Selected Podcast
Breast Cancer Awareness
Anna Higham M.D. discusses Breast Cancer and Benign Breast Disease. She shares information on recognizing patients that are at high risk for breast cancer and the treatment options available.
Featuring:
Learn more about Anna Higham, MD
Anna Higham, MD
Anna Higham, MD is an Associate Program Director, Surgical Oncologist.Learn more about Anna Higham, MD
Transcription:
Melanie Cole, MS (Host): Expert Insights is an ongoing medical education podcast. The Carle Division of continuing education designates that each episode of this enduring material is worth a maximum of .25 AMA PRA Category 1 credit. To collect credit, please click on the link and complete the episode’s post-test.
Welcome. Today we’re talking about breast cancer, benign breast disease, and patients that might be at higher risk for breast cancer. My guest is Dr. Anna Higham. She’s a breast surgeon with the Carle Foundation hospital. Dr. Higham, what a pleasure to have you with us. Explain just a little bit about breast cancer. What are you seeing as far as incidence and awareness? Are more women getting screened?
Anna Higham M.D. (Guest): Well as far as breast cancer goes, it is the second most common cancer that will effect women outside of skin cancer. The incidence and awareness for breast cancer have increased over the years as well as screening. Now in regards to screening for breast cancer, we saw the biggest leap in screening in the 1980s. That’s really when mammography came on board as a great tool to help detect early stage breast cancer. We saw a huge leap then. Then over the past decade or so we’ve really seen the screening and incidence kind of level out. As far as awareness, I think that is something that goes up and up on an annual basis. As we know, the famous pink ribbon identifying breast cancer awareness month in October.
Host: So as a result of more women getting screened, are you noticing more benign breast lumps being identified?
Dr. Higham: Well as screening as gone up over the years, we have overall seen more benign breast disease. However, it has really stabilized over the last several years.
Host: Does it put a women at greater risk of breast cancer? How do you group benign conditions into category as to whether they raise the risk? Do some increase the risk more than others? Tell us about that.
Dr. Higham: Well, that’s a great question. We actually do categorize benign breast disease into low risk versus high risk lesions. Now, we have our typical benign things within the breast. Things like papillomas, fibro adenomas that by themselves really don’t increase the risk for breast cancer. However, though, we do move into other categories such as atypical ductal hyperplasia, atypical lobular hyperplasia. Those are markers for an increased risk of breast cancer and some even consider a pre-cursor to breast cancer. Now, we know those do increase your risk for breast cancer. However, it is kind of hard to define exactly what that risk is. So now we really take into account the entire picture of the patient. What their family history is, with their personal history is. We have really nice risk calculators that we can use to give an individual woman her individual risk.
Now we have other lesions such as lobular carcinoma in situ, which sounds very scary because it has that word carcinoma in it, but it is not a cancer. This is a true marker of breast cancer. Women who have lobular carcinoma in situ are at a higher risk for developing breast cancer on either breast. So it’s important that we identify these women as well so we can talk about ways to reduce their risk.
Host: Well, that’s really…It’s so important and one of the main messages for sure. Now you mentioned risk factors. Is there a genetic predisposition? Tell us a little bit about what role inherited trait plays in developing breast cancer.
Dr. Higham: Absolutely. So to start off, most women who come in with a diagnosis of breast cancer do not have a family history of cancer at all. Now, the risk goes up as women have relatives that have had breast cancer, especially first degree relatives. That does increase a woman’s risk for breast cancer. Now, we all hear about the specific genes that are out there. The most common ones we hear about are BRCA-1 and BRCA-2 genes. Again, these are very rare within the population. But for women that have a very strong family history of breast and ovarian cancer, they're at a higher risk for carrying one of those genes, which we can test for. So it’s important that a patient is aware of their family history as well as their personal history to determine if they need a specific type of testing done.
Host: Do you have any advice to facilitate the development of appropriate and targeted risk reduction strategies? I mean obviously we can’t change family history if we’re an Ashkenazi Jew or you’ve got the BRCA gene mutation, but what about some of the things we can control?
