Transcription:
Breast Cancer: Know Your Body, Own Your Health

Deborah Howell (Host): Hello and welcome to the show. You are listening to Weekly Dose of Wellness brought to you by MemorialCare Health System. I'm Deborah Howell, and today's guest is Dr. Homayoon Sanati. Dr. Sanati is the medical director at the MemorialCare Breast Center at Long Beach Memorial and is triple-board certified in medical oncology, geriatrics, and hospice palliative care. Dr. Sanati has been honored with numerous awards, including America's Top Oncologist selected by Consumers Research Council of America. Dr. Sanati leads Long Beach Memorial's multidisciplinary breast program that features an integrated team of experts who provide state-of-the-art breast care. Welcome to you today, Dr. Sanati.

Dr. Homayoon Sanati (Guest): Thank you.

Deborah: Today we're going to be talking about breast cancer, knowing your body, and owning your own health. Let's start with a nutshell definition. What is breast cancer?

Dr. Sanati: Breast cancer is basically breast cells that are growing out of control. Initially, it starts with one cell that basically doesn't stop dividing. As it grows more, it makes more errors in their gene, and they become invasive. They may penetrate into the other tissue and into the blood or lymphatic tissue.

Deborah: Okay. What are the signs and symptoms of breast cancer?

Dr. Sanati: Actually, you see the signs of breast cancer probably a little late in that. Oftentimes, in early breast cancer, there are no signs or symptoms. You can feel the tumor itself when it's growing larger. The tumor may spread to the local lymph nodes; usually it's in the axilla, under the arm. Sometimes, if the tumor is close to the skin, you can see skin dimpling, and you may see redness or even a bruise. Sometimes the tumor can cause breast edema. One of the signs of that is the skin looks like the texture of a skin of an orange, and it has those patterns that you see on an orange. Pain is rarely seen with breast cancer. Usually, when you have pain, it's a more advanced cancer.

Deborah: Okay, very good. This leads us to mammograms. In your definition, what really is a mammogram?

Dr. Sanati: Mammogram is basically an x-ray of the breast. They shoot an x-ray and they capture it on the other side with a film or, nowadays, within a digital camera. In order to get a better picture, one thing that the technician needs to do is to compress the breast tissue. That's why mammograms are painful, because when you press the breast tissue, you would have better resolution on the mammogram.

Deborah: Right. We all wished there was a different solution. But there isn't, right?

Dr. Sanati: No, there is not.

Deborah: At what age should women look forward to these lovely mammograms?

Dr. Sanati: Most guidelines recommend starting at age 40 for an average risk woman. If a woman has a family history of breast cancer—for example, someone in the family was diagnosed younger than age 40—they may need to consider screening that at a younger age. This topic actually has been very controversial, but most guidelines really recommend starting at age 40. Annual mammogram is really the best way to go. There was a recent article that was published that recommended more screening for younger women because the impact of screening in saving life years is more in younger women.

Deborah: Absolutely. Then, of course, there are those that say that you should only have them every three years. But I think you can't go wrong if you go with the standard, which is once a year after 40.

Dr. Sanati: Correct. Every three years or every two years is going to be too long.

Deborah: Right.

Dr. Sanati: You will miss a lot of breast cancers.

Deborah: Okay. There is another way that we can help ourselves, and that's breast self-exams. How important are these?

Dr. Sanati: Again, that's another topic that hasn't been discussed in detail. But in my opinion, it's very important. Some want to reduce the impact of this self-exam, but three days ago, I saw one patient who had a normal mammogram three months before, and she palpated a mass in her breast. Actually, she went to her doctor, and the doctor was kind of reluctant to order additional imaging. She was diagnosed with stage 1 breast cancer.

Deborah: Wow.

Dr. Sanati: I think it's very important. Women should be aware of their breasts. There is no real downside to it. I think every woman should do that.

Deborah: That's right. How can women reduce their risk of breast cancer?

Dr. Sanati: Having a healthy lifestyle, exercise, avoiding smoking, reducing alcohol intake are good strategies. Avoiding hormone replacement treatment for women who have postmenopausal symptoms, if possible, is a good strategy. These are all shown to reduce the breast cancer. I think we don't emphasize the importance of exercise, and again, recently, there was an article published that had shown exercise has a huge impact in reducing breast cancer. Actually, the cancer recurs as well in a woman who has been diagnosed with breast cancer.

Deborah: All right, ladies, get moving. You could save your own lives, right?

Dr. Sanati: That's correct.

Deborah: Are there any other advancements in the treatment of breast cancer that you could share with us?

Dr. Sanati: There are new technologies that are coming up. One you may already have heard about is the tomosynthesis, also known as 3-D mammogram. Basically, this is a mammogram that takes multiple pictures of the breasts. And because you have multiple pictures, you have a slightly better sense if a density is malignant-looking versus not malignant-looking. It reduces the call-back rate, basically.

Deborah: Okay.

Dr. Sanati: That reduces a lot of anxiety. Another technology is an automated whole-breast ultrasound that had shown to detect smaller tumors and doubles the rate of detection.

Deborah: Technology is always moving forward and in our favor, isn't it?

Dr. Sanati: Always. However, proving that this technology work and showing that it reduces the mortality from breast cancer may take many years.

Deborah: Sure. There's another development I'd like to talk about. Maybe you can help me with the pronunciation. Is it Per-jee-ta or Per-jet-a?

Dr. Sanati: Perjeta. This is a new drug that was FDA approved for stage 4 metastatic breast cancer and, recently, for preoperative treatment of locally advanced breast cancer. Let me give you a little background.

Deborah: Sure.

Dr. Sanati: About 15 to 20 percent of breast cancer have a receptor called HER2 receptor.

Deborah: Okay.

Dr. Sanati: HER2 stands for human epidermal growth factor receptor #2. We have one drug called Herceptin—the genetic name is trastuzumab—that is a protein antibody that blocks this HER2 receptor and had shown improved survival. A woman with a HER2-positive breast cancer, they have a very aggressive disease.

Deborah: Okay.

Dr. Sanati: This Perjeta or pertuzumab, which is the generic name, is another antibody that blocks this receptor at a different site that the trastuzumab does. Basically, using trastuzumab and pertuzumab, these two antibodies have helped to better block that receptor and had improved survival and improved what we call complete pathological response when given before surgery.

Deborah: All right, doctor. Thank you. Let me stop you there because I want people to have some place they can contact for more information.

Dr. Sanati: We have a very nice cancer risk and prevention program that can answer patients' questions about their risks. If they need assistance and genetic counseling and so forth, that number is 562-933-RISK. Again, that's 562-933-7475.

Deborah: Thank you so much, doctor. We really appreciate it.

Dr. Sanati: Thank you very much.