Breast Care of Western New York uses a range of minimally invasive procedures in the detection and diagnosis of breast health conditions, including mammography and ultrasound biopsies, stereotactic and ultrasound-guided staging tests, and sentinel lymph node biopsy.
As a community practice of Roswell Park Comprehensive Cancer Center, you'll have access to the most advanced services in breast cancer diagnosis, including access to expert pathology review by a world-class team at Roswell Park Comprehensive Cancer Center.
In this segment, Mariola Poss, MD, FACS, discusses breast care, different types of breast surgery, her role at Breast Care of WNY and the importance of community practices such as Breast Care of Western New York.
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Breast Care and Treatment at Breast Care of Western New York
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Learn more about Mariola Poss, MD
Mariola Poss, MD
Mariola Poss, MD practice at Breast Care of Western New York offers women of all ages comprehensive surgical breast care for both benign and malignant conditions, including high risk evaluation and screening.Learn more about Mariola Poss, MD
Transcription:
Breast Care and Treatment at Breast Care of Western New York
Bill Klaproth (Host): When it comes to breast health and options if cancer is detected, you want the best care you can find. Here to talk with us about breast care and different types of surgical options, is Dr. Mariola Poss, Assistant Professor of Oncology and Roswell Park Surgical Oncologist at Breast Care of Western New York. Dr. Poss, thank you for your time today. Can you share with us the latest recommendations and guidelines when it comes to breast health?
Dr. Mariola Poss (Guest): So when it comes to breast health, we know that screening is one of the most important ways – and the best way we know of to decrease mortality from breast cancer. Over the past few years, there have been various changes in guideline recommendations from a lot of the large organizations – the American Cancer Society put out some recommendations a few years ago, which are a little different than the standard recommendations that had been placed prior regarding annual mammography. I tend to go by the National Comprehensive Cancer Network Guidelines, the NCCN, which still recommend the annual screening mammography starting at the age of 40 for women who we consider average risk. Risk assessment is part of the overall evaluation when we first see a woman as far as discussing guidelines and screening and what would be appropriate. That can vary from person to person based on not only family history, but their own personal history and individual risk factors.
Bill: And what about risks, or family history, or potential symptoms? How do you address that as it relates to those guidelines?
Dr. Poss: When we first do an evaluation with a woman for risk, we obviously ask about family history of breast cancer and ovarian cancer. We nowadays also evaluate people for potential genetic testing. We know that there are women who have certain genetic mutations or alterations that can increase their risk of breast cancer in the course of their life and we tend to consider that type of testing when we see a woman who has three or more people in the family with breast cancer at any age or breast cancer at a very young age – pre-menopausal breast cancer before the age of 45, before the age of 50. Those are the family considerations that we look at.
In addition, just even if somebody was negative for testing, just having extensive cancer in the family would usually place you at higher risk. Now, in addition to the family history factors, we also look at a woman’s individual history, which would include if she’s had any prior biopsies in the breast, if there were any atypical cells in the breast and what the results of those biopsies were, the number of children she’s had and the age that she had her first child, in addition to age of menarche and then menopause, and things like that.
Bill: So, when it comes to potential symptoms – we’ve all heard about self-examination and looking for lumps, are their other potential symptoms a woman should be looking out for?
Dr. Poss: Generally speaking, breast cancer, when it presents, will present as a painless lump. Now, with screening recommendations as they are we more often than not will find a cancer early so that a lot of women I see do not actually feel anything abnormal on their breast exam, even with a diagnosis of breast cancer. There have been various recommendations as far as doing breast self-exams also, and generally speaking, they have not been officially recommended because a lot of times, women have a hard time knowing what is something that’s worrisome versus what is not. I still think it’s important to be familiar with your own breasts, and so if you notice anything different, that’s something they should certainly bring to the attention of your physician. Any new, hard lumps, skin changes, nipple discharge, things like that, are things that you should bring to the attention of your physician. Breast pain generally is not associated with cancer, but certainly can be. Anything that would be new or different in a woman’s own breast exam or breast health as it’s been throughout her life should be brought to the attention of her physician.
Bill: Well, that’s excellent, and thank you for sharing that with us, Dr. Poss. When it comes to treatment then, can you tell us about the minimally invasive procedures in the detection and diagnosis of breast health conditions?
Dr. Poss: What’s wonderful is the majority of breast cancers nowadays, as I had discussed before, present early. More often than not, we are able to do breast conservation – or what’s called a lumpectomy -- for most women with early-stage breast cancer so that we can take out the area of cancer with a little bit of normal breast tissue around it and leave the remaining breast so that the majority of women do not need the mastectomy. The lumpectomy does go along with radiation treatment so that we treat the entire breast comprehensively, but the outcomes of those two options do not vary as far as the outcome and overall survival. That’s a great option nowadays that we know works very well for the majority of women.
They do not have to deal with the changes as far as dealing with losing a breast and their own self-image, but in how that relates to other people and interpersonal relationships as well. I think a lot of the times we focus on treatment for women in the acute situation and getting them through that, but we don’t really do as good of a job of dealing with the life-long issues that women have after treatment and dealing with that process as they go along their road to recovery. When certain issues too, such as self-image and interpersonal relationships can change obviously, after even having a smaller surgery for breast cancer.
