Important Questions

I am worried about my risk of developing breast cancer, because some of my relatives have had cancer.

Breast cancer seems to run in some families. There are known genes that can make some women more susceptible to breast cancer than others.

Knowing whether of not someone has a gene making them more susceptible to breast cancer can help a woman decide whether to take certain steps to reduce her risk of breast cancer. If a woman is found to have special breast cancer genes, she may help her relatives by alerting them to the possibility they too may have this susceptibility gene.

Women may particularly want a genetic counseling appointment if they have:

  1. A close relative who has been told that she (or he) has a gene for breast cancer susceptibility.
  2. If she has breast or ovarian cancer and is less than 50, or;
  3. If she has breast cancer and close relatives with breast or ovarian cancer.

Women with cancer susceptibility genes may want to talk with a surgeon about prophylactic breast surgery.

For an appointment to see our genetic counselor please call the Breast Clinic.

I would like to reduce my risk of getting breast cancer

There are many things that you can do reduce your risk of breast cancer. There are medicines (tamoxifen and raloxifene) that are FDA approved for reduction of breast cancer. You make want to talk with the medical oncologist about whether one of these medicines is appropriate for you. The medical oncologist may talk with you about the additional things you can do. There is strong evidence that maintaining a healthy life style, including a proper diet, can help you reduce your cancer risk.

At the CTRC there is a Wellness Program with courses and information on how to adopt a more healthy diet and lifestyle.

Women with cancer susceptibility genes may want to talk with a surgeon about prophylactic breast surgery.

To make an appointment relating to breast cancer risk reduction please call the Breast Clinic.

I would like to get a screening mammogram

Getting regular screening mammograms after age 40 has been shown to save lives of women even if they have no special risk factors.

Special risk factors include:

  • Close relatives with breast cancer or ovarian cancer
  • Radiation therapy to the breasts during teens and twenties
  • Prior biopsies showing changes that can lead to breast cancer

The particular strength of screening mammograms is that they can find breast cancers before they can be felt either by you or your doctor.

At our Breast Center we have a screening mammography center. CTRC has radiologists who specialize in breast image interpretation. We have state-of-the-art digital mammogram machines that expose you to less radiation and allow computer image enhancement techniques.  All breast images are immediately interpreted by a radiologist, and should additional imaging be needed such as ultrasound, it can usually be done immediately.

If a needle biopsy is needed, it can often be done immediately, before leaving the mammography office.

To make an appointment to get a screening mammogram call:  (210) 450 – 4000.

I have a lump or change in my breasts and want to see a doctor

An important part of early detection of breast cancer is self examination.

One of the reasons advanced breast cancer is becoming less common it that women are better informed about the importance of self exams. This means they are being seen sooner for changes in their breasts. Although these changes often are not indications of cancer, they should be checked out as soon as possible in case they are cancer.

A woman should be particularly alert to the following changes in her breasts.

  • A lump or thickening of tissue anywhere in the breast.
  • Skin dimpling or puckering of the breast.
  • A nipple that is pushed in (inverted) and hasnt always been that way.
  • Discharge from the nipples that come out and is not clear in color, staining your clothing or sheets.
  • Any change in the shape, color or texture of the skin such as raised or thickened skin.

Having these changes does not mean you have breast cancer. There are many things that can cause these changes, such as infections, benign cysts.  However, if these changes occur, they could be an early sign of cancer and you should bring them to the attention of a healthcare professional who should examine your breasts and decide if some special test (such as a mammogram) would be appropriate.

Usually the best person to see first is your general doctor or gynecologist. If you cannot do this we would be happy to have you call us about an appointment, for your further breast evaluation.

I have an abnormal mammogram and have been told I need further evaluation and/or a breast biopsy

If a screening mammogram shows an abnormality that might be cancer, the radiologist will often recommend that you have additional evaluation which may include an ultrasound of your breast, or a biopsy. This biopsy is often done with a needle, but may be done with a surgical excision of all or some of the abnormal area.

If you have had your screening mammogram at the CTRC, this will be discussed with you.

If you have been told at another health care facility that you have an area in your breast that needs addition evaluation after a screening mammogram or after other tests, we would happy to talk with you about making an appointment at our the clinic to discuss what further evaluation should be done.

I have had a breast biopsy and have been told that although it is not invasive breast cancer that I should talk with a doctor about the biopsy and how to reduce my risk of breast cancer

Some breast biopsies show abnormal cells that are not invasive breast cancers, but have the potential to change to invasive cancers months or years later.

The common types of these premalignant breast cancers are called.

Ductal carcinoma in situ (DCIS)
Lobular carcinoma in situ (LCIS)
Atypical ductal hyperplasia (ADH)
Atypical lobular hyperplasia (ALH)

These are usually removed surgically. For some woman with DCIS, radiation therapy is also given. For some women we recommend medicines to reduce the risk of developing breast cancer or to reduce the risk of recurrence of breast cancer.

If you are concerned about these, please call the Breast Clinic for an appointment.

I have a breast biopsy and have been told it shows breast cancer and I have been told that I need to have a plan to remove the cancer and possible further therapy

There are two basic questions that breast cancer patients must decide on.

1. How should I best have the breast cancer removed?

Options include mastectomy, which is the removal of the entire breast, or lumpectomy, which spares most of the breast.

Additional radiation therapy is recommended for some patients after a mastectomy and nearly all women after a lumpectomy.

Seeing a CTRC surgeon and a radiation oncologist is important to making your decision.

2. Is there a chance that my cancer has spread beyond the breast so that surgery (and sometimes radiation to the breast area) will not be enough?

For all women with invasive breast cancer there is some risk that breast cancer has had time to spread beyond the breast and the lymph nodes in the axilla (arm pit). This risk is usually low (about 20%) but it can be higher or lower depending on the size of the breast cancer in the breast, whether it has spread to the lymph nodes in the axilla, and other factors.

Medical oncologists specialize in the use of anti cancer medicines: hormonal therapy, chemotherapy, immunotherapy and other drugs, to reduce this risk of recurrence. An assessment by a medical oncologist involves getting an estimate of the risk of recurrence with and without such therapy. Your medical oncologist can help you understand the risks and benefits of different treatment options to better allow you to understand and participate in making the decision for your care.

I have cancer that has spread beyond my breast cancer and that I need treatment

Some women with breast cancer develop "metastatic" disease. Breast cancer that has spread from the breast (and away from the arm pits lymph nodes) to other places such as the bones, lungs or liver. This is a serious situation, but many such women can live years with a good quality of life.

The breast center can help by discussing your options for therapy. Not only are the best conventional options available, but you may also consider new research options, that may be the therapies of future.

I have had breast cancer surgery and I would like plastic surgery

For many women who will have a breast removed because of cancer or cancer risk, having breast reconstruction is important. Reconstructive surgery can help women put the loss of the breast and the stress of the situation behind them, and help restore their healthful image.

This can often be done at the same time of the removal of the breast, or is sometimes done later. The CTRC has experienced plastic surgeons that can discuss the options with you and plan your surgery.

I have not had breast cancer, but I would like plastic surgery

For many women her breasts are am important part of their self image. Some women find themselves with breasts that are smaller or larger than they would like. There are a number of surgical options that can help. We have experienced plastic surgeons that can discuss the options with you and plan your surgery.