Selected Podcast
High Risk Breast Cancer Populations
Dr. Sunny Mitchell shares information about the High Risk Cancer Program at The Breast Center at Montefiore Nyack Hospital.
Featured Speaker:
Dr. Mitchell is a pioneer in the field of Oncoplastic Breast Surgery who specializes in breast-conserving and nipple-sparing surgical techniques that leave a very small surgical footprint while still providing the best possible optimal medical and cosmetic results. As an expert Hidden Scar™ breast surgeon, Dr. Mitchell teaches other breast surgeons who are pursuing training for this highly skilled and advanced surgical procedure.
Sunny Mitchell, MD
Sunny D. Mitchell, M.D., a board-certified and Fellowship-trained oncolplastic breast surgeon, is the Medical Director of The Breast Center at Montefiore Nyack Hospital. Dr. Mitchell has extensive experience working with high-risk breast cancer populations and provides patient-centered care with a holistic approach. She is passionate about helping her patients, from diagnosis through the entire survivorship process, which begins at the time of diagnosis, continues through treatment, and beyond.Dr. Mitchell is a pioneer in the field of Oncoplastic Breast Surgery who specializes in breast-conserving and nipple-sparing surgical techniques that leave a very small surgical footprint while still providing the best possible optimal medical and cosmetic results. As an expert Hidden Scar™ breast surgeon, Dr. Mitchell teaches other breast surgeons who are pursuing training for this highly skilled and advanced surgical procedure.
Transcription:
High Risk Breast Cancer Populations
Alyne Ellis (Host): If you have a high risk of developing breast cancer, here’s information on how to protect yourself as much as possible and catch problems early when the chances of curing the disease are the greatest. My guest today is Dr. Sunny Mitchell, the Medical Director of The Breast Center at Montefiore Nyack Hospital. Dr. Mitchell has extensive experience working with high risk breast cancer populations. The is Health Track the podcast from Montefiore Nyack Hospital. I’m Alyne Ellis. So, Dr. Mitchell, who is at the highest risk for breast cancer and how should they be monitored?
Sunny Mitchell, MD (Guest): In general, individuals who may be at higher risk for breast cancer are those that may be gene positive, have tested positive for having a gene that confers an increased risk of breast cancer. They may be also individuals who had a previous breast cancer. They may have other risk factors where they’ve had breast biopsies that have demonstrated atypia. Some of those individuals we know are at an increased risk of breast cancer in the future. They may have had certain types of radiation exposure in the past. They may have a family history of breast cancer or other disorders or situations that also confer an elevated risk of breast cancer.
So, there’s quite a number of ways you can be at increased risk of breast cancer.
Host: So, Dr. Mitchell, what monitoring do you recommend for people who are at a higher risk?
Dr. Mitchell: The best tool that we have for screening right now is a mammogram. Which is essentially an x-ray of the breast. And generally, the radiologist will take a few different views so a few different snapshots of that mammogram picture of the breast. We also have the ultrasound which when added to the mammogram, is able to pick up more cancers within the population, within the number of people that get screened. And then the third modality that we have that may be especially useful in high risk and in high risk that are younger aged women would be a breast MRI.
So, between the three of those, either a combination of two of them, at least one of them being the mammogram and then sometimes all three; may be utilized for someone when they are high risk. It’s an individualized strategy.
Host: When it comes to the mammogram, I’m assuming you would recommend the gold standard 3-D mammogram?
Dr. Mitchell: The 3-D mammogram is great. Yes definitely.
Host: And how often should they have these tests? More often than the average person who is looking to find out if they have anything that’s of trouble?
Dr. Mitchell: That’s a really good question. The standard of care for the general population right now, is a screening mammogram or a mammogram once a year unless the radiologist recommends a short-term follow up, may be come back in six months and we’ll get another mammogram or an ultrasound, something like that. When you are high risk, you still follow the same guidelines or routines of a mammogram once a year. It’s a really good question. Because what they found in general is that the one year interval for breast imaging for breast screening is very effective. There’s really no benefit to preemptively get a mammogram every eight months for the rest of your life or something like that.