Bill: Well, that is very important to discuss, so let’s talk about support and follow-up care. That’s very important. Can you talk about the different types of support services that are available?
Dr. Poss: So, after a diagnosis of breast cancer, we often will see the patients on regular intervals. Both the surgery oncologists, such as myself and the other doctors involved in the care, will be seeing the patient at regular follow-ups. One of the things that’s important to realize about breast cancer is that it is a multidisciplinary disease. Most women have more than one form of treatment, and most women see more than one physician. In addition to seeing myself, they would see a medical oncologist to discuss chemotherapy and antihormonal therapy, as well as a radiation doctor to discuss that type of treatment. There are several doctors that are in the loop initially in the postoperative treatment recovery process.
In addition to that, at Roswell, we have multiple resources that can be helpful for women. We have a resource center there that can provide information about anything that they might need whether it’s community resources as far as support groups and things like that, from wigs to breast prosthetics and where to get those and how to address all of that. We have a lot of services in that respect. If women need additional services such as physical therapy for postsurgical issues as far as mobility or lymphedema – which is arm swelling after surgery – we can provide resources to help with those issues as well.
Bill: Those resources and support – it’s just so important. Can you talk about the importance of community practices such as Breast Care of Western New York, which is a Roswell Park Cancer Institute Community Cancer Practice?
Dr. Poss: It is. And I think it’s a great resource in the community because obviously, Roswell has a lot of wonderful resources, but not everyone likes to go there for all of their treatment. It’s nice to have facilities out in the community, which can be more convenient for people on a regular basis, particularly if they are coming for more frequent visits, or other treatments, such as infusions which they may have to go for every week or every few weeks, and they might not want to go down to the main hospital for all of those things. I’ve found that people find it a very convenient resource and we’re lucky to have it in the area.
Bill: Absolutely, and DR. Poss, you’re a specialist in comprehensive surgical breast care for both benign and malignant conditions including high-risk evaluation and screening. Can you quickly tell us about that?
Dr. Poss: That’s right. I see a lot of women with breast cancer, but also, I see a lot of women just for discussion about risk factors, such as those that I had mentioned before – family history, individual risk factors. I see women who have abnormal imaging that just needs an opinion about how to proceed as far as following that. I see women who have had prior biopsies, and whether they are benign or show atypical cells, which sometimes need surgery for better evaluation, I address those types of issues with women. It’s the full spectrum of going over symptoms that might be totally benign and imaging that might be benign through women who have a cancer diagnosis, and we’re able to provide evaluation and services for all of those things at Breast Care of Western New York.
Bill: Well, Dr. Poss, thank you so much for your time today. We really appreciate it in talking with us about breast health and surgical options. For more information, please visit RoswellPark.org, that’s RoswellPark.org. You’re listening to Cancer Talk with Roswell Park Comprehensive Cancer Center. I’m Bill Klaproth. Thanks for listening.
Breast Care and Treatment at Breast Care of Western New York
Bill Klaproth (Host): When it comes to breast health and options if cancer is detected, you want the best care you can find. Here to talk with us about breast care and different types of surgical options, is Dr. Mariola Poss, Assistant Professor of Oncology and Roswell Park Surgical Oncologist at Breast Care of Western New York. Dr. Poss, thank you for your time today. Can you share with us the latest recommendations and guidelines when it comes to breast health?
Dr. Mariola Poss (Guest): So when it comes to breast health, we know that screening is one of the most important ways – and the best way we know of to decrease mortality from breast cancer. Over the past few years, there have been various changes in guideline recommendations from a lot of the large organizations – the American Cancer Society put out some recommendations a few years ago, which are a little different than the standard recommendations that had been placed prior regarding annual mammography. I tend to go by the National Comprehensive Cancer Network Guidelines, the NCCN, which still recommend the annual screening mammography starting at the age of 40 for women who we consider average risk. Risk assessment is part of the overall evaluation when we first see a woman as far as discussing guidelines and screening and what would be appropriate. That can vary from person to person based on not only family history, but their own personal history and individual risk factors.
Bill: And what about risks, or family history, or potential symptoms? How do you address that as it relates to those guidelines?
Dr. Poss: When we first do an evaluation with a woman for risk, we obviously ask about family history of breast cancer and ovarian cancer. We nowadays also evaluate people for potential genetic testing. We know that there are women who have certain genetic mutations or alterations that can increase their risk of breast cancer in the course of their life and we tend to consider that type of testing when we see a woman who has three or more people in the family with breast cancer at any age or breast cancer at a very young age – pre-menopausal breast cancer before the age of 45, before the age of 50. Those are the family considerations that we look at.
In addition, just even if somebody was negative for testing, just having extensive cancer in the family would usually place you at higher risk. Now, in addition to the family history factors, we also look at a woman’s individual history, which would include if she’s had any prior biopsies in the breast, if there were any atypical cells in the breast and what the results of those biopsies were, the number of children she’s had and the age that she had her first child, in addition to age of menarche and then menopause, and things like that.
