Transcription:
Advances in Breast Cancer Technology

Caitlin Whyte: Besides skin cancer, breast cancer is the most commonly diagnosed cancer among American women. In 2020, it's estimated that about 30% of newly diagnosed cancers in women will be breast cancers. So today we're going to talk about breast cancer awareness and new technologies with Dr. Rhonda Henry-Tillman, a Breast Cancer Surgeon, and a Professor for the Department of Surgery and Chief of Breast Oncology at UAMS. This is UAMS Health Talk, the podcast by the University of Arkansas for Medical Sciences. I'm Caitlin Whyte. So doctor, can you talk about the importance of breast cancer screenings in general?

Dr. Henry-Tillman: So, breast cancer screening saves lives, early detection saves lives, breast cancer screening, and tells one recognition knowing your risk and going in for a test called a mammography, is the most common screening test for early detection of breast cancer. A mammogram is just an X-Ray picture of the breast. And it can find calcifications in tumors that are small, where you can't feel it

Host: Now talking about risk. What should people know about their breast cancer risk and what can they do just to stay ahead of it?

Dr. Henry-Tillman: Well, we often talk about risk, identifying those that are high risk is very important. And so I like to tell people to know the three main things, know your history, know your family history, your biggest risk factors are being a female and getting older. And so once you know your family history, if you don't have any genetic risk for breast cancer, what are your personal risks for breast cancer? Is it your age? Is it your diet and exercise? Those are just things that you can do to improve your risk of developing breast cancer. Exercise can reduce your risk by 25%. And that's significant having a healthy weight is also very important.

Host: Now breast cancer patients are still able to receive diagnoses and treatment during this ongoing pandemic. Can you talk about the importance of getting checks still during this time?

Dr. Henry-Tillman: Yes. So nothing's changed in regards to being able to come into a screening facility or into an outpatient center to be screened for breast cancer. Initially in the onset of the pandemic of COVID, they did close centers down to non urgent or emergent procedures, but they quickly reopened that. And so women are able to come in and get screened. The screening facilities are open just everywhere, everything is about your protection and about the protection of your providers. So when you come in, you’re screened with several questions and you have to wear a mask, and typically it's very safe. Most of the time, there's not even anyone in the waiting room with you, they usually have you wait and be called from your phone with your questionnaire. If you don't have fever, if you haven't been exposed and you go in and get your standard mammogram. So we screen every day, we also have the mobile van. We call the mammo van that goes to facilities that don't have screening facilities in their County.

Host: That leads me into my next question. Why is surgical efficiency and minimizing patient's time in healthcare facilities, more important than ever?

Dr. Henry-Tillman: So, you know, efficiency has always been important and keeping patients out of the hospital has always been an important, as far as exposure to COVID, I think that with all the protection and all the things that the institutions have instituted to protect us as safe is for their safety. And so nothing's really changed other than wearing a mask, making sure your hands are clean, make sure you're not exposed to anyone with COVID, but we are very conscientious of care for the patient make re you know, this isn't like we're rushing you in to get this mammogram. That's not what I want the message to be. There's nothing changed regarding how you get your mammogram, it's how you’re screened to get into the facility that is important.

Host: Now, can you tell us about some of the advances we're seeing in breast cancer technologies?

Dr. Henry-Tillman: Well, the main objective for the treatment of breast cancers is to identify it early. Early detection save lives. When it comes to treatment of breast cancer, breast cancer is a multi specialty disease. And what I mean by that is that you have multiple providers that are caring for you. You have an expert that start out with your radiologist. That's a person who probably gets your mammogram, does your biopsy. You then, if you are diagnosed with a cancer, your specimens are sent to your pathologist who reads them, you're sent to a fellowship or expert train breast cancer doctor. That could be your surgeon. If you need surgery, your medical oncologist who gives chemo, they also have support from a behavioral perspective because getting a diagnosis of breast cancer is about treating, not just treating the cancer, but it's treating the individual person. And so it can make you depressed. It can make you afraid. So we have all types of support. We have your radiation doctor, who's your radiation oncologist. We have team of doctors that care for breast cancer. We have your plastic surgeon. They're a part of the team that helps restore you to a cosmetically acceptable outcome.

And so, everyone has different desires. We do procedures that we now refer to as oncopastic techniques, where our goal is to give you minimal deformity or change in the breast. If you decide to have a mastectomy, are you required to have a mastectomy, having reconstruction as an option either by using your own tissue or using implant based on reconstruction. We do a lot of symmetry surgery, where we make sure that if we remove a volume of tissue, that we make the correction to the other breast, so that you're symmetrical. We also do hidden scar type of surgicals, where we approach it from a natural fold within the breath, instead of on the breast. Treatment is so advanced that we're able to also determine whether you need radiation, whether you need chemotherapy. By studying the biology of the tumor, our pathologists are very thorough and the fact that they could look at that tumor and look for specific proteins, and then we could send it to look at the genomics of that tumor and tell us is your tumor very aggressive, where he's going to have a high risk of recurrence. And make a decision on whether you need chemo or not based on specific level one evidence that supports the benefit of chemo in you.

Host: Now we're going to get a bit technical here. How can the use of 3D specimen tomosynthesis in the OR help improve surgical outcomes and reduce the need for second surgeries?