So, one year should be quite effective.
Host: And if somebody for example, has particularly dense breasts; would the ultrasound be more effective, or would you just recommend the 3-D mammogram or both?
Dr. Mitchell: Dense breasts, that’s physiologic meaning normal. Dense breasts does not really confer a meaning of abnormality. Dense breasts are normal. The only reason that we end up talking about them really is because sometimes it’s difficult to read a mammogram on breasts that are dense. It kind of looks a little bit like a whiteout. So, the addition of an ultrasound at that time, or at some point in time, to that mammogram is definitely helpful.
Host: And what about men? Are men at high risk for breast cancer too?
Dr. Mitchell: Well men can be at high risk for breast cancer if they have any of those high risk characteristics. So, if they are gene positive, if they have other – all the other characteristics that we mentioned for women as well, they can be, yes.
Host: So, if a person is diagnosed with breast cancer and they come to you; you take a patient-centered holistic approach and what does that mean?
Dr. Mitchell: So, what that means is that you utilize evidence-based medicine, so all of the treatment strategies and algorithms for how we know how to treat each breast cancer; is highly data driven. Essentially protocol driven so there’s a tremendous amount of data and numbers, statistics, rationale for why we offer the specific treatment to an individual. So, while we do that, at the same time, it’s very important to listen to the individual who is a patient and make sure that they fully understand what their options are.
Oftentimes, there are more than one. There’s more than one surgical option for example, for a lot of women and there may be more than one chemotherapy options or medication based options. The same may go for radiation therapy as well. So, to make sure that people who, when they are in the role of a patient, actually are fully informed and are able to participate in that decision making process when offered options that are all evidence-based, all standard of care strategies and treatments.
And then an additional component is this component that we call survivorship, meaning from the time an individual is diagnosed with breast cancer, we make a conscious effort to think of how we are going to facilitate not only the process of - the ability of that patient to process the diagnosis of a breast cancer but to facilitate getting them through all of the different treatments that breast cancer may entail and making sure that we are not only taking care of removing the cancer with surgery for example, giving medications and radiation therapy to help decrease the risk of this individual having to deal with breast cancer again and also completing the treatment process, but also take into account that person’s psychosocial and emotional needs as well.
Host: And let’s talk about the surgery for just a minute because you are also a specialist in one particular type of surgery where you can save part of the breast and even sometimes part of the nipple. And I’m wondering if you can describe what that is and who is a candidate for it?
Dr. Mitchell: The world of breast surgery has come very far over the years and that’s directly in response to all of the data that we have and all of the basic science research that has been accomplished allowing us to have a greater knowledge of breast cancer and breast anatomy as well as a time period where technology affords us excellent tools to be able to accomplish these things.
So, an example would be – there’s two types of breast surgery. One is a mastectomy which is removing all of the breast tissue under the skin and the other is a lumpectomy which is removing just a portion of the breast, the part that has cancer and leaving the rest in place. So, what we can do now for many if not most women, is do what’s called a nipple sparing mastectomy and that’s where all of the breast tissue is removed under the skin, but the nipple and all of the skin is left in place. So, when you combine that with immediate reconstruction; when the patient comes out of surgery that day and they look down at their chest, they are going to look like they have breasts. It’s much less of a drastic change from what we used to do. Mastectomies used to routinely remove the nipple. And so now we know that for the most part, most people can be preserved.
And then as far as lumpectomy or breast conservation; we know have the tools and the knowledge base to be able to perform surgery via more remote incisions. We can operate on lesions or cancers that we used to think automatically needed a mastectomy based off of the size or the location of the cancer, the lesion. So, it’s just a whole new world. It’s very good for the patients.
Host: Is there anything else you would like to add?