Bill: So, when it comes to potential symptoms – we’ve all heard about self-examination and looking for lumps, are their other potential symptoms a woman should be looking out for?
Dr. Poss: Generally speaking, breast cancer, when it presents, will present as a painless lump. Now, with screening recommendations as they are we more often than not will find a cancer early so that a lot of women I see do not actually feel anything abnormal on their breast exam, even with a diagnosis of breast cancer. There have been various recommendations as far as doing breast self-exams also, and generally speaking, they have not been officially recommended because a lot of times, women have a hard time knowing what is something that’s worrisome versus what is not. I still think it’s important to be familiar with your own breasts, and so if you notice anything different, that’s something they should certainly bring to the attention of your physician. Any new, hard lumps, skin changes, nipple discharge, things like that, are things that you should bring to the attention of your physician. Breast pain generally is not associated with cancer, but certainly can be. Anything that would be new or different in a woman’s own breast exam or breast health as it’s been throughout her life should be brought to the attention of her physician.
Bill: Well, that’s excellent, and thank you for sharing that with us, Dr. Poss. When it comes to treatment then, can you tell us about the minimally invasive procedures in the detection and diagnosis of breast health conditions?
Dr. Poss: What’s wonderful is the majority of breast cancers nowadays, as I had discussed before, present early. More often than not, we are able to do breast conservation – or what’s called a lumpectomy -- for most women with early-stage breast cancer so that we can take out the area of cancer with a little bit of normal breast tissue around it and leave the remaining breast so that the majority of women do not need the mastectomy. The lumpectomy does go along with radiation treatment so that we treat the entire breast comprehensively, but the outcomes of those two options do not vary as far as the outcome and overall survival. That’s a great option nowadays that we know works very well for the majority of women.
They do not have to deal with the changes as far as dealing with losing a breast and their own self-image, but in how that relates to other people and interpersonal relationships as well. I think a lot of the times we focus on treatment for women in the acute situation and getting them through that, but we don’t really do as good of a job of dealing with the life-long issues that women have after treatment and dealing with that process as they go along their road to recovery. When certain issues too, such as self-image and interpersonal relationships can change obviously, after even having a smaller surgery for breast cancer.
Bill: Well, that is very important to discuss, so let’s talk about support and follow-up care. That’s very important. Can you talk about the different types of support services that are available?
Dr. Poss: So, after a diagnosis of breast cancer, we often will see the patients on regular intervals. Both the surgery oncologists, such as myself and the other doctors involved in the care, will be seeing the patient at regular follow-ups. One of the things that’s important to realize about breast cancer is that it is a multidisciplinary disease. Most women have more than one form of treatment, and most women see more than one physician. In addition to seeing myself, they would see a medical oncologist to discuss chemotherapy and antihormonal therapy, as well as a radiation doctor to discuss that type of treatment. There are several doctors that are in the loop initially in the postoperative treatment recovery process.
In addition to that, at Roswell, we have multiple resources that can be helpful for women. We have a resource center there that can provide information about anything that they might need whether it’s community resources as far as support groups and things like that, from wigs to breast prosthetics and where to get those and how to address all of that. We have a lot of services in that respect. If women need additional services such as physical therapy for postsurgical issues as far as mobility or lymphedema – which is arm swelling after surgery – we can provide resources to help with those issues as well.
Bill: Those resources and support – it’s just so important. Can you talk about the importance of community practices such as Breast Care of Western New York, which is a Roswell Park Cancer Institute Community Cancer Practice?
Dr. Poss: It is. And I think it’s a great resource in the community because obviously, Roswell has a lot of wonderful resources, but not everyone likes to go there for all of their treatment. It’s nice to have facilities out in the community, which can be more convenient for people on a regular basis, particularly if they are coming for more frequent visits, or other treatments, such as infusions which they may have to go for every week or every few weeks, and they might not want to go down to the main hospital for all of those things. I’ve found that people find it a very convenient resource and we’re lucky to have it in the area.
Bill: Absolutely, and DR. Poss, you’re a specialist in comprehensive surgical breast care for both benign and malignant conditions including high-risk evaluation and screening. Can you quickly tell us about that?
Dr. Poss: That’s right. I see a lot of women with breast cancer, but also, I see a lot of women just for discussion about risk factors, such as those that I had mentioned before – family history, individual risk factors. I see women who have abnormal imaging that just needs an opinion about how to proceed as far as following that. I see women who have had prior biopsies, and whether they are benign or show atypical cells, which sometimes need surgery for better evaluation, I address those types of issues with women. It’s the full spectrum of going over symptoms that might be totally benign and imaging that might be benign through women who have a cancer diagnosis, and we’re able to provide evaluation and services for all of those things at Breast Care of Western New York.
Bill: Well, Dr. Poss, thank you so much for your time today. We really appreciate it in talking with us about breast health and surgical options. For more information, please visit RoswellPark.org, that’s RoswellPark.org. You’re listening to Cancer Talk with Roswell Park Comprehensive Cancer Center. I’m Bill Klaproth. Thanks for listening.