Dr. Higham: Exactly. Well, I think the most important thing is is for patients to be upfront with their primary care providers, their gynecologists—whoever that frontline person is that’s ordering their mammograms—about their family histories. Strong family histories should be seen by a breast specialist to do a formal risk evaluation where we can categorize women into low risk, high risk, and whether or not that risk meets the level of needing to do genetic testing. Now, for those women that are a higher risk, it’s very important to make sure they're on the right screening regiment. We do, for women at high risk, add in breast MRIs on an annual basis along with their normal mammogram.
There are also options that we talk about with women regarding medication. There are some medications that we use that are hormone blockers within the breast, if you will, that are actually very effective at reducing a woman’s risk for developing breast cancer. Those medications can reduce the risk by about 50%.
Host: Wow. So Dr. Higham, as we’re speaking to other providers and they're counseling their patients, as they start to approach the age for screening mammography and possible benign cysts showing up—which is scary for all of us. I mean it really is. Why is there confusion over the current recommendations for screening mammography and what would you like other providers to tell their patients?
Dr. Higham: Oh, that is the million dollar question right now. In the past several years, there has been a lot of data coming out about when we should start screening mammography. There have been studies that are looking at different elements of screening mammography, things like the effect of false positives on patients. Are we over diagnosing breast cancer? Anxiety associated with having mammograms and having to be called back in. Overall, from the world of oncology, our recommendations are pretty straightforward and strong. We believe people should have screening mammography starting at the age of 40 and on an annual basis. Some of the studies that are out there discuss women maybe being able to start a little bit later with not having a high risk for breast cancer, and that’s sometimes hard to tell in the primary care setting. So we do encourage people to have screening mammography starting at 40 and every year.
Host: That’s good information. So if you do find a cyst, a lump—again, so scary for women—what are some of her options regarding surgery? Do you automatically biopsy it? Do you automatically do a lumpectomy? Tell us a little bit about what you do.
Dr. Higham: Well, it depends on what we find. For things like benign disease or benign appearing lesions—such as a cyst or benign tumors like a fibro adenoma—at a certain age our radiologist will recommend core needle biopsy. That’s a strong point to bring home. Every woman that has an issue on mammogram that needs further workup should have that done with a core needle biopsy. We don’t jump to surgery right away. The reason for that is surgeons like myself, we really need to know what we’re getting into. We want to plan the appropriate surgery for the patient and the appropriate treatment.
If a person comes in, a woman comes in, with the diagnosis of breast cancer, she has several options. It’s so scary to get that diagnosis, but by in large we are diagnosing early stage breast cancer, which is essentially curable breast cancer in 2019. As far as surgery, they have lots of choices. Breast conservation, mastectomy, reconstruction after any of these surgeries. Our first goal is to make sure that they get a really great oncologic surgery, but I always say close second is we want to make sure that we leave them feeling whole at the end of it.
Host: Certainly true. What a great point. So before we wrap up, what does current research indicate for future developments and treatments? Give us a little blueprint. What do you see in happening out there that’s really exciting you Dr. Higham?
Dr. Higham: There's so much that is exciting. I would say we stand on the shoulders of thousands of women that participated in clinical trials to get us this far where we are right now in breast cancer treatment, and it’s just going forward. I think as far as surgical treatments, I like to joke and say we’re going to slowly research me out of a job. I think our surgical treatments will be less invasive in the future. As far as medications, I think we will have more targeted therapies. We’ve already developed some. I think those will continue to be developed. We’re moving into the world of things like immunotherapy as well. I think we will progress forward with that. There’s even some studies working on vaccines for breast cancer right now. I think from where we’ve started even just a few decades ago with breast cancer treatment, because of the research we’ve come so far. I think we’re just going to keep going all the way down the road until hopefully this is a disease no woman has to suffer from.
Host: Well said. Thank you so much, Dr. Higham, for coming on and telling us about it and really sharing your expertise. What great information. That wraps up this episode of Expert Insights with the Carle Foundation Hospital. For a listing of Carle Providers and to view Carle sponsored educational activities, head on over to our website at carleconnect.com for more information and to get connected with one of our providers. We hope the information gained will be applicable to your work and life. If you found this podcast as informative as I did, please share. Share with other women, share on your social media and with other providers, and be sure not to miss all the other interesting podcasts in our library. Until next time, I'm Melanie Cole.
