Arleen:
Can you explain what a papillary neo plasm is? I was diagnosed with it. I have to go for surgery next week. Maybe you can explain it in layman's terms so I can understand what it is.

Marcia C. Boraas, MD:
Your description does not provide enough information for me to provide you with a complete answer. For your reference, a papillary neo plasm is a type of growth that occurs within the breast ducts. It can include a variety of conditions, some of which are more serious than others, therefore I encourage you to speak to your doctor for more detailed information regarding your specific condition. To schedule an appointment with a Penn physician, call 1-800-789-PENN.

Dolores:
I am a 48 year old African American woman that has been diagnosed with breast cancer invasive to the right axillia nodes. My doctor feels that since there is extensive lymph node involvement with no palpable lump any surgery would involve a complete mastectomy. Are there any other alternatives available to me?

Kevin R. Fox, MD:
One alternative would be an MRI scan of the breast on the side where the lymph nodes are involved. Somtimes, but not always, this scan can find the breast cancer in your breast. If the cancer is small enough, sometimes it can be removed by a lumpectomy rather than a mastectomy. For more information or to schedule an appointment, call 1-800-789-PENN or visit pennhealth.com.

Linda:
Why are some breast cancer patients administered chemo and radiation, while others are given only radiation?

Marcia C. Boraas, MD:
Chemotherapy and radiation therapy are given for different purposes. Radiation therapy is usually combined with surgery for local treatment of the cancer within the breast. Chemotherapy or hormonal therapy is used to minimize the risk of cancer spreading to other areas of the body. Radiation is required after lumpectomy surgery and occasionally after mastectomy. Chemotherapy may be added based on the characteristics of an individual tumor and the anticipated risk of spread. For more information and/or to schedule an appointment, please call 1-800-789-PENN or visit pennhealth.com.

Paula:
I'm 44. Have been having yearly mammograms and yearly breast exams. I have large breasts that are also fibrocystic. Is a yearly mammagram sufficient screening tool for me or should I be doing more?

Kevin R. Fox, MD:
Mammograms and regular breast examinations by a physician are still the best methods that we have. There are special programs at some hospitals, including Penn, that use MRI scans in addition to mammograms. You may qualify for one of these programs. Just remember that MRI scans are not routine, and we really don't know if they are better than mammograms. However, it may be worth a try.

Annamaria:
I have breast tissue under my right armpit; this area swelled a bit when I was lactating through my last 2 children. Now, when my son lies his head in this area while, say, watching tv, it causes terrible pain, say an '8' on the pain scale. My internist told me it was not my lymph nodes and possibly adipose tissue. I hope so. However, it is swollen, it is painful and my mother had a radical mastectomy at 48, I am now 44 and concerned. Any thoughts and also have you ever seen breast cancer in the armpit? Thank you in advance.

Marcia C. Boraas, MD:
Breast tissue located in the armpit area is not uncommon and may respond to hormonal changes just like tissue within the breast. If you are experiencing a new symptom in this area, it should be evaluated. While it may represent a benign condition, breast cancer can occur anywhere breast tissue is present. It would be uncommon however for breast cancer to present as pain with no other symptoms. For more information and/or to schedule an appointment, please call 1-800-789-PENN or visit pennhealth.com.

Maureen:
Recently I have been experiencing burning in my right breast (I had two operations on this breast already). This is a new feeling for me, do I need to be more concerned than the last two findings? I will be going to see a surgeon on May 21, I had an ultrasound and a mammogram done recently.

Eleanor Harris, MD:
Sometimes burning is a symptom of mastitis, an infection, or an injury to the breast. Pain is an uncommon symptom of breast cancer. However, it is prudent to have breast imaging and an examination by a surgeon or gynecologist to ensure that there are no suspicious findings in the breast.

Patti:
I am trying to find any help you may suggest for me- I am a 39 year old woman who has breast cancer (ductal carcinoma in-siti high grade w/calcification) which has spread to my bones and my liver. I feel that the current doctor is not able to research any further due to the fact that it is asmall community hospital and is not up on the current medical procedures that are out there, and I am not sure where to go with my condition.

Kevin R. Fox, MD:
Your case is unusual, and perhaps, you should get a second opinion from a major medical center, such as Penn. You should request a second opinion from a medical oncologist. For more information or schedule an appointment, call 1-800-789-PENN or visit pennhealth.com.

