHART, "THE CANCER IS OUT OF MY BODY."  GRETCHEN, WHAT'S A MASTECTOMY? HOW COMMON IS IT? WOULD YOU HAVE ADVISED HER TO HAVE ONE? LAURA THAT IS.

DR. AHRENDT: WELL A MASTECTOMY IS COMPLETE REMOVAL OF THE BREAST, AND THAT USUALLY INVOLVES REMOVING THE NIPPLE AS WELL. SO IT DOES SUBSTANTIALLY ALTER A WOMAN'S BODY, APPEARANCE AND BODY IMAGE.  I THINK I WOULD DISCUSS WITH HER VERY CAREFULLY WHAT HER MOTIVATION IS FOR HAVING THE MASTECTOMY.

DR. SALGO: SHE SAID, "I WANT THE CANCER OUT.  I'M NOT CONVINCED THAT I'M SAFE, YOU'RE GIVING ME STATISTICS BASED ON THIS AND THAT AND THE OTHER THING. TAKE THIS BREAST OFF AND GET RID OF THIS, LUMPS BELONG IN BOTTLES."

DR. AHRENDT: SURE. AND I WOULD TALK TO HER ABOUT THE FACT THAT THE LUMP HAS SURGICALLY BEEN REMOVED AND THAT THERE MAY BE A VERY SLIGHT DIFFERENCE IN TERMS OF HER RISK OF IT RECURRING WITHIN THE BREAST.  IF SHE COMPLETES HER RADIATION SHE'LL PROBABLY BE ON A HORMONE DRUG AS WELL, PROBABLY TAMOXIFEN, BUT ALL OF THOSE MEASURES ARE DESIGNED TO REDUCE THE RISK OF IT RECURRING IN THE BREAST. IF WHAT SHE'S REALLY WORRIED ABOUT IS ANOTHER BREAST CANCER, THEN REMOVING THIS BREAST ISN'T GOING TO ELIMINATE HER RISK OF ANOTHER BREAST CANCER. SHE STILL HAS ANOTHER BREAST.  AND WE NEED TO IMAGE BOTH BREASTS, OR HER REMAINING BREAST IF SHE CHOOSES A MASTECTOMY. AND SO IF IT'S REALLY A CANCER FEAR ISSUE THAT'S MOTIVATING HER TO HAVE THE MASTECTOMY, I WOULD TRY TO EXPLORE THAT WITH HER AND MAKE SURE SHE FULLY UNDERSTANDS OTHER OPTIONS TO PREVENT BREAST CANCER OTHER THAN SURGICAL OPTIONS.

DR. BERG: WELL THIS IS ONE OF THE SITUATIONS...WE HAVE TO TALK ABOUT MRI IN THIS SITUATION BECAUSE IT IS AN ADDITIONAL WAY TO IMAGE THE BREAST.  IT'S EXQUISITELY SENSITIVE FOR BREAST CANCER, BUT IT HAS THE DOWNSIDE OF FINDING LOTS OF EXTRA BENIGN THINGS AS WELL THAT AREN'T CANCER.  IN A SITUATION LIKE THIS WHERE HER INITIAL CANCER DID NOT SHOW UP ON MAMMOGRAPHY, DID NOT SHOW UP ON ULTRASOUND, AND MIND YOU COLLECTIVELY ONLY 3% OF LUMPS THAT ARE CANCER ARE NOT GOING TO SHOW UP ON EITHER ONE, SO SHE IS UNLUCKY IN THE EXTREME, THEN MRI, MAGNETIC RESIDENCE IMAGING, CAN LOOK AT THE BREAST VERY ACCURATELY, GIVE HER A LOT MORE INFORMATION, LOOK NOT ONLY AT THAT BREAST TO MAKE SURE THERE ISN'T A SECOND CANCER HIDING AS WELL, BUT ALSO TO LOOK AT THE OTHER BREAST.

DR. SALGO:  WHAT DO YOU THINK LAURA DID?

DR. AHRENDT: I HOPE SHE DIDN'T HAVE A BILATERAL MASTECTOMY.

DR. BERG: I'M THINKING DID.