Melanie Cole, MS (Host): Expert Insights is an ongoing medical education podcast. The Carle Division of continuing education designates that each episode of this enduring material is worth a maximum of .25 AMA PRA Category 1 credit. To collect credit, please click on the link and complete the episode’s post-test.
Welcome. Today we’re talking about breast cancer, benign breast disease, and patients that might be at higher risk for breast cancer. My guest is Dr. Anna Higham. She’s a breast surgeon with the Carle Foundation hospital. Dr. Higham, what a pleasure to have you with us. Explain just a little bit about breast cancer. What are you seeing as far as incidence and awareness? Are more women getting screened?
Anna Higham M.D. (Guest): Well as far as breast cancer goes, it is the second most common cancer that will effect women outside of skin cancer. The incidence and awareness for breast cancer have increased over the years as well as screening. Now in regards to screening for breast cancer, we saw the biggest leap in screening in the 1980s. That’s really when mammography came on board as a great tool to help detect early stage breast cancer. We saw a huge leap then. Then over the past decade or so we’ve really seen the screening and incidence kind of level out. As far as awareness, I think that is something that goes up and up on an annual basis. As we know, the famous pink ribbon identifying breast cancer awareness month in October.
Host: So as a result of more women getting screened, are you noticing more benign breast lumps being identified?
Dr. Higham: Well as screening as gone up over the years, we have overall seen more benign breast disease. However, it has really stabilized over the last several years.
Host: Does it put a women at greater risk of breast cancer? How do you group benign conditions into category as to whether they raise the risk? Do some increase the risk more than others? Tell us about that.
Dr. Higham: Well, that’s a great question. We actually do categorize benign breast disease into low risk versus high risk lesions. Now, we have our typical benign things within the breast. Things like papillomas, fibro adenomas that by themselves really don’t increase the risk for breast cancer. However, though, we do move into other categories such as atypical ductal hyperplasia, atypical lobular hyperplasia. Those are markers for an increased risk of breast cancer and some even consider a pre-cursor to breast cancer. Now, we know those do increase your risk for breast cancer. However, it is kind of hard to define exactly what that risk is. So now we really take into account the entire picture of the patient. What their family history is, with their personal history is. We have really nice risk calculators that we can use to give an individual woman her individual risk.
Now we have other lesions such as lobular carcinoma in situ, which sounds very scary because it has that word carcinoma in it, but it is not a cancer. This is a true marker of breast cancer. Women who have lobular carcinoma in situ are at a higher risk for developing breast cancer on either breast. So it’s important that we identify these women as well so we can talk about ways to reduce their risk.
Host: Well, that’s really…It’s so important and one of the main messages for sure. Now you mentioned risk factors. Is there a genetic predisposition? Tell us a little bit about what role inherited trait plays in developing breast cancer.
Dr. Higham: Absolutely. So to start off, most women who come in with a diagnosis of breast cancer do not have a family history of cancer at all. Now, the risk goes up as women have relatives that have had breast cancer, especially first degree relatives. That does increase a woman’s risk for breast cancer. Now, we all hear about the specific genes that are out there. The most common ones we hear about are BRCA-1 and BRCA-2 genes. Again, these are very rare within the population. But for women that have a very strong family history of breast and ovarian cancer, they're at a higher risk for carrying one of those genes, which we can test for. So it’s important that a patient is aware of their family history as well as their personal history to determine if they need a specific type of testing done.
Host: Do you have any advice to facilitate the development of appropriate and targeted risk reduction strategies? I mean obviously we can’t change family history if we’re an Ashkenazi Jew or you’ve got the BRCA gene mutation, but what about some of the things we can control?