Mary:
What exactly is chemotherapy?

Kevin R. Fox, MD:
Chemotherapy is a general term for drugs that kill rapidly growing cells. These drugs kill cancer cells more effectively than they kill normal cells. There are nearly 40 different chemotherapy drugs which are used in all types of cancer.

Betsy:
My younger sister was diagnosed with breast cancer 8 years ago (she was treated at Penn through Dr. Solin) and my older sister was diagnosed with breast cancer 2 months ago (she had her mastectomy surgery done by Dr. Boraas). My question is...how do I monitor my own breast health. I've been receiving mammograms for the last 8 years, but would like to be involved with the MRI screening trail. How do I go about this process?

Marcia C. Boraas, MD:
While there are no universal standards for screening women at higher than average risk of breast cancer, you certainly should be followed by an experienced specialist. You may wish to contact the Cancer Risk Evaluation Program at the Hospital of the University of Pennsylvania, led by Barbara Weber, MD, for their recommendations regarding your personal risk and appropriate screening. You may qualify for one of the MRI screening studies. For more information and/or to schedule an appointment, please call 1-800-789-PENN or visit pennhealth.com.

Joyce:
My mother at 84, was diagnosed with breast cancer, had a lumpectomey and is finishing radiation therapy. Her cancer is the "fast growing, highly invasive kind". Hers was encapsulated in a fluid cyst. I have had a history of fluid cycsts, am I at greater risk of breast cancer, is there a connection? They have told me lately that aspirating a cyst I have had for over two years is not important... is that normal to leave it? It's slightly over 2 cm.

Kevin R. Fox, MD:
Fluid cysts do not themselves increase the risk of getting breast cancer. If you have a cyst that keeps recurring, it is acceptable to let it alone unless it grows or causes pain.

Lisa:
I was adopted, so I have no medical history to know if I am high risk. I will be 40 and have not had a mamogram yet. How would I go about getting a more accurate test. I have Aetna Health Plan and all my doctors are with Doylestown Hospital. I am originally from Philadelphia and trust Philadelphia hospitals more.

Eleanor Harris, MD:
It is recommended that you have your first screening mammogram at age 40. The technology for obtaining a mammogram is standard, and should be available at a community hospital. The difference in the quality of diagnosis is related to the expertise of the technician performing the mammogram and the radiologist interpreting the images. You are more likely to have a breast specialist read your films at a cancer center. You should ask your insurer where you are allowed to have your mammograms performed. If you are capitated to a local hospital, you can ask for a second opinion once the mammogram has been performed.

Nancy:
Does breast cancer always stay isolated in the breast and lymph nodes? Or can it spread to other organs?

Kevin R. Fox, MD:
Breast cancer can spread to other organs in some cases. Fortunately, it does not spread in most cases. Some patients receive chemotherapy or hormonal therapy, or both, to reduce the chance of the cancer spreading.

Mary:
I had a lumpectomy two years ago and was diagnosed with atypical ductal hyperplasia. Because of a history of stroke and coronary artery disease, I have not been prescribed Tamoxifen. Is there any other preventive measure recommended beyond yearly mammogram and twice yearly examination by a doctor?

Marcia C. Boraas, MD:
Atypical ductal hyperplasia is a benign condition which is associated with an increased lifetime risk of breast cancer. Your associated medical conditions would preclude the use of Tamoxifen, and at this time there are no other medications approved for breast cancer risk reduction. Outside of a research study, the screening that you are receiving seems appropriate. If you have concerns, please be sure to address them with your physician. For more information and/or to schedule an appointment, please call 1-800-789-PENN or visit pennhealth.com.

Beth:
After a lumpectomy and chemotherapy (A/C and Taxidere), I went through radiation. Although my treatment ended last May, my hair is not growing in. Is there any help for this? I am presently taking Tamoxifin.

Kevin R. Fox, MD:
This is a rare problem, which we have seen only a few times. We have tried Rogaine treatments a few times, and have not been very successful. Unfortunately, we do not have a more helpful suggestion.

Fran:
I had a modified radical mastectomty due to microcalcification. What is the likelihood of it occuring in my other breast? Also, do you have available a video that I can purchase on mastectomy, I always have been interested in seeing what actually was performed on me. Thank you and I enjoyed your show tonight.

