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PODCAST: Is there a “best” way to deliver a cancer diagnosis?

Published on | Eric Brown

DescriptionTranscript

There is no good way to tell a patient she has cancer. In a recent podcast, the breast surgeons at Comprehensive Breast Cancer discussed the best way to deliver a cancer diagnosis.

They all agree that an initial telephone conversation is the option they choose.

“If we wait until a patient comes to our office to receive the news for the first time, in the vast majority of cases, as soon as the patient hears she has breast cancer, she stops listening and the rest of our conversation is pointless,” finds Linsey Gold, DO.

Receiving the diagnosis over the telephone allows the patient an opportunity to bring family members to the in-person consult, gives the patient time to be better prepared to ask questions, and most importantly, provides time – time for the patient to absorb the news, get over the initial shock, scream, cry … release all of the emotions she is experiencing.

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Tune in on Apple Podcasts, Google Play,   or listen wherever you get your podcasts.

Comprehensive Breast Care recently launched “The Breast of Everything,” a podcast series designed to serve as a trusted resource for breast health information, support and encouragement.

If you have a subject you would like the surgeons to discuss, please email your ideas to https://compbreastcare.com. The doctors want to hear from you! The views, thoughts and opinions shared in “The Breast of Everything” podcasts are intended for general educational and informational purposes only and should not be substituted for medical advice, treatment or care from your physician or health care provider. Always consult your health care provider first.

Unknown Speaker 0:00
Welcome to the breast of everything podcast your trusted resource for breast health information, support and encouragement. Your hosts today are Dr. Eric Brown, Dr. Lindsay gold. And Dr. Ashley Richardson of comprehensive breast care. Welcome.

Unknown Speaker 0:16
Welcome, everybody to the breast of everything podcast, I am so excited that you chose to join us today. I’m Dr. Lindsay gold joined today by my partner’s Dr. Eric brown and Dr. Ashley Richardson. Today we’d like to talk about some of the most common myths that we hear about breast cancer. As you know, we see lots and lots of newly diagnosed breast cancer patients every year. In addition, we see women who have not yet been diagnosed. So we get to talk to lots of ladies. And we hear so many common themes about what they think and believe about breast cancer and its risks and what causes it a whole host of things. So we thought we would sort of get together today and dispel some of the most common myths that we hear routinely in our clinic visits. Again, we are so glad to have you. I am Dr. Lindsay gold, and I’m joined by Dr. Eric Brown, and Dr. Asher Richardson. So I think that one of the most common myths that even many clinicians are prone to not understanding is that the only requirement for getting breast cancer is essentially having breasts, right? So sometimes when we have students or residents or fellows, I will jokingly say let’s talk about pediatric best breast problems. And then I say name one, and they can’t, because pediatric people, they they don’t have breasts, right? Like little kids don’t have boobs. So there are no child boob problems. So the issue is do young women get breast right? So young women do get breast cancer, it is not common at all. But they do get it. So when we approach women in the office, regardless of age, that topic will always be in our mind in our differential diagnosis. It doesn’t mean it’s common, but it means you always have to consider it.

Unknown Speaker 2:26
And I think it’s important for a women to know that. Typically, as a younger person, your breast cancer is going to be more aggressive. I mean, statistically, the more aggressive subtypes of breast cancer are much more common in young women. That being said, we don’t want everybody who’s listening today to think that the next time they have breast pain, it’s going to be because they have a breast cancer. But I think that what happens not infrequently is younger women with breast problems, kind of fall into categories of the quote unquote, lumpy breast syndrome, or it’s probably just assist. And while that may be true, I think it’s important that any woman, especially a younger woman, pay attention to these quote unquote, likely benign problems. And if they persist, take it to the next step and find out exactly what’s going on.

Unknown Speaker 3:23
Well, and I think we hear that a lot, where ladies will say, Well, I’m always lumpy, bumpy, I’ve always felt this, and I just kind of ignored it. And it’s important that we counsel them that if they notice a change or something’s new to them, that they bring it to the attention of their primary care doctor. And oftentimes, we hear it far too frequently, where moms will say I just got busy with this or my kids took precedence over be going to the doctor and unfortunately, things just get put to the wayside and often ignored. Exactly. So it’s okay to be a young woman, which we’ll define in general is under the age of 40, maybe even under the age of 35. Pre pre menopausal, meaning you get your period regularly. It’s okay for a woman in that age bracket to feel a lump. Oftentimes, it’s tender and wait for a menstrual cycle, let’s call it three, four weeks, right? To see and observe if there’s any changes. Now, many of you might be listening and be like, what if I felt the lump? There’s no way I’m waiting three or four weeks. And, and that’s okay, too. But common things are common, right? And breast cancer is not common in young women’s breast. Not that it doesn’t occur, but it’s not common. And if common things are common, then the likelihood when a woman feels a lump is that it’s not going to be breast cancer. So it is okay to observe for one menstrual cycle. If you go to your ob gyