Maggie McKay (Host): If you've been diagnosed with breast cancer, you probably have a million questions. We're here to help you learn what comes next, from diagnosis to treatment and recovery. We're joined by breast surgeon, Dr. Mustafa Amani, who will fill us in.

Welcome to Putting Your Health First, a podcast from Health First. I'm your host, Maggie McKay. Thank you so much for being here, Dr. Amani.

Dr. Ahmad Mustafa Amani: Thank you very much for having me. It's a pleasure to be here.

Host: Absolutely. I imagine it's extremely emotional to get a breast cancer diagnosis and then all the questions swirling around in your mind like, "Will I need further diagnostic testing?"

Dr. Ahmad Mustafa Amani: Absolutely. And let me just start by saying that breast cancer is right now the most common cancer diagnosed in women second to skin cancer. So, this is, as you mentioned, a very common occurrence. And as far as diagnostic testing is concerned, it really depends on what you have done already. So typically, when patients present to me, they come in with a mammogram that's been done that has shown abnormal activity within the breast tissue. And then, we go on from there and do additional diagnostic imaging that can include a variety of different imaging modalities.

Host: And what type of biopsy will be done?

Dr. Ahmad Mustafa Amani: So, the biopsy, typically, it's a core-needle biopsy is what it's called. So, it's retrieving a piece of tissue from within the breast that looks abnormal within the imaging. That biopsy is done in a variety of ways. It could be ultrasound-guided, meaning that they use an ultrasound machine to guide the needle placement, or it could be MRI-guided meaning they use an MRI machine to guide the needle or stereotactic, and that's done using a mammogram to guide where the needle placement is done and where the biopsy is taken.

Host: And how do you see if the cancer has spread within my body?

Dr. Ahmad Mustafa Amani: So, that's typically done through what's known as a staging workup. So, staging typically refers to doing additional, again, diagnostic imaging to see if there's any other activity beyond the breast tissue. So, that's done through a PET CT scan, or you can also do a chest CT, abdomen CT and a pelvic CT as well as a bone scan.

Host: What is my prognosis? What about chances for relapse?

Dr. Ahmad Mustafa Amani: So, this is a loaded question to say the least. So, the prognosis depends on several factors. One of the most important prognostic indicators for breast cancer has been the stage of the cancer at the time of diagnosis. But the stage also depends on several factors, which we'll talk about in a minute, but the prognosis depends on what we call biomarkers, or the biology of the cancer. That biology of the cancer is determined whether it's what we call hormone-positive, or hormone-negative, triple negative or what we call HER2-positive. These are all terms that will be explained to you during your consultation with your breast surgeon or your medical oncologist as to what all those terms mean, but those terms essentially identify or define the biology of the cancer at hand.

Host: I'm thinking a big question for somebody diagnosed would be, will I develop cancer in my other breast?

Dr. Ahmad Mustafa Amani: Absolutely. So, breast cancer, and I get this question a lot. Individuals come to me and they say that, "Well, I have breast cancer on the left side. Does that mean that I'm absolutely going to get it on the right side? Or will the surgical procedure itself cause the spread of the cancer over to the right side?" And both of those answers are no. So, you can have development of breast cancer on both breasts or in both breasts at the same time, but that's extremely rare. Typically, breast cancer develops on one side and is treated as such. If breast cancer is identified on both sides, that will be additionally evaluated through the staging workup that we described earlier to see if it's anywhere else beyond the breast tissue. That changes our prognostic outlook significantly, if it is.

Host: And what do you say to someone who's been diagnosed when they ask you should I undergo genetic testing?

Dr. Ahmad Mustafa Amani: As far as genetic testing is concerned, there's several factors that go into whether or not you need to do genetic testing. And it really depends on the guidelines that are laid out by the National Comprehensive Cancer Network or the NCCN guidelines. So, it has to do with several factors such as your age at diagnosis, your familial history of breast cancer, and other factors like the type of cancer that you currently have and factors like this that your breast surgeon or your medical-oncologist will go over with you.

Host: And how do you know which type of breast cancer I have?