Eleanor Harris, MD:
Any woman has had a breast cancer in one breast has about a 10% lifetime risk of developing a cancer in the opposite breast, regardless of how it presented. For information about mastectomy, please contact the American Cancer Society.

Denise:
I was just diagnosed with breast cancer. I had a lumpectomy, but have more ducts with cancer cells remaining. I then had a bone scan and a CT scan so far. I am scheduled for lymph node surgery for testing to see if it has spread. I was told I need radiation and probably chemo. Is lymph node surgery necessary and what will the results tell? Will I be able to continue to work full time?

Kevin R. Fox, MD:
A lymph node operation is useful for two reasons. First, it gives us a way to predict how likely the cancer will spread to other organs. Second, it helps determine exactly what type of chemotherapy will be used. You may be able to work full-time, or at least part-time, during chemotherapy. I believe it is best to stay in your job and see how you feel.

Susan:
I am a 40 year old who has had 5 non-cancerous breast tumors removed. Diagnosed with LCIS and neoplasia. I currently have a mammogram every 6 months, most recently in April with some small calcium deposits noted. Should my follow-up be more aggressive? I have had a grandmother and 5 cousins (premem.) die of this disease.

Marcia C. Boraas, MD:
Based on the information you provided, your risk of breast cancer would be considered higher than the general population. There are no generally accepted standards for screening women at high risk, but you may wish to contact the Cancer Risk Evaluation Program at the Hospital of the University of Pennsylvania, led by Barbara Weber, MD, for an individual assesment and recommendations. You may qualify for an MRI screening study. For more information and/or to schedule an appointment, please call 1-800-789-PENN or visit pennhealth.com.

Sue:
I finished chemo last June and my hair is still not grown back. Any suggestions?

Kevin R. Fox, MD:
This is a rare problem that we see very infrequently. We have tried Rogaine treatments in a few patients. We have not had much success, but it is worth a try.

VJ:
I have had a third recurrence of breast cancer. This time the cancer spread to my brain and my sternum. I have had the tumor removed from my brain, radiation treatments and I am currently undergoing Xeloda chemo. This past week I was told that the chemo is not working. Can you help me?

Eleanor Harris, MD:
The University of Pennsylvania's Abramson Cancer Center has a number of clinical trials for women with recurrent and metastatic breast cancer. Please contact the number listed above for more information. Or you can log onto Oncolink for a listing of active studies. For more information or to schedule an appointment, call 1-800-789-PENN or visit pennhealth.com.

Jennifer:
My mother-in-law is just finishing chemo and radation. She is supposed to take something called Tamoxifen and this made her sick. How important is this and does she need to take it for a good recovery?

Kevin R. Fox, MD:
Tamoxifen is as important as chemotherapy in breast cancer treatment, and sometimes more important. However, if it is making your mother sick, there are alternatives to Tamoxifen for some patients. You should ask the oncologist if these alternatives are appropriate for your mother.

Cassandra:
I had a lumpectomy for DCIS. I have just completed one week of radiation. However, my oncologist wants me to have a CT scan of my pelvis, abdomen and chest as well as bones because my CA127 marker test was elevated. I am confused because I was told that DCIS is not a spreadable cancer, therefore, why is the cancer marker test elevated and why am I to have a CT scan of other parts of my body? In addition, couldn't this wait until radiation therapy is completed as I am already overwhelmed?

Marcia C. Boraas, MD:
You are correct that DCIS by definition does not spread out of the breast and would not be expected to elevate tumor marker tests. Some times the test results will be falsely elevated in normal, healthy people. Your physician may be ordering the CT scan to exclude an unrelated cause for the test result. I suggest that you speak directly with him or her for clarification. For more information and/or to schedule an appointment, please call 1-800-789-PENN or visit pennhealth.com.

Linda:
What is the likelihood, given today's advances, that a breast cancer patient in her 30s will lose her hair during chemotherapy treatment? And is the chemotherapy drug combination for breast cancer the same as for other cancers, or do you use different chemicals to target different organs? Thank you very much for providing this forum and the television show.

Kevin R. Fox, MD:
The chemotherapies we use for breast cancer are also used to treat some other cancers. Unfortunately, the very best chemotherapy drugs for breast cancer cause hair loss. The hair regrows normally in almost every case.

Marissa:
I have very large and dense breasts. I do not feel that a mammogram would be sufficient in detecting any abnormalities. Also, my insurance most likely will not cover MRI. I am in my forties and I do the self breast exams but due to the large tissue I am concerned I would not feel anything abnormal.