Dr. Henry-Tillman: Well, we take you to the operating room. Our goal is to make sure we remove that cancer. Make sure we can find those lymph nodes and make sure we don't have to take you back to our second procedure. So we use a lot of tools in the operating room, and we use a lot of imaging technology. We use 3D tomosynthesis, similar to a tomosynthesis, but we use 3D imaging in the operating room to look where we can remove your tumor and look at the tissues under x-ray and look to see if there's additional calcification, is the tumor is close to the edge. That's called a margin. If we see that we can move additional tissue at the time of surgery, instead of waiting on the path report, we can use that information to help us do better surgery.

Host: What is something you wish more people knew or understood about breast cancer and surgical oncology?

Dr. Henry-Tillman: The earlier you find the cancer, the better chance of survival, and that survival is also dependent on the biology of the cancer and your response to treatment. And everyone is different. Every tumor is different. Every patient responds to treatment different. And a lot of times everyone has their story. Doesn't always mean. That will be your story. I'm often amazed sometimes where people will go, well, there'll be younger and they have a lump and they didn't get it checked out because they said, well, you're not old enough to get breast cancer. You know, true. Most women who get breast cancer are in their fifties, but we do have younger women who get breast cancer. And so for not just the patients, but also our providers to know if an individual comes in with a lump that they should have it evaluated.

The only way to assess that lump is by looking at it first with an ultrasound. And if their age, if it's something that is of concern, you can get a mammogram just because you're not 40 doesn't mean you can't get a mammogram. Is that if you find something, then it becomes a diagnostic. And we book that up accordingly. And so I've seen times where individuals wait, because they said, well, I'm not old enough. It's not always about age. And so I wish people knew if they feel an abnormality in their breast, or they feel a lump, to have it evaluated with a diagnostic test. And if you're young, they'll do an ultrasound, they'll tell you if it looks like a cyst, or if it looks like a fibro adenoma, or if it looks like a cancer, they can sample it and tell you what it is. And you don't have to wait and come in with a late diagnosis.

Host: Now wrapping up here when it comes to treatment, what are some options that people can consider?

Dr. Henry-Tillman: The primary goal of treatment is to remove the cancer. Check, to see if it's spread and make sure it does not come back. And removing the cancer, the options are either taking the cancer out of the breast. That's called a lumpectomy. We look for spread by doing a, what we call a Sentinel Lymph Node, that's checking the Lymph Node that drains the breast. If that is negative, we don't take any additional nodes. And then depending on the biology of that tumor, we will provide radiation, that's breast conservation therapy. If the biology of that tumor is hormone sensitive, depending on the menopausal state of that patient, they will go on endocrine therapy and depending on the size and the genomics of that tumor will determine whether they need chemo. The other option is you can remove the breast to get rid of the cancer, and that's a personal decision. And sometimes it's dependent on the size or the type of the cancer. So the earlier the cancer more options you have for treatment. And so either removing the cancer out of the breast with a lumpectomy, followed by radiation, and checking the lymph node or mastectomy with, or without reconstruction, depending on the type of cancer. And that's an individual choice, we do make decisions together. Sometimes patients get genetic testing and they may have a genetic mutation. And in that case, we look at that mutation and make the decision together on what is the best option for them.

Host: Great doctor, is there anything else you want to add to this conversation about breast cancer that we didn't touch upon already?

Dr. Henry-Tillman: So, one of the things is that a lot of times I talked to you about risk assessment, and it's important that knowing your history, knowing your family history, understanding whether or not, you know, the three generations of family history. If you look at medical records today, the most common thing is not capturing a complete cancer family history. And so I always, you know, you may not know your family history, but it's important because it does help us and not just your breast cancer history. Well, is there prostate cancer in your family? Is there colon cancer in your family? Is there Gastric cancer in your family? So that we can put that information together. We talked about when you do that, there are different calculators that we can use to assess your risk. And the most common one that we recommend to get a true risk assessment is what we call Ibis or the Tyra Cusick Model, which takes into account breast density. And so there are other risk models that we can use, but we can actually calculate your risk and make a true assessment of what your risk is.

Because if you're high risk, you can go into high risk cancer surveillance. And if you have a family history that suggested mutation, we can do genetic testing, you and identify whether you have that mutation before you get cancer. So, history, and knowing that information is just as important as getting a screening mammogram. And I always tell people there's specific guidelines that we follow to do that we have a high risk clinic. We have a high risk assessment clinic, and we can help you identify clearly what your risk is. So you'll know whether you should be getting mammograms sooner than age 40, because if you have a significant risk or you can be in a high risk where you may need to be screened as well with mammography and MRI. So that's one of the most important things that I could tell individuals as well. We don't all have the same risk, the risk that we do have associated as being a female on getting older, but that family history is important knowing that information. So we can do a better assessment of your lifetime risk for development of breast cancer.

Host: Well, thank you so much again for this critical information and for sharing it with us today, that was Dr. Rhonda Henry-Tillman, a breast cancer surgeon and professor for the department of surgery and chief of breast oncology at UAMS. For more information on breast health visit uamshealth.com. And thank you for listening today. This has been UAMS Health Talk, the podcast by the University of Arkansas for Medical Sciences. I'm Caitlin Whyte, stay well.