DR. GRIGGS: I'M HOPING SHE DIDN'T.

DR. SALGO: LET ME TELL YOU WHAT LAURA DID. YOU WERE ONLY HALF RIGHT. LAURA WENT AHEAD AND HAD A MASTECTOMY, ON THE SIDE THAT SHE'D ALREADY HAD THE OTHER SURGERY, AND SHE DID NOT HAVE A BILATERAL MASTECTOMY.  SO YOUR HOPE WAS NOT ENTIRELY DASHED.

DR. BERG: I WASN'T HOPING, JUST FEARING.

DR. SALGO: SUSAN, YOU HAD A MASTECTOMY.

HUNT: I DID PETER.

DR. SALGO: AND WHAT WAS THAT LIKE?

HUNT: WELL, IT WAS THE EASIEST THING THAT I EXPERIENCED THROUGHOUT ALL THE TREATMENT ONCE I MADE THE DECISION, AND I HOPE I WON'T UPSET YOU ALL...

DR. SALGO: OH GO AHEAD, UPSET THEM.

HUNT: ...BUT I HAD DOUBLE MASTECTOMY AND IT WAS A PERSONAL DECISION. IT WAS SOMETHING I FELT THAT I WANTED TO DO.  I TALKED TO MY DOCTORS, THEY TALKED ME THROUGH THE ENTIRE PROCESS, I HEARD EVERYTHING THEY SAID AND EVERYTHING THAT YOU ALL HAVE SAID AND ULTIMATELY IN MY HEART I THOUGHT, I DON'T WANT TO BE GOING BACK EVERY 6 MONTHS TO BE CHECKED, OR EVERY 3 MONTHS.  I COULDN'T LIVE WITH IT.  SO FOR ME, IT WAS A CORRECT DECISION AND IT'S INTERESTING BECAUSE WHEN I TALKED TO MY ONCOLOGIST ABOUT IT, I SAID, "THIS IS WHAT I WANT TO DO", EXPECTING HER TO JUST RAIL, AND SHE SAID, "DO YOU FEEL COMFORTABLE WITH THAT DECISION?" AND I SAID "YES" AND SHE SAID, "MOST OF MY PATIENTS THAT DO THAT NEVER LOOK BACK", AND I HAVE TO BE HONEST WITH YOU, I'VE NEVER LOOKED BACK.  AND YOU KNOW WHAT, THERE'S NO GUARANTEE ON ANY OF THIS AS WE ALL KNOW, BUT IT'S WHAT YOU CAN LIVE WITH.

DR. SALGO: WHAT I HEARD IN HERE, AND YOU KNOW, STEP ON ME ALL YOU WANT, THERE'S A CERTAIN PC BUZZ WHICH I'VE HEARD FOR YEARS ABOUT BREAST CANCER, THAT BREAST CONSERVATION IS THE CORRECT THING TO DO, MASTECTOMY IS THE WRONG THING TO DO.

DR. GRIGGS: THERE'S A LOT OF PRESSURE ON DOCTORS AND ON WOMEN TO KEEP THE BREAST, BUT A PERSONAL PREFERENCE REALLY DRIVES THIS MORE THAN ANYTHING.

DR. AHRENDT: IT TRULY SUPERCEDES IT, IT DOES.

DR. SALGO: WHY WERE YOU THEN SO OPPOSED TO WHAT LAURA WA TO DO?

DR. GRIGGS: BECAUSE MY...

DR. SALGO: I HEARD A REAL HONESTY IN THAT.

DR. GRIGGS: BECAUSE MY CONCERN IS THAT SHE'S MUTILATING HER, SHE WANTS--IT'S NOT YOUR CASE, BUT THERE'S A HUGE, "THE BREAST HAS BETRAYED ME", AND SOME WOMEN FEEL THAT WAY, "THE BREAST IS BAD, SOMEHOW I'VE CAUSED THIS", I'M NOT SAYING THAT... I HAVE HEARD THIS OUT OF MY PATIENTS' MOUTHS, I REALLY HAVE. I HAVE HEARD, "I CAUSED THIS BREAST CANCER, GIVE ME THE MOST TREATMENT YOU CAN," MEANING MASTECTOMY AND CHEMO EVEN WHEN IT'S NOT INDICATED.

