Transcription:
Breast Cancer and Surgery

Disclaimer: The medical health information provided during this program is for general information and educational purposes only, and is not a substitute for professional advice. None of the given information is for the purpose of diagnosis or treatment. Neither does this program serve as approval for any health product or brand.

This program aims to enhance your personal health and wellness through the adoption of healthy lifestyles and your prompt presentation to the health professional whenever you suspect that you are ill. For treatment and professional advice, ensure you consult your physician. Welcome to Say Yes to Good Health with Memorial Hospital. I'm Melanie Cole, and I invite you to join us as we discuss breast cancer and surgical options available at Memorial Hospital. Joining me is Dr. Peter Perll. He's a General Surgeon at Memorial Hospital. Dr. Perll, it's such a pleasure to have you back with us again today. So, as we get into some of those options, before we talk about any of that stuff, tell us about the risk for breast cancer and what is it that increases our risk as women?

Peter Perll, MD (Guest): You have to remember that breast cancer is the most commonly diagnosed cancer and the second most common cause of death in the United States for women. So, it's something that really needs to be addressed, and we want those numbers to go down, but there are several risk factors. There are some that you just can't modify. you get older, your risks go up, actually, you know, obviously being a female, your risk is there more than males. a family history again, having that genetic history is, really a large risk factor. Dense breasts could be a risk factor. This needs to be looked at closer. So, those are the ones that you really don't have any way to modify, but again, back to our usual things, people that are overweight or obese, have a higher risk factor. of the things that if you have pregnancy at a later age, or if you don't breastfeed can sometimes increase your risks, but again, alcohol and smoking are an easily modifiable risk factor that we need to look at all the time for breast cancer, as well as other disease processes.

And then some feel that there may be a benefit to eating lower fat diets as high of factor as other disease processes, but it's still there. And then physical activity is good your overall health, as well as your risk of breast cancer

Host: What an excellent list. Ladies, I hope that you took note of that list from Dr. Perll, because that was excellent and very comprehensive. So, let's speak a little bit about breast cancer screening. Now I'm a 57 year old woman, so I've been having mammograms for quite a while, every single year also, because you even mentioned dense breasts. We, you know, I get an ultrasound, so I get whole ultrasound done every year as well, because that puts me at that increased risk. What do you want to tell women listening about these mammograms and the importance of that type of screening?

Dr. Perll: Well, before we get to that, I want to mention one of the things that we need to emphasize and still emphasize, is physical exams. Women need to do a self-breast exam. They are their best advocate. They we're going to find things that aren't right or seem different, faster than their physicians or anyone else. So I want to just stress that it's very important to start that at a younger age, get used to doing it on a monthly basis. And if you find something, go into your doctor and get it checked because you're going to find things faster than other people. Beyond that, then again, we have the screening mechanisms.

Mammogram is still the mainstay unless you have some other risk factors, particularly the the hereditary side, then mammograms usually start at forty. If you find something though, you're going to get something earlier. So, if you came in at age 32 with a problem we're going to check that out with

mammogram and likely ultrasound like you said

ULtrasound is good for finding lesions that may be amenable to

less invasive diagnostics So

the two mainstays are mammogram And ultrasound of the breast but those

are

Host: if they find something that's not cancer, like I had papilloma, a couple of them. One, I did have a lumpectomy for, so that kind thing, Dr. Perll is something that you might recommend that's minimally invasive right. But also takes care of an issue that what, could cause problems later

Dr. Perll: majority of Obviously the first thing is to get an image of it, to see what it looks like. The radiologists are very good at looking at this saying, we feel this needs to be diagnosed with pathology or it's something they feel that they can watch. But typically if it's not palpable, it's usually dealt with by a needle localized biopsy where you're getting some tissue by just putting a needle into it, which hopefully shows that it's benign, It's not cancerous, something that we don't necessarily need to take out. There are some that you palpate and women would rather have those out so we do make

Host: on

Dr. Perll: open biopsy but I

think that's becoming less and less now that we're finding stuff so early that you can't even feel it We're doing that needle localized biopsy to get a tissue diagnosis to make sure that it's something we need to act on further as if it's a malignancy or it's benign something to give the woman you know, some confidence that she can keep going on and not worry about it as much.

well,

Host: Peace of mind. That is Absolutely the case. speak to that. So, when after a breast cancer diagnosis, because that is certainly so many of us, it's a big fear, when might surgery be recommended and tell us a little bit about the

Dr. Perll: typically we're going to look at surgery with either ductal carcinoma in situ, which again is cancer that hasn't broken out or early cancers. Those are, we're seeing those more often now because we're doing the screenings more. You're to be given choices and usually women are choosing the, call it breast conservation or the lumpectomy, as you talked about where you're taking just piece of breast tissue. Typically with that, you're also doing, what's called a sentinel lymph node, which means you're checking the first few nodes in the axilla to see if there's any signs of cancer spread.