Eleanor Harris, MD:
Mammogram is less accurate for women with very dense breasts. Please contact the Abramson Cancer Center to learn about whether you are eligible for a screening study for women with dense breast tissue run by Dr. Blackwood-Chirchir. For more information or to schedule an appointment, call 1-800-789-PENN or visit pennhealth.com.

Linda:
I completed 5 years of Tamoxifen in 1996 and had DCIS in 1999. I'm wondering if an aromotase inhibitor should be considered.

Kevin R. Fox, MD:
There is not enough information regarding aromatase inhibitors in DCIS as yet. We are not recommending them at this time. More information will be coming in the next few years.

Lynne:
I am a 34 y/o f, I found a lump on my breast about 6 months ago. Two inches from my nipple, its hard but no pain, recently drainage has come from that nipple. The lump has remained in size (small). The drainage is clear yet milky? It has only happend twice. Is this a concern?

Eleanor Harris, MD:
A hard painless lump with discharge should be evaluated further. Please see your primary doctor or gynecologist for a breast exam and mammogram.

Denise:
What are the side effects of lymph node sampling, I heard of arm swelling, is this permanent?

Marcia C. Boraas, MD:
Lymph node surgery for breast cancer may be limited to one or two nodes removed (sentinel node biopsy), or may require removal of all the nodes in the armpit area. The risk of arm swelling (lymphedema) will depend on the extent of surgery as well as factors such as obesity, which are poorly understood. If lymphedema develops, it may be minimal or obvious, but can be reversed or minimized with appropriate physical therapy interventions. For more information and/or to schedule an appointment, please call 1-800-789-PENN or visit pennhealth.com.

Teri:
How is the decision made on what drug to give a patient that has breast cancer?

Kevin R. Fox, MD:
Drug treatments for breast cancer come in two types: chemotherapy and hormonal therapy. Breast cancer tissue is tested to see if it has hormone receptors. Cancer that have hormone receptors are usually treated with hormonal therapies, and cancers that do not are usually treated with chemotherapy. There are many types of hormonal therapies and even more types of chemotherapies. We choose which treatment we use based on the health of the patient and which drug will cause the fewest side-effects.

Denise:
I am 48 and have beast cancer, my daughter is 21 years old, should she have a mamogram now and every year since I have a history now? I have no other family history of cancer but am concerned for my daughter's health.

Kevin R. Fox, MD:
Mammograms are not very useful for very young women, such as your daughter. The breast are too dense in young women, and the mammogram cannot see anything. She doesn't really need to start having mammograms until she is between 30 and 40. At this time, it is more important that she have a breast examination by a doctor every year

Joan:
I am 72 years of age. Five years ago I had a lumpectomy for an early stage breast cancer in my right breast - nodes were negative. I took Tamoxifen for 5 years. I recently had another lumpectomy for the same thing in my left breast - again nodes were negative. I was told it wasn't a recurrence; it was a new primary cancer. What is the difference? Also, my oncologists are sending me to Penn for a bilateral MRI. How will this MRI benefit me at this time?

Eleanor Harris, MD:
It is rare for breast cancer to travel from one breast to the other. In most cases a second breast cancer in the opposite breast is a new breast cancer, although it is not always possible to see a difference under the microscope because two-thirds of all breast cancers are the same type (infiltrating ductal cancer). The prognosis for a second early stage (node negative) breast cancer is still very good. An MRI is a useful study in addition to mammography in women with prior and known current breast cancers to further evaluate the size and distribution of cancer in the breast, and to rule out a recurrence of the first cancer. Because dye which is absorbed by the tumor cells is used for the MRI, this study will sometimes give a better picture of the breast tissue and the cancer within it.

Cindy:
I was diagnosed with lobular carcinoma in situ 5 years ago; I'm now 52 and have had numerous biopsies - all benign. Should I take Tamoxifen? Would I be a candidate for the Cancer Risk Evaluation Program? I am having multiple mammograms and ultrasounds every year and it is overwhelming my life!!! Thanks.

Kevin R. Fox, MD:
Tamoxifen can reduce the risk of breast cancer in patients with lobular carcinoma in situ. You may be candidate for Tamoxifen, but you would be an excellent candidate for the Cancer Risk Evaluation Program. For more information, call 1-800-789-PENN or visit pennhealth.com.