Dr. Mitchell: I would add that most breast cancer is incredibly treatable, and it is well worth the time and the effort to please take care of yourself and get that mammogram every year. It’s a bit of an nuisance but we need all of you out there living and participating in life and early detection is definitely the key. It’s treatable and you can then move on with the rest of your life.
Host: Thank you so much Dr. Mitchell for your time. That’s Dr. Sunny Mitchell, the Medical Director of the Breast Center at Montefiore Nyack Hospital. That wraps up this episode of our Health Track Podcast. For more information or to schedule a consultation appointment please call 845-348-8551 or head over to our website at www.montefiorenyack.org/breastcenter to get connected to one of our providers. If you found this podcast as helpful as I did, share it on your social media, with your friends and family. And be sure to check out the entire podcast library for topics of interest to you. I’m Alyne Ellis. Thanks for listening.
High Risk Breast Cancer Populations
Alyne Ellis (Host): If you have a high risk of developing breast cancer, here’s information on how to protect yourself as much as possible and catch problems early when the chances of curing the disease are the greatest. My guest today is Dr. Sunny Mitchell, the Medical Director of The Breast Center at Montefiore Nyack Hospital. Dr. Mitchell has extensive experience working with high risk breast cancer populations. The is Health Track the podcast from Montefiore Nyack Hospital. I’m Alyne Ellis. So, Dr. Mitchell, who is at the highest risk for breast cancer and how should they be monitored?
Sunny Mitchell, MD (Guest): In general, individuals who may be at higher risk for breast cancer are those that may be gene positive, have tested positive for having a gene that confers an increased risk of breast cancer. They may be also individuals who had a previous breast cancer. They may have other risk factors where they’ve had breast biopsies that have demonstrated atypia. Some of those individuals we know are at an increased risk of breast cancer in the future. They may have had certain types of radiation exposure in the past. They may have a family history of breast cancer or other disorders or situations that also confer an elevated risk of breast cancer.
So, there’s quite a number of ways you can be at increased risk of breast cancer.
Host: So, Dr. Mitchell, what monitoring do you recommend for people who are at a higher risk?
Dr. Mitchell: The best tool that we have for screening right now is a mammogram. Which is essentially an x-ray of the breast. And generally, the radiologist will take a few different views so a few different snapshots of that mammogram picture of the breast. We also have the ultrasound which when added to the mammogram, is able to pick up more cancers within the population, within the number of people that get screened. And then the third modality that we have that may be especially useful in high risk and in high risk that are younger aged women would be a breast MRI.
So, between the three of those, either a combination of two of them, at least one of them being the mammogram and then sometimes all three; may be utilized for someone when they are high risk. It’s an individualized strategy.
Host: When it comes to the mammogram, I’m assuming you would recommend the gold standard 3-D mammogram?
Dr. Mitchell: The 3-D mammogram is great. Yes definitely.
Host: And how often should they have these tests? More often than the average person who is looking to find out if they have anything that’s of trouble?
Dr. Mitchell: That’s a really good question. The standard of care for the general population right now, is a screening mammogram or a mammogram once a year unless the radiologist recommends a short-term follow up, may be come back in six months and we’ll get another mammogram or an ultrasound, something like that. When you are high risk, you still follow the same guidelines or routines of a mammogram once a year. It’s a really good question. Because what they found in general is that the one year interval for breast imaging for breast screening is very effective. There’s really no benefit to preemptively get a mammogram every eight months for the rest of your life or something like that.
So, one year should be quite effective.
Host: And if somebody for example, has particularly dense breasts; would the ultrasound be more effective, or would you just recommend the 3-D mammogram or both?
Dr. Mitchell: Dense breasts, that’s physiologic meaning normal. Dense breasts does not really confer a meaning of abnormality. Dense breasts are normal. The only reason that we end up talking about them really is because sometimes it’s difficult to read a mammogram on breasts that are dense. It kind of looks a little bit like a whiteout. So, the addition of an ultrasound at that time, or at some point in time, to that mammogram is definitely helpful.
Host: And what about men? Are men at high risk for breast cancer too?