That's the most probably common route now. There

still

Host: options

Dr. Perll: modified radical mastectomy people

Host: are

Dr. Perll: they want breast and all of the tissue taken out That may be an option for someone that may come in with more cancer There are some women that want that done just as a choice They'd rather not go through the modified because part of the treatment of people that have breast conservation is typically radiation therapy to that breast. You have to think about you've taken, you've localized the cancer, you've taken it out, but you still have remaining breast tissue behind that needs to be treated. And typically we're going to treat that with radiation.

Host: So, with so many options, how does a woman decide Dr. Perll? how do you work women? mean, obviously they're in a very distressed state and when talk about breast conservation and reconstruction, and now a lot of things are done at the same time, right?

Dr. Perll: They are. Sometimes there is early breast cancers that could be reconstructed. Typically that is done by plastic surgeons Some plastic surgeons would rather wait until you

make sure that all of the pathology is done you're going to need anymore treatments before they do anything but there are some that are getting immediate reconstruction.

How I treat women is treat them like I would want my family treated. You have to give them options. You have to help them understand. I want them to understand their options and not look at me for the final decision. going to work with them. They need to be comfortable with the procedures that we're coming up with.

And if they're comfortable with things, then things are gonna work out a lot better for everybody, for me as a surgeon and for that person as a patient and their family.

Host: that's certainly an excellent philosophy of care. And what can a woman expect when she comes

into Memorial Hospital to see you and for a breast cancer surgery? What is that like and for her family?

Dr. Perll: She is going to have usually come through her primary care. They're going to have done a test. like to see them hopefully before they've even had the abnormality biopsy, but sometimes they come in after the tissue is there. I explain to them how good it is that we found things early and that's the beauty of these screening exams, and also the biopsies, is even if we're finding a cancer, it's typically at a very early stage, and that's much better than waiting for this to grow and become a bigger problem. So, we're going to explain to them what the diagnosis is, what means between having an invasive cancer or possibly having that ductal carcinoma in situ going to talk about the surgery.

Typically I'd like to have them do the less invasive, but I'm going to work with whatever their choice is. There's a level of comfort in women and I want them to be happy and comfortable with the choice that they made. I don't want them all to have one thing. We're giving them choices because part of the healing and getting better from this process is the within themselves they made the right choice and that they're going to do well from that choice So we're going to give them those options We're going to do the procedure we're going to have the final pathology back and then typically After I'm done they are going to go on to an oncologist to talk about some of the other treatments that may be available which are as you said, there are a lot of different scenarios that people fall into There is so much more involved today than even 10 or 15 years ago Testing the cancer seeing how it is to treatment options Kind of giving people it's a good choice or a bad choice to go through different treatments there is a lot of activity after surgery, After we clear the breast of the cancer and moving on to the rest of their life.

Host: Well, it's certainly a lot of great information. So, Dr. Perll, you and I were talking off air a little bit about the importance of these screening mammograms and the screening options that we do have for breast cancer, including learning self-exams. I mean, I started my daughter right at like 16 and in her first gyne visit something that, you know, the doctor teaches. It's so important that we learn our own body. And you have some stories about the importance of screening don't you?

Dr. Perll: Yes I women them get involved in kind cancer detect or screening programs where they're going in every year and they someone It's just I want again as we talked about at important it is to keep up the yearly vigilance of getting that mammogram I have many stories of women that started at a young age been going to these they thought about stopping because they are getting a little bit older They may be getting in their 60s and all of the sudden they do in cancer which is where we want to find things and they have you know a good outcome So being persistant and doing those

screenings early is the best way to find cancer early or find abnormalities that aren't cancer that can be treated. So again, I can't stress how important it is, as you said, the self-breast exam and getting those screening tests, which are available widely. They're available here in Carthage, they're available throughout the country. So, we need to keep pushing women to get that

Host: I'd like to stress to women myself, because that is how my papillomas were found. And I'm glad that they were. And ladies, while it may seem scary to get your mammogram, they don't hurt. And nowadays, there's so much new technology. So it's better to know. And as Dr Perll says to find these things early, and even if it's some benign thing, boy, the peace of mind that you get really helps you to go on with your life and take care of your family and your loved ones.

And now if they find something and as we've said, there's so many options, Dr. Perll tell us about the surgery iself and the hospital stay and what that's like and what you do as far as making women feel comfortable. Because, I mean, let's be honest sometimes, it is a little bit about vanity. I mean, we want to get the cancer out or whatever it is but we also don't want to look or feel like there's some part our womanhood that is lost now. So I know you can understand this right?

Dr. Perll: Yes. I mean, I, I see breast surgery as an opportunity for me to bring out kind of the art and science of medicine. I want the woman to be comfortable with the decision. And as we talked about earlier, the minimally invasive surgery is probably more common than doing a mastectomy, but whatever the choice is, I want to get an adequate specimen clear the cancer but I also want to keep the cosmesis I want the woman to feel comfortable with the end result Obviously no matter what you do there may be a defect there, but I don't want it to feel like they've been invaded. I don't want to say mutilated, but just, I want it to look as good as possible. And that's my goal is to clear the cancer, but also to preserve their dignity and, and as you said, their womanhood they want to go through this but they don't want to be scarred. And that's, my goal is to make it as good as possible.