Sheila:
I have found a small lump in one breast, had X-ray and mamography immediately. Neither showed anything yet the lump is there. My doctor is seeing me again and will, she says, probably refer me to a surgeon for more evaluation. Ae there malignant lumps not detectable in the early stages? I am 80 and in good general health.

Eleanor Harris, MD:
Mammogram fails to detect up to one-third of breast cancers, and is less accurate in women with denser breasts. Therefore, when a palpable mass is not visible on mammogram, it should be biopsied.

Denise:
Would I be a good candidate for Tamoxifen, I had deep vein thrombo phlebitis with my pregnancy in 1980. It took me a long time to recover from this.

Kevin R. Fox, MD:
This is an excellent question. Before prescribing Tamoxifen in patients with a history of serious blood clots, we usually obtain a consultation with a hematologist (blood specialist) with a specialty in blood clotting. There are several excellent specialists of this type at Penn. For more information, call 1-800-789-PENN or visit pennhealth.com.

Fran:
Exactly what is microcalcification?

Eleanor Harris, MD:
Microcalcifications are tiny deposits of calcium that are often associated with cancers in the breast. There are different patterns of calcifications that can be seen on mammography, and some are more suspicious, that is, more likely to be associated with a cancer. Microcalcifications are more suspicious, and typically should be biopsied.

Betsy:
It's me again....thank you for answering my question. My sisters were diagnosed with DCIS, one at the age of 31 and the other at the age of 44. Is it unusual for two sisters to have the exact same kind of breast cancer?

Marcia C. Boraas, MD:
There are only a few types of cancer which occur in the breast. The majority of breast cancers are ductal, either in situ (DCIS) or invasive. DCIS, which is the more favorable type, is what we hope to find when breast cancer is detected early. Statistically, this may explain why both of your sisters were found to have it. For more information and/or to schedule an appointment, please call 1-800-789-PENN or visit pennhealth.com.

Harold:
My wife and I moved here from Idaho, where the medical care she received was in a small community. Shortly after my wife was diagnosed with thyroid cancer, and we were scheduling her for a thyroidectomy she was also diagnosed with breast cancer. We were told that there was no connection between the two, but I have always wondered if it was possible that the cancer that spread downward could somehow have metastisized to her breast? Is that a possibility? Or were to two truly totally unrelated?

Kevin R. Fox, MD:
I do not think that your wife's two cancers were related. Thyroid cancers do not spread downward to the breast, or at least I have not seen or heard of this happening.

Cassandra:
Dear Dr. Boraas, Thank you for your response. However, I need to know what unrelated cause she could be trying to exclude?

Marcia C. Boraas, MD:
There are several conditions which could result in an abnormal test. Unfortunately, without knowing your medical history, I cannot be more specific about your doctor's recommendations. For more information and/or to schedule an appointment, please call 1-800-789-PENN or visit pennhealth.com.

Paula:
I am 31 yrs old. I have breast cancer and no one in my family has it. How does not having any children yet relate to getting breast cancer? Also, I am getting Taxotere and Adriamycin to shrink the tumor prior to surgery. Will they make me infertile? We do want to have children when this is over.

Kevin R. Fox, MD:
Why women who never had children get breast cancer more often is a mystery. For some reason, getting pregnant and having a child protects the breast somewhat from getting cancer. The good news is that you probably will not get infertile from your chemotherapy. Very young women usually maintain their fertility after chemotherapy. This is not a guarantee, but your chances are good.

Marie:
I have implants and when I got a mammagram it was really uncomfortable. What can I do?

Eleanor Harris, MD:
For your mammogram, you could try taking some pain medication prior to your study. Implants in some women may make mammograms more difficult to interpret, therefore, you can also consider having MRIs of the breast, which does not involve any compression of the breasts. However, please remember that MRI is not considered the standard screening study and may not be covered by your insurance.

Lou:
Can proper diet help to cut the risk of breast cancer? Also after treatment can it be helpful in cutting the risk of the cancer returning? We hear so much about the importance of micro-nutrients in fruits and vegetables. Thanks!!

Kevin R. Fox, MD:
Our real understanding of breast cancer and diet is very poor. The only thing we can say for sure is that drinking more than 2-3 alcoholic drinks per day increases breast cancer risk. We also believe that diets high in fruits and vegetables might reduce the risk of many types of cancer. That is all we can say for sure.