Dr. Higham: Exactly. Well, I think the most important thing is is for patients to be upfront with their primary care providers, their gynecologists—whoever that frontline person is that’s ordering their mammograms—about their family histories. Strong family histories should be seen by a breast specialist to do a formal risk evaluation where we can categorize women into low risk, high risk, and whether or not that risk meets the level of needing to do genetic testing. Now, for those women that are a higher risk, it’s very important to make sure they're on the right screening regiment. We do, for women at high risk, add in breast MRIs on an annual basis along with their normal mammogram.
There are also options that we talk about with women regarding medication. There are some medications that we use that are hormone blockers within the breast, if you will, that are actually very effective at reducing a woman’s risk for developing breast cancer. Those medications can reduce the risk by about 50%.
Host: Wow. So Dr. Higham, as we’re speaking to other providers and they're counseling their patients, as they start to approach the age for screening mammography and possible benign cysts showing up—which is scary for all of us. I mean it really is. Why is there confusion over the current recommendations for screening mammography and what would you like other providers to tell their patients?
Dr. Higham: Oh, that is the million dollar question right now. In the past several years, there has been a lot of data coming out about when we should start screening mammography. There have been studies that are looking at different elements of screening mammography, things like the effect of false positives on patients. Are we over diagnosing breast cancer? Anxiety associated with having mammograms and having to be called back in. Overall, from the world of oncology, our recommendations are pretty straightforward and strong. We believe people should have screening mammography starting at the age of 40 and on an annual basis. Some of the studies that are out there discuss women maybe being able to start a little bit later with not having a high risk for breast cancer, and that’s sometimes hard to tell in the primary care setting. So we do encourage people to have screening mammography starting at 40 and every year.
Host: That’s good information. So if you do find a cyst, a lump—again, so scary for women—what are some of her options regarding surgery? Do you automatically biopsy it? Do you automatically do a lumpectomy? Tell us a little bit about what you do.
Dr. Higham: Well, it depends on what we find. For things like benign disease or benign appearing lesions—such as a cyst or benign tumors like a fibro adenoma—at a certain age our radiologist will recommend core needle biopsy. That’s a strong point to bring home. Every woman that has an issue on mammogram that needs further workup should have that done with a core needle biopsy. We don’t jump to surgery right away. The reason for that is surgeons like myself, we really need to know what we’re getting into. We want to plan the appropriate surgery for the patient and the appropriate treatment.
If a person comes in, a woman comes in, with the diagnosis of breast cancer, she has several options. It’s so scary to get that diagnosis, but by in large we are diagnosing early stage breast cancer, which is essentially curable breast cancer in 2019. As far as surgery, they have lots of choices. Breast conservation, mastectomy, reconstruction after any of these surgeries. Our first goal is to make sure that they get a really great oncologic surgery, but I always say close second is we want to make sure that we leave them feeling whole at the end of it.
Host: Certainly true. What a great point. So before we wrap up, what does current research indicate for future developments and treatments? Give us a little blueprint. What do you see in happening out there that’s really exciting you Dr. Higham?
Dr. Higham: There's so much that is exciting. I would say we stand on the shoulders of thousands of women that participated in clinical trials to get us this far where we are right now in breast cancer treatment, and it’s just going forward. I think as far as surgical treatments, I like to joke and say we’re going to slowly research me out of a job. I think our surgical treatments will be less invasive in the future. As far as medications, I think we will have more targeted therapies. We’ve already developed some. I think those will continue to be developed. We’re moving into the world of things like immunotherapy as well. I think we will progress forward with that. There’s even some studies working on vaccines for breast cancer right now. I think from where we’ve started even just a few decades ago with breast cancer treatment, because of the research we’ve come so far. I think we’re just going to keep going all the way down the road until hopefully this is a disease no woman has to suffer from.
Host: Well said. Thank you so much, Dr. Higham, for coming on and telling us about it and really sharing your expertise. What great information. That wraps up this episode of Expert Insights with the Carle Foundation Hospital. For a listing of Carle Providers and to view Carle sponsored educational activities, head on over to our website at carleconnect.com for more information and to get connected with one of our providers. We hope the information gained will be applicable to your work and life. If you found this podcast as informative as I did, please share. Share with other women, share on your social media and with other providers, and be sure not to miss all the other interesting podcasts in our library. Until next time, I'm Melanie Cole.