Host: What about women, Dr. Perll, that are still of childbearing age? Is there a difference in, how you go about

things

Dr. Perll: Well, they, you know, they still need be taken care of. If you're doing something on the breast, you know, could you potentially disrupt the duct system that if they wanted to breastfeed. We try to we try to be as noninvasive as possible but the primary goal is to treat if that is a cancer we have to treat We want that woman to live a long life and to be able to continue to have children if they choose. So, yes, we do want to preserve the breast tissue, as much as possible, but we also need to get an adequate treatment of that cancer. So that's our primary goal.

Host: And now how long are we, you know, usually in the hospital and you've mentioned this word Minimally invasive few times. Some listeners may not know what that means. How long is the hospital stay? And what's minimally invasive mean?

Dr. Perll: Minimally invasive means as kind of a small incision as possible, as far as it's not like abdominal surgery where you're bringing in scopes, et cetera. If there's needle localization of that, nonpalpable lesion, we're trying to make a small incision and go down and get the tissue we need. If someone's undergoing what we call the, you know, breast conservation or taking a portion of the breast again, we're trying make it as, as small as possible, but get the adequate margins know, different than the mastectomy when the entire breast comes off.

But the stays typically for those breast conservation or especially the needle localized or small open procedures is the same day You're going to go home the same day with the incision and follow up afterwards to discuss the pathology. mastectomy is an inpatient procedure but typically it is just a day or two in the hospital So they're not long term stays If you're in the hospital it certainly is a short stay but the

Host: Isn't that

amazing what you can

Dr. Perll: outpatient

Host: today? and What positive outcomes have

you seen? Post-surgery Do you have any good

stories

Dr. Perll: Well, it's just wonderful. Number one, if you have a person that you can come up with a, you benign or non-cancerous there's it's very gratifying to see how happy they are. They've gone through lot of stress and now you know, at least have a negative result again, emphasizing them that is a negative result, but to keep vigilant. You, you can't predict the future and you need to keep on this for the rest of their life.

But when we do find cancers, typically they're very early, which is great. I mean, the cure rates of those early stage cancers is, you know, well over 95% on a five-year basis. So, the earlier we find things, if we can keep the majority of malignancy or breast cancer at that early stage, our chances of curing those people kind of consider it a cure if you're for five years that's the very gratifying

Host: Certainly true. Now there are for some women Dr. Perll, this BRCA gene, and we talked a little bit about that hereditary factor for breast cancer.

When some women do get that genetic test and find that out, do they come talk you about the options for prophylactic mastectomy reduce their risk? Is this something that you discuss with them or is their primary? care Who do they discuss that with?

Dr. Perll: Typically if they have had that testing. Then that bilateral mastectomy has become more prominent. chances of developing breast cancer are so much higher in those people that carry that gene, that they really would rather not take a chance, They want an early mastectomy, and usually with reconstruction later.

So it is something that, that we can do here at Carthage. It is typically when they're doing that testing, it's been done by their oncologist or someone that they've been referred to. So it's it could we get it done here? We could, but typically it's not something that we're going to order a lot here at Carthage, but if they want to have their treatment doing the surgery is certainly a possibility.

And again

Host: Well, it's certainly a comprehensive and as you've been mentioning all these other specialists, it's a multidisciplinary approach that you're taking. Do you have any final thoughts for us about screening, lifestyle, risk factors for breast cancer, Dr. Perll, you really have so much knowledge to offer. So wrap it up for us with your best advice for women about the importance of screening. And the options that are out there and lifestyle, all of those things to reduce our risk.

Dr. Perll: I what work with the to get this done and also typically we will be talking with the plastic surgeon trying to get them to see finding things early, is the key to getting a cure finding things early is also if there is a cancer just The amount the armamentarium

of the oncologist tissues All of that is just amazing at getting things done and getting women cured of this terrible disease And reduce stage that We that find things And obviously we've talked about this things that you can tobacco abuse things like that that are easy What great advice. Thank you so much, Dr. Perll for joining us today and really giving us what we need to hear about the importance of screening and a healthy lifestyle to reduce our risk for breast cancer. Thank you again. And to schedule a consultation with Dr. Peter Perll, you can call 217-357-2173 That concludes this episode of Say Yes to Good Health with Memorial Hospital. For more health tips, like you heard here and great health information, you can go to our website at mhtlc.org. We'd like to thank our audience and invite you to download subscribe rate, and review Apple podcast, Spotify and Google podcast.

Host: And be sure to share this show with your friends and family on your social channels. We're learning from the experts at Memorial Hospital together. I'm Melanie Cole. Thanks so much for listening.

Disclaimer: The medical health information provided during this program is for general information and educational purposes only, and is not a substitute for professional advice. None of the given information is for the purpose of diagnosis or treatment. Neither does this program serve as approval for any health product or brand. This program aims to enhance your personal health and wellness through the adoption of healthy lifestyles and your prompt presentation to the health professional whenever you suspect that you are ill. For treatment and professional advice, ensure you consult your physician.