Marie:
I would like to know what exam is accurate when you have implants?

Eleanor Harris, MD:
Mammograms may be adequate, you should ask your doctor (primary care or radiologist) if that is the case for you. It depends upon the type of implants, and other factors such as any surgical scarring that may have developed. If there are any concerns regarding the interpretation of your mammograms, you should consider having MRIs as well.

Denise:
I was told if the root of the breast cancer (the primary source I was told) was killed, it is easier to treat and kill cancer in other parts of your body--if it would spread. Is this true and would it stop other areas from developing cancer?

Marcia C. Boraas, MD:
If breast cancer is diagnosed before there is any sign of spread to other parts of the body, removing the primary tumor is essential to cure of the cancer. Sometimes cells can travel from the breast but not be detectable by available tests. A treatment program for breast cancer should address both the cancer in the breast and the possibility that cells could have already spread. For more information and/or to schedule an appointment, please call 1-800-789-PENN or visit pennhealth.com.

Marie:
Will the compression break the implant?

Eleanor Harris, MD:
It is possible for compression from a mammogram to rupture an implant, although it is rare.

Mary:
I will begin chemo this week. My white blood cells are already below normal. Will this cause complications with the chemo? Is there anything to help boost the white cells?

Kevin R. Fox, MD:
This is a very good question. There are medications called neupogen and neulasta which can boost the white blood cells. These medications are shots you must take after your chemotherapy. Your doctor may wish to use these if your white count is already very low. If your white count is only slightly low, these medications may not be necessary.

Fran:
Thank you for your previous answer. I had reconstructive surgery with saline implant. What is the probable life expectancy for these implants?

Marcia C. Boraas, MD:
In reconstructive surgery the implant is usually placed behind the chest (pectoral) muscle. While most people feel that an implant can be expected to last about 10 years, the range is variable. An implant does not need to be replaced unless a specific problem develops. For more information and/or to schedule an appointment, please call 1-800-789-PENN or visit pennhealth.com.

Joyce:
Thank you for your earlier response. Another question, several years ago, breast cancer in elderly relatives was not considered as history, but then that changed and I was told it is counted as history. What changed, and is it important in evaluating risk? Does risk increase through perimenopause/menopause?

Eleanor Harris, MD:
There is a higher risk of breast cancer for relatives of women who develop breast cancer at a young age, particularly among first degree relatives (mother, sister, daughter). However, there is an increased risk of breast cancer for women who have a relative who develops breast cancer at any age. Therefore, any family history is considered a risk factor. Breast cancer is more common in postmenopausal women, thus the risk of developing breast cancer does increase with age.

Mary:
My doctor put me on Letrozole after radiation because I had TIA several years ago. Will this do the same for me as Tamoxifen?

Kevin R. Fox, MD:
Your doctor made a good decision. Letrozole is at least as good, and maybe better than, Tamoxifen.

Denise:
How long of a time span will radiation and chemo take--up to 36 months or a year??

Kevin R. Fox, MD:
Chemotherapy and radiation generally take from 5-8 months to complete. Chemotherapy takes from 3-6 months, and radiation lasts for just under 2 months.

Denise:
I am post-menopausal, 2 years, I was not given estrogen because of my former deep vein phlebitis history. Did that put me at a greater risk for breast cancer?

Marcia C. Boraas, MD:
Neither a history of phlebitis nor a lack of estrogen use is known to contribute to the risk of breast cancer. The risk of breast cancer does increase after menopause independent of the factors you mentioned. For more information and/or to schedule an appointment, please call 1-800-789-PENN or visit pennhealth.com.

Iris:
Is someone with breast cancer more susceptible to cancers in other parts of the body, i.e. ovaries, colon or skin?

Eleanor Harris, MD:
There is an association between breast cancer and certain other cancers. Women who have inherited breast cancer, which is related to the BrCa1 and BrCa2 genes, are at significantly increased risk for ovarian cancer. There are also other inherited family cancer syndromes which include breast, colon and endometrial cancers. Skin cancer is probably not associated with breast cancer.

Sue:
Thanks for your answer. It seems Beth and I have the same problem. Someone told me patients who receive chemo every 2 weeks instead of every 3 are having this problem with hair regrowth. Have you heard anything about that?

