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Bill Klaproth (Host): A breast cancer diagnosis can be frightening, but empathetic care with the latest medical technologies can provide reassurance. Here to discuss how breast care and treatment has advanced and what the future holds is Dr. Kara Kort and Dr. Scott Albert, both surgical physicians at St. Joseph’s Health. Dr. Kort and Dr. Albert thank you so much for your time. Dr. Kort, let’s start with you. What are the common risk factors for breast cancer?

Dr. Kara Kort (Guest): Sure, so obviously the biggest one is female gender, although we always say that men can get breast cancer too, it’s pretty rare. Age is another one. The majority of breast cancers occur in women over age 50, but certainly, we see it under that age as well. Probably the biggest one people talk about is family history, very often having other first-degree relatives like your mother or your sister who had breast cancer that increases an individual’s risk as well. A couple of other things we always look at is what we call a woman’s sort of menstrual and birth history, how old was she when she got her first menses, how old was she when she had her first child or if she has never had a child, those are things that sort of alter a woman’s future risk of getting breast cancer and some of the newer things we have learned recently is excessive intake of alcohol increases a woman’s risk of breast cancer and that’s probably more than a couple of drinks a day and then the other big thing we have learned is that obesity is a real risk for breast cancer and I don’t think we talk about that a lot, but there is a lot of interesting research on that now. So, that’s something we have to be careful of as well.

Bill: Well, that’s a very detailed list, certainly a lot of risk factors and that’s why screening is so important. So, Dr. Albert, what are the current screening guidelines?

Dr. Scott Albert (Guest): Yes, so there has been a little bit of controversy of late, but generally speaking, for the average woman the guidelines are still at age 40 yearly mammography and that’s in part because as Dr. Kort said, the risk for breast cancer goes up as you age and as you get into your 50s, the risk continues to climb, so for most women, we would recommend yearly screening starting at 40. There are some guidelines that different societies publish guidelines, some have also suggested starting at 45 or every other year screening and again, these are for average risk women.

Bill: And Dr. Kort, we all know early diagnosis is vitally important. What are the current procedures to make an accurate diagnosis?

Dr. Kort: So, like Dr. Albert just said, that’s where screening mammography comes in and again, like he just alluded to, there has been a little controversy when you should start. I think we typically recommend 40. I think the majority of breast cancers are picked up nowadays by just screening mammography but probably at least 40 plus percent or maybe a little less, women notice an abnormality in their own breast exam or it’s picked up by a physician, somebody notices something unusual on a routine exam. And then from there, those individuals are usually either referred to someone like us or they are set up right for a biopsy when something unusual is found on exam or seen on imaging.

Bill: So, Dr. Albert, when it comes to treatment then, can you briefly share with us the advances in treatment and the different treatment options available today?

Dr. Albert: Yeah, the treatment for breast cancer is somewhat complex. I always tell people that it’s really a team because it’s a surgeon, oftentimes a medical oncologist and a radiation oncologist then we have to be familiar with each team member and what they offer because it can impact our decisions regarding surgical treatment. Generally speaking, surgery is the first step for treatment of breast cancer and I always tell people there’s really two main options; removal of just the tumor and a rim of normal breast tissue which we call a lumpectomy or partial mastectomy, or the second option is a mastectomy where we essentially remove the whole breast.

Now the challenging aspect of breast cancer is you want to treat the cancer appropriately and adequately but also balance cosmesis and I think that’s where breast cancer treatment has changed recently. And so we oftentimes have a plastic surgeon involved depending on some of the details of the cancer and patient desires and we have to try and balance the oncologic side of treatment with cosmesis and so the most common treatment overall for breast cancer is a lumpectomy or a partial mastectomy and radiation, but there has been a trend throughout the country to move towards mastectomies in part because I think there is some advances in the plastic reconstruction and sort of the implant revolution in the country that has really sort of driven some of the changes in how we treat breast cancer. But each person is very – the treatment is very individualized I would say, because depending on a lot of the details of the tumor biology and size really would help dictate what the treatment should ultimately be. But, I think we continue to improve both surgically our techniques as well as how we deliver radiation and who gets chemotherapy and there’s been quite a change in how we can reconstruct a breast with our plastic surgery colleagues. So, it’s definitely a changing field and so it’s important to kind of stay up to date.

Bill: Well a cancer diagnosis is very traumatic, and you just mentioned individualized treatment plans. Dr. Kort, can you talk about multispecialty approach to breast care?

Dr. Kort: Sure. I mean like Dr. Albert alluded to, it’s really more – we are the surgical aspect breast cancer care and the vast majority of women will undergo surgery, but in addition to that, they are going to no doubt see a medical oncologist and very often a radiation oncologist and so, we work very closely with those individuals. Every other week we have an hour-long conference where we discuss most of the cases that we saw that week and it’s very helpful. In addition to that, our program has a nurse navigator who works not only with us as surgeons, but she also works with those medical and radiation oncologists. So, she’s a wonderful liaison between us and the patients because as surgeons, very often we are in the operating room and we can’t get to all those phone calls or perhaps reassure them about what we just talked about and so that’s very beneficial. And in addition to that, we have a genetics counselor, one of our nurse practitioners who specializes in genetic counseling and testing and so, she’s part of our team as well. So, it really involves a lot of individuals.

Bill: So, a complete team to provide support during and after treatment. And if you could wrap it up for us Dr. Albert. What else do we need to know about breast care and treatment at St. Joseph’s Health?

Dr. Albert: I think Dr. Kort said it pretty nicely is that we really have a large team that’s involved in breast cancer treatment. It really takes a dedicated team because you really have to understand some of the changes and nuances to treatment and try and provide the best care for each situation. So, I think Dr. Kort said it nicely in terms of how we have a large group here that is dedicated to breast cancer treatment.

Bill: Well Dr. Kort and Dr. Albert, thank you so much for your time. For more information about breast care, please visit www.womenshealthsjh.org, that’s www.womenshealthsjh.org. This is St. Joseph’s Health MedCast from St. Joseph’s Health. I’m Bill Klaproth. Thanks for listening.