DR. SALGO: WELL, LET ME TELL YOU ABOUT LAURA FOR A MOMENT, BECAUSE LAURA, SHE DID FINE.

DR. GRIGGS: SHE SOUND'S LIKE SHE'S GOT HER HEAD ON STRAIGHT. ABSOLUTELY.

DR. SALGO: SHE WENT BACK TO WORK.  SHE HAD NOT VERY MUCH TROUBLE RECOVERING FROM THE SURGERY, SHE WAS PRETTY COMFORTABLE ABOUT THE WHOLE THING, AND SHE'S HAPPY WITH HER DECISION AT THIS TIME.  SO NOW LAURA HAS THE OTHER QUESTION, WHICH IS LOOKING BACK ON THIS ENTIRE EXPERIENCE, SHE ASKED HER DOCTOR, "IS THERE ANYTHING I COULD HAVE DONE PRIOR TO THIS TO AVOID GETTING BREAST CANCER IN THE FIRST PLACE?" WHAT DO YOU TELL HER NOW?

DR. GRIGGS: WHO WANTS TO TAKE THAT ONE?

DR. SALGO: YOU'RE ALL BACKING AWAY RAPIDLY.

DR. GRIGGS: WELL, ONLY HALF THE PATIENTS THAT I SEE, AND ALL I DO IS BREAST CANCER CARE, ONLY HALF THE PATIENTS HAVE EVEN ONE RISK FACTOR.  I THINK WE MAKE THIS LIST OF THINGS THAT CAN CAUSE AN INCREASED RISK OF BREAST CANCER IN A SENSE, IN A WAY TO CONTROL IT.  SO THAT, IF WE CAN JUST FIGURE OUT WHY I GOT IT, I CAN MAKE SURE I WON'T GET IT AGAIN, OR MY KIDS WON'T GET IT, OR MY FRIENDS, AND YOU KNOW I CAN GO OUT AND BE A CRUSADER FOR MAMMOGRAPHY WHICH, BY THE WAY, DOESN'T PREVENT BREAST CANCER, WE HOPE IT DETECTS IT EARLY.  WOMEN WOULD RATHER IN A WAY FEEL GUILTY THAN POWERLESS.

DR. SALGO: LET ME JUST RUN THROUGH A COUPLE OF THESE RISK FACTORS, SOME ARE MODIFIABLE, SOME ARE NOT.  EARLY PERIOD, THAT'S CERTAINLY NOT MODIFIABLE.

DR. GRIGGS: IT IS, IF YOU EXERCISE. GIRLS ARE HAVING THEIR PERIODS EARLIER AND EARLIER AND EARLIER, AND PART OF THAT IS DUE TO INCREASING BODY FAT, AND SO THIS EPIDEMIC OF OBESITY IN CHILDREN, NOT ONLY IS IT LEADING TO MORE DIABETES AND JOINT PROBLEMS AND HEART PROBLEMS, BUT OUR YOUNG GIRLS ARE GETTING HEAVIER AND HEAVIER ESPECIALLY AROUND THE TIME WHEN BREAST TISSUE IS DEVELOPING.

DR. SCHNITT: AS A GENERAL PRINCIPLE PRETTY MUCH ANYTHING THAT INCREASES THE LEVEL OF CIRCULATING ESTROGEN IN A WOMAN'S BODY, OR INCREASES THE LENGTH OF TIME IN WHICH HER BODY SEES UNOPPOSED ESTROGEN, INCREASES THE RISK OF BREAST CANCER.

DR. SALGO: YES OR NO, IS SMOKING IMPORTANT? 

DR. GRIGGS: YES. ONE STUDY SHOWING, VERY RECENTLY PUBLISHED IN THE JOURNAL OF THE NATIONAL CANCER INSTITUTE, THAT THERE IS A LINK.

DR. SALGO: ALRIGHT I WANT TO STOP THIS RIGHT HERE JUST FOR A MOMENT, BECAUSE WE HAVE TO SUM THINGS UP AGAIN.  THERE ARE SOME THINGS THAT YOU REALLY NEED TO REMEMBER.  THERE ARE RISK FACTORS FOR BREAST CANCER.  THE ONES YOU CAN'T CONTROL ARE GETTING YOUR PERIOD EARLY IN LIFE, YOUR AGE, YOUR FAMILY HISTORY OF BREAST CANCER. YOU CAN'T REALLY PICK YOUR PARENTS, MUCH AS SOME OF US WOULD LIKE TO.  THE RISK FACTORS YOU CAN CONTROL, HOWEVER, ARE HORMONE THERAPY, YOUR SMOKING HISTORY, NOT USING ALCOHOL EXCESSIVELY. I REALLY WANT TO THANK ALL OF YOU FOR BEING HERE. TREMENDOUS DISCUSSION, AND SUSAN WHAT CAN WE SAY?  THANK YOU SO MUCH FOR BEING HERE.

HUNT: CAN I LEAVE YOU WITH ONE THOUGHT?

DR. SALGO: ONE THOUGHT.

HUNT: I THINK THAT ONCE YOU IDENTIFY THAT HEALTH CARE TEAM, STAY THE COURSE, STAY WITH IT BECAUSE IT'S NOT A DEATH SENTENCE.

DR. SALGO: ALRIGHT, WE'VE COVERED A LOT OF GROUND TODAY.  I WANT TO REVIEW THE INFORMATION THAT YOU REALLY NEED TO REMEMBER FROM WHAT WE DISCUSSED.  EVALUATION OF A SUSPICIOUS BREAST SHOULD PROCEED UNTIL BOTH THE DOCTOR AND THE PATIENT ARE CONVINCED THAT THERE IS NO REASONABLE CHANCE THAT CANCER EXISTS.  THE POWERFUL PROGNOSTIC FACTORS THAT INFLUENCE THE TREATMENT OF BREAST CANCER ARE THE SIZE OF THE TUMOR, IF IT'S INVASIVE OR NOT, IF IT'S METASTATIC AT THE TIME OF DIAGNOSIS, IF IT'S HORMONALLY SENSITIVE AND IF THERE'S A FAMILY HISTORY OF BREAST CANCER.  REGARDLESS OF THE TREATMENT OPTIONS, THE PATIENT'S CHOICE IS ULTIMATELY A PERSONAL CHOICE AND THERE ARE VERY FEW WRONG ANSWERS.  THERE ARE RISK FACTORS FOR BREAST CANCER.  THE ONES YOU CAN'T CONTROL ARE GETTING YOUR PERIOD EARLY IN YOUR LIFE, YOUR AGE, A FAMILY HISTORY OF BREAST CANCER.  THE RISK FACTORS YOU CAN CONTROL ARE HORMONE THERAPY, NOT SMOKING, NOT USING ALCOHOL EXCESSIVELY.  FINAL MESSAGE, AS ALWAYS IS THIS, TAKING CHARGE OF YOUR HEALTH MEANS BEING INFORMED AND HAVING QUALITY COMMUNICATION WITH YOUR DOCTOR.  I'M DR. PETER SALGO, AND I'LL SEE YOU NEXT TIME ON ANOTHER SECOND OPINION.

SEARCH FOR HEALTH INFORMATION AND LEARN MORE ABOUT DOCTOR/PATIENT COMMUNICATION ON THE SECOND OPINION WEB SITE.  THE ADDRESS IS PBS.ORG.

MAJOR FUNDING FOR SECOND OPINION IS PROVIDED BY THE GUIDANT FOUNDATION  THROUGH PHILANTHROPIC PARTNERSHIPS, THE GUIDANT FOUNDATION IS COMMITTED TO INCREASING PATIENT AWARENESS AND ACCESS TO ADVANCEMENTS IN CARDIOVASCULAR CARE, WITH ADDITIONAL SUPPORT FROM THE FOLLOWING: THE JOSIAH MACY JR. FOUNDATION AND THE PARK FOUNDATION.
 
###