John Turner, MD, FACS, Medical Director or Cancer Services and Clinical Co-Manager of the Thyra M. Humphreys Center for Breast Health, has a long history of working directly with patients once they’ve received a breast cancer diagnosis. An accomplished breast surgeon and avid researcher on breast health and other cancer, Dr. Turner helps guide patients through not only the diagnosis, but the decision-making related to treatment and survivorship.

Here are some of the answers to the questions he most commonly hears from his patients.

Question: what are the risk factors for developing breast cancer?

Dr. Turner: There are multiple risk factors for patients to take into consideration as it relates to the breast cancer. A list we look at as medical professionals is as follows:
– Family history of breast or ovarian cancer
– Early onset of menstruation (under age 12) or later onset of menopause (after 55)
– Having your first child after the age of 30 or never having a full-term pregnancy
– Genetic mutations
– Certain types of hormone replacement therapy (discuss with your medical provider)
– Alcohol use
– Smoking (also linked to benign breast disease including recurring subareolar abscesses)
– Physical inactivity and obesity
– History of radiation therapy to the chest (such as for Hodgkin’s Lymphoma)

Question: Even though breast cancer is often asymptomatic, are there symptoms of which to be aware?

Dr. Turner: Women (and men) should always be aware of what is normal for their bodies. There are some symptoms that can appear related to breast cancer including, a palpable (felt) mass, discharge from a nipple, a sudden inversion of a nipple, or a change in color (red) or texture of the breast skin (developing a textured appearance that looks similar to the skin of an orange).

Question: Should I undergo breast cancer screening and what should that include?

Dr. Turner: Women of average risk for developing breast cancer should begin annual screening mammograms and clinical exams at the age of 40.

Regardless of age, all women should have a screening program that is based on their personal risk. At the Center for Breast Health, all women who are seen for any reason are sent a link to a questionnaire that determines their risk for genetic mutation or indication for genetic testing and their calculated lifetime risk for breast cancer.

If women are determined to have an elevated risk of breast cancer, they are offered genetic testing and a high-risk consultation with a customized plan of follow-up, including how often they may want to consider being screened and what screenings are most indicated for them. This could include enhanced screening with the addition of MRI to the annual mammogram and prophylactic medication (medication for disease prevention) to lower risk.

Question: Is one surgery for breast cancer better than another?

Dr. Turner: The two most common surgeries done for breast cancer are:
– lumpectomy, which is the removal of the cancer itself with a rim of normal tissue which is typically followed by radiation
– mastectomy which is removal of the breast tissue down to the muscle but leaving the muscle intact. With the mastectomy option, the amount of skin taken is dependent upon the tumor site and size as well as the patient’s potential desire for reconstruction.

In the vast majority of patients, the outcome both in respect to cancer recurrence and survival are identical between the two surgical options when managed appropriately. There are certain specific instances in which mastectomy is required, but that is rare.

Question: will I need chemotherapy after surgery?

Dr. Turner: Indication for chemotherapy has nothing to do with the type of breast cancer surgery chosen by the patient. The decision for chemotherapy is based on lymph node involvement and a test called Oncotype DX, which determines risk of metastasis (the moving of cancer from one part of the body to another). It is commonly thought that everyone who has a breast cancer will have to undergo chemotherapy, when in fact, most patients do not have an indication for the type of treatment.

Question: If I do choose mastectomy, is reconstructive surgery covered by insurance?

Dr. Turner: Yes, insurance is required to cover the cost of reconstructive surgery, including any procedure done to the opposite breast, such as breast reduction, to balance the two sides.

For patients seeking reconstruction, the surgery is most often done at the same time as mastectomy in a coordinated effort between the patient’s breast surgeon and a plastic surgeon. There are several reconstructive options available to patients which should be discussed and considered based on what the patient wants most based on their lifestyle and goals.

Final Thoughts from the Doc

The most important decision is putting health first and taking the step to be screened. About 1 in 8 women in the United States will develop invasive breast cancer over the course of her lifetime. Every woman is encouraged to make a routine mammogram part of their health maintenance approach. Breast cancer is treatable with a high success rate if caught early. Don’t wait, set up a screening appointment today.

Financial resources may be available for those who are uninsured or underinsured to receive breast health screenings. For more information about the Thyra M. Humphreys Center for Breast Health, visit http://www.evanhospital.com or call 570-522-4200.

John Turner, MD, FACS, Thyra M. Humphreys Center for Breast Health