Dr. Mitchell: Well men can be at high risk for breast cancer if they have any of those high risk characteristics. So, if they are gene positive, if they have other – all the other characteristics that we mentioned for women as well, they can be, yes.
Host: So, if a person is diagnosed with breast cancer and they come to you; you take a patient-centered holistic approach and what does that mean?
Dr. Mitchell: So, what that means is that you utilize evidence-based medicine, so all of the treatment strategies and algorithms for how we know how to treat each breast cancer; is highly data driven. Essentially protocol driven so there’s a tremendous amount of data and numbers, statistics, rationale for why we offer the specific treatment to an individual. So, while we do that, at the same time, it’s very important to listen to the individual who is a patient and make sure that they fully understand what their options are.
Oftentimes, there are more than one. There’s more than one surgical option for example, for a lot of women and there may be more than one chemotherapy options or medication based options. The same may go for radiation therapy as well. So, to make sure that people who, when they are in the role of a patient, actually are fully informed and are able to participate in that decision making process when offered options that are all evidence-based, all standard of care strategies and treatments.
And then an additional component is this component that we call survivorship, meaning from the time an individual is diagnosed with breast cancer, we make a conscious effort to think of how we are going to facilitate not only the process of - the ability of that patient to process the diagnosis of a breast cancer but to facilitate getting them through all of the different treatments that breast cancer may entail and making sure that we are not only taking care of removing the cancer with surgery for example, giving medications and radiation therapy to help decrease the risk of this individual having to deal with breast cancer again and also completing the treatment process, but also take into account that person’s psychosocial and emotional needs as well.
Host: And let’s talk about the surgery for just a minute because you are also a specialist in one particular type of surgery where you can save part of the breast and even sometimes part of the nipple. And I’m wondering if you can describe what that is and who is a candidate for it?
Dr. Mitchell: The world of breast surgery has come very far over the years and that’s directly in response to all of the data that we have and all of the basic science research that has been accomplished allowing us to have a greater knowledge of breast cancer and breast anatomy as well as a time period where technology affords us excellent tools to be able to accomplish these things.
So, an example would be – there’s two types of breast surgery. One is a mastectomy which is removing all of the breast tissue under the skin and the other is a lumpectomy which is removing just a portion of the breast, the part that has cancer and leaving the rest in place. So, what we can do now for many if not most women, is do what’s called a nipple sparing mastectomy and that’s where all of the breast tissue is removed under the skin, but the nipple and all of the skin is left in place. So, when you combine that with immediate reconstruction; when the patient comes out of surgery that day and they look down at their chest, they are going to look like they have breasts. It’s much less of a drastic change from what we used to do. Mastectomies used to routinely remove the nipple. And so now we know that for the most part, most people can be preserved.
And then as far as lumpectomy or breast conservation; we know have the tools and the knowledge base to be able to perform surgery via more remote incisions. We can operate on lesions or cancers that we used to think automatically needed a mastectomy based off of the size or the location of the cancer, the lesion. So, it’s just a whole new world. It’s very good for the patients.
Host: Is there anything else you would like to add?
Dr. Mitchell: I would add that most breast cancer is incredibly treatable, and it is well worth the time and the effort to please take care of yourself and get that mammogram every year. It’s a bit of an nuisance but we need all of you out there living and participating in life and early detection is definitely the key. It’s treatable and you can then move on with the rest of your life.
Host: Thank you so much Dr. Mitchell for your time. That’s Dr. Sunny Mitchell, the Medical Director of the Breast Center at Montefiore Nyack Hospital. That wraps up this episode of our Health Track Podcast. For more information or to schedule a consultation appointment please call 845-348-8551 or head over to our website at www.montefiorenyack.org/breastcenter to get connected to one of our providers. If you found this podcast as helpful as I did, share it on your social media, with your friends and family. And be sure to check out the entire podcast library for topics of interest to you. I’m Alyne Ellis. Thanks for listening.