Blog Post < Previous | Next >
MarinHealth
Breast Cancer Awareness Month: What People Need To Know Today
In observance of Breast Cancer Awareness Month, I had the pleasure of speaking with Dr. Leah Kelley, a physician specializing in breast surgical and gynecologic surgery at MarinHealth. To give a little background, Dr. Kelley attended Yale University and obtained her medical degree from the University of Chicago in 2003. While a medical student, Dr. Kelley developed a lifelong passion for women's health. She completed a residency in obstetrics and gynecology at the University of California, San Francisco, and was elected chief resident. She completed a fellowship in breast surgical oncology at the University of Southern California, studying under Dr. Melvin Silverstein. Combining state-of-the-art breast surgical care with a holistic approach to breast cancer and gynecologic care, Dr. Kelley strives to bring the best of women's healthcare to each patient. Her publications include topics related to breast health, breast cancer outcomes, lesbian health and medical education.
Thank you for taking the time to speak with me today, Dr. Kelley.
To kick things off, what are the latest treatments available for people with breast cancer?
Dr. Kelley: Breast cancer treatment is increasingly individualized based on tumor subtype and genomic testing. People diagnosed with breast cancer can expect direct tailoring of all treatment types to their individual situation.
Have you noticed any trends happening around breast cancer discovery?
Dr. Kelley: Breast cancer treatment is increasingly individualized based on tumor subtype and genomic testing. People diagnosed with breast cancer can expect direct tailoring of all treatment types to their individual situation.
Have you noticed any trends happening around breast cancer discovery?
Dr. Kelley: As in most of oncology, there is a big focus on immunotherapy -- a very promising, diverse class of agents that are designed, through a variety of mechanisms, to target the immune system toward malignant cells. Generally speaking, we are moving toward less invasive surgical approaches, shorter courses of radiation therapy, and more targeted systemic approaches.
Depending on when it's caught, has longevity increased over the years?
Dr. Kelley: Stage at diagnosis is the still the best predictor of disease-free survival, which is why early detection continues to be an extremely important part of breast cancer treatment from an individual and public health perspective. That said, disease-free survival has increased in recent years for certain tumor subtypes due to new targeted chemotherapy and immunotherapy agents.
For women in various age groups, what are the signs they should be aware of for breast cancer?
Dr. Kelley: All women should practice breast self-awareness, and come in to see a doctor right away if they notice any persistent change in the appearance or texture of their breasts. However, physical symptoms are often a late sign of breast cancer, which is why all women over age 40 should undergo screening mammography.
What is the latest guidance on getting a mammography?
Dr. Kelley: For all women, beginning mammography at 40 and continuing to screen yearly carries the most benefit in terms of years-of-life saved. Low and average risk women (those with no significant breast cancer risk factors) can discuss with their physician whether they wish to begin screening at 40, 45 or 50. They should screen every 1-2 years. Later start and longer intervals will decrease the false positive risk but also increase the risk of missed cancers. Women with any increased breast cancer risk should start annual mammograms at 40 and have one every year. A woman who is unsure about her risk should discuss this with her doctor.
Are there different types of breast cancer? If so, can you briefly explain what they are?
Dr. Kelley: There are four primary types of invasive breast cancer, which are defined by their grade and receptor status. New breast cancers are tested for estrogen receptors, progesterone receptors and a protein receptor called Her-2.
- Low-risk (Luminal A) breast cancers are low or intermediate grade, ER/PR positive, and her-2 negative
- Higher risk (Luminal B) breast cancers are higher grade, ER positive, PR variable and her-2 negative
- Her-2 enriched breast cancers overexpress Her-2 and are classified together regardless of ER status
- Triple negative (basal type) breast cancer do not express ER, PR or Her-2
DCIS (ductal carcinoma in situ) is a different kind of breast cancer and is not classified in the same way. It is always stage 0.
What happens if my cancer is left untreated?
Dr. Kelley: All breast cancers will progress if untreated. The time course for this progression may vary greatly depending on the characteristics of the cancer. Progression may be local within the breast, including enlarging tumor, lymph node involvement in the armpit, and involvement of the skin and chest muscle. It may instead or also be metastatic, including spread of the breast cancer to the bones, liver, lungs and brain.
What does a typical breast cancer screening with a doctor consist of?
Dr. Kelley: Routine clinical breast examinations are part of primary and obstetric care for younger women. Women 40 and over should discuss mammography with their doctors and may also have clinical examinations as part of their routine care.
What does the "stage" of cancer mean?
Dr. Kelley: Stage is a general description of the size and location of a newly diagnosed breast cancer including tumor size and lymph node involvement. Tumor subtype is also part of staging.
How important is it for women to self-exam themselves for breast cancer, How can women self-exam themselves for breast cancer, how often should they do it?
Dr. Kelley: Self- exam is no longer recommended.
Marin County once led the country in breast cancer rates. While this was deemed related to genetics, do you have the latest numbers and were Marin County currently ranks?
Dr. Kelley: Actually, the previous increased per capita rate of breast cancer in Marin in known to be attributable to a complex amalgam of risk factors present in the population of this county. Genetics is one, but others include reproductive risk patterns, lifestyle factors such as alcohol consumption, and the widespread use of post-menopausal hormone replacement therapy. Marin now has breast cancer rates comparable to similar counties in other parts of the country, and not significantly higher than the rest of the state (80-100/100,000).
What inroads been made with women that have dense breasts (preventing detection)?
Dr. Kelley: Tomosynthesis (AKA 3-D mammography) has improved the detection rate of small breast cancers and reduced the false positive rate in women with dense breasts. All mammography at MarinHealth is 3-D.
Is it true that approximately one out of every 100 breast cancers detected belongs to a man? What message to you have for men to get checked and how often?
Dr. Kelley: Male breast cancer constitutes less than 1% of all breast cancer cases in the US annually. The most significant risk factor, other than aging, is family history. It is estimated that up to 50% of men who get breast cancer have a genetic predisposition to cancer (compared with 10-15% of women). There is no recommended screening for healthy men, however, men should never ignore a breast, chest or armpit mass, and should see their doctor right away if they have symptoms.
The decades-old debate over whether antiperspirant deodorants can lead to breast cancer has been reignited in the scientific community with two new studies. Do you have any thoughts on the same?
Dr. Kelley: This is a great example of how real laboratory science can be hijacked by social media and turned into pseudoscience that is mostly designed to generate 'clicks.' Those two studies were both basic bench research using cellular and animal models of carcinogenesis. They in no way "prove" that antiperspirant causes breast cancer. All prior epidemiologic studies of this issue have not shown an association between antiperspirants and breast cancer. All cancers are complex, multifactorial events and there is almost never a single cause. Undoubtedly, the modern environment contains many chemicals that can affect our cells and DNA in negative ways. There are excellent government and non-profit groups working with scientists to try to make our living environment safer. We can all be informed about what is in our food, cosmetics and consumer products, and try to buy and consume safely.