Dr. Ahmad Mustafa Amani: So, that's basically defined by the pathology report. So when we were talking about earlier about the core-needle biopsy, so the biopsy is taken and given to pathology to analyze and that analysis or that report is then provided to us and then we go over that report with you. Now, that report will provide what type of cancer is it. Is it what we call an infiltrative cancer or invasive cancer? Is it an in situ cancer? Or is it some rare type of cancer? So, the pathology report that will be provided to you and will be gone over with you by the breast version will be what's given that information then.

Host: Dr. Amani, is there a way to know the size of the tumor?

Dr. Ahmad Mustafa Amani: Absolutely. So again, this is through the imaging modalities that we had discussed earlier. So, the mammogram that's done initially, the ultrasound that's done initially, or the MRI that's done initially, all three of these modalities can help define the size of either the mass of a tumor, or sometimes cancer can be within the form of just calcifications within the breast tissue. So, it can also help us define the span of calcifications. The size of the cancer is very important when it comes to surgical planning because then you get into what can we do as far as surgery is concerned. Can we do breast conservation or do we need to do more as such as a full mastectomy? But again, that is a conversation that's had in more detail later, but typically the size is initially provided through the imaging modalities.

Host: So when a patient hears something like you have stage IV or stage III, how do you determine the stage of cancer?

Dr. Ahmad Mustafa Amani: So, the stage of the cancer is basically done through a system, it's a staging system that we use. So, the size of the tumor comes into play, the nodal status, and by nodal status, what I mean is, are there lymph nodes involved with this particular cancer? So, you have a diagnosis of cancer within the breast tissue, but do you have cancer that's also identified within the lymph nodes within the axilla or the armpit? So, the size, the nodal status. And then, finally, is there distant metastatic disease, meaning is there cancer that has already gone beyond the breast tissue? These three factors help us determine what stage you are at clinical presentation.

Host: Okay. And so, do you perform more testing before you decide on treatment?

Dr. Ahmad Mustafa Amani: Yes, we do. And again, it depends on what's already been done. But typically. When the patient comes to me, they have already done most of the time the basic work up as far as they've done a mammogram and they've found some abnormal activity within the mammogram that needs further workup. So then, I take it from there and I order either the biopsy, if that has not already been done, or additional workup as we had mentioned, the staging. Do I need to get a PET scan to evaluate any kind of activity beyond the breast tissue? Or do I need to get an MRI of the breast to further evaluate the breast that has the cancer as well as the contralateral or the opposite breast? So, these are all additional workup that is done indeed.

Host: So once I've been diagnosed, do I need to see any other doctor or healthcare professional?

Dr. Ahmad Mustafa Amani: Yes, absolutely. So, breast cancer as with other cancers, the treatment of it is handled through a multidisciplinary approach. So, what I mean by that is I always refer to myself the surgical cancer doctor or the breast surgical oncologist. And you will also meet a medical oncologist as well as a radiation oncologist. We have genetic counselors also available at Health First, as well as myriad of other ancillary staff members that you will also meet along your journey. So, the treatment of it is definitely multidisciplinary.

Host: In closing, is there anything else you'd like to add that we didn't cover?

Dr. Ahmad Mustafa Amani: No. The main thing is that this breast cancer diagnosis can be jarring to say the least. It is very life-altering also to say the least. But understand that your healthcare professional, whomever that person is that you meet along the way, they're there to help you and they're there to guide you along your path, along this journey through the breast cancer treatment. Myself, again, I'm a breast surgical oncologist, so I specifically treat and I deal with the diseases of the breast, you know, malignant as well as benign. So, my patients, when they come to me, you know, I try to level with them as much as I can and guide them along their journey and set up expectations of what's next along each step.

Host: Well, thank you so much for sharing your expertise. It's such an emotional topic, and I'm sure you've put a lot of people's minds at ease.

Dr. Ahmad Mustafa Amani: Thank you very much for having me. I enjoyed it thoroughly.

Host: Absolutely. Again, that's Dr. Mustafa Amani. For questions about the support group, you can call 321-728-6002. That's the Health First Breast Cancer Support Group. The number again, 321-728-6002. And if you'd like to learn more about breast cancer treatment at Health First, you can visit hf.org/breasthealth. If you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. I'm Maggie McKay. Thanks for listening to Putting Your Health First from Health First.