Kevin R. Fox, MD:
We have not seen this problem anymore frequently in patients receiving chemotherapy every 2 weeks instead of every 3 weeks. The large clinical study which compared chemotherapy every 2 weeks versus every 3 weeks also did not report this problem.

Paula:
Thanks for answering my prior question. If I don't get a port for my chemotherapy, which is Taxotere, will the chemo damage my veins in some way or does it depend on the chemo drug? I am nervous about the port - where is it inserted? Does it bypass my veins, then where does the chemo go in my body?

Kevin R. Fox, MD:
Taxotere is not very damaging to the veins. Other drugs used in breast cancer treatment can be much more irratating to the veins. A port is usually placed under the skin just below the collarbone. It is placed into a large vein. The chemotherapy is injected into the port, and it flows directly into the vein. This can make chemotherapy administration much easier. Placing a port is not difficult surgery and is not risky. You do not need to be worried.

Cindy:
What is the false negative rate for sential node biospy if there is only one sentinal node? How would this impact survival if there were positive nodes further "down" that were not sampled, and only Tamoxifen therapy and local radiation were given? Thank you.

Marcia C. Boraas, MD:
The accuracy of sentinel node biopsy is dependent on technique and the surgeon's experience. While the average number of sentinel nodes removed during surgery is two to three, often only a single sentinel node is present. If the mapping and detection of the sentinel node(s) is accurate, treatment recommendations can safely be made based on the results of even a single node. If you have concerns about the accuracy of your procedure, you should address them with your surgeon or oncologist. For more information and/or to schedule an appointment, please call 1-800-789-PENN or visit pennhealth.com.

Gina:
My sister has breast cancer, she lives in Romania. After the chemotherapy she is very sick right now. She may have chance to recover? Please, just give me some information about. Thank you so much for your help.

Response:
You can find more information about chemotherapy and its side effects on Oncolink.

MiMi:
My sister was diagnosed with invasive breast cancer at 40 and I was just diagnosed at 46. I have two older sisters and we all have daughters. Would you recommend genetic testing or anything else for us?

Eleanor Harris, MD:
You should consider genetic testing, since you and your sister have had breast cancer at a relatively young age. The Abramson Cancer Center has a program called the Cancer Risk Evaluation Program. For more information or to schedule an appointment, call 1-800-789-PENN or visit pennhealth.com.

Iris:
How soon after surgery should chemo begin?

Kevin R. Fox, MD:
Chemotherapy generally begins no sooner than 2 weeks after surgery. You must allow enough time for complete healing of your surgical wounds. The average time between surgery and chemotherapy is 3-4 weeks.

Louise:
I had to have 3 surgeries before my doctor got the margins she needed. Is this very common? I then went to radiation.

Marcia C. Boraas, MD:
I assume you are referring to a lumpectomy procedure which is intended to remove all the detectable cancer from the breast prior to initiating radiation. The problem with this surgery is that the cancer does not always form a lump that can be felt by the surgeon during the procedure. Microscopic tumor cells are sometimes only detected at the edge of the specimen by the pathologist several days after the surgery. In this situation, more tissue must be removed. Because it is so important to completely clear the cancer from the breast, sometimes several procedures will be required to accomplish this.

Terri:
When does the 5 year period begin? Is it 5 years after treatment, or diagnosis?

Eleanor Harris, MD:
The five year period typically starts at the date of diagnosis, that is when you had your biopsy that showed cancer.

Marie:
I had the sentinel node biopsy performed and 2 out of 3 were positive. I had axillary dissection which showed all 13 additional nodes were negative. I had a 1.5 tumor and am 45 years old. What chemo drugs would you recommend for me?

Kevin R. Fox, MD:
Because you are young, we would generally recommend a fairly aggressive course of treatment. We would usually recommend a combination of adriamycin, cytoxan, and Taxol. There are other choices. If you need more information call 1-800-789-PENN or visit pennhealth.com

Terri:
I had tram flap reconstruction 2 years ago on the right breast. Now I notice that the left is a little saggier than the "new" one. Should I wait the 5 year waiting period before getting the left adjusted to match?

Marcia C. Boraas, MD:
It is not unusual for the natural breast to show some changes over time, which are not observed in the reconstructed breast. If you are unhappy with the appearance and you are not receiving active breast cancer treatment, you should consult with your plastic surgeon, as there is no specific reason to wait. For more information and/or to schedule an appointment, please call 1-800-789-PENN or visit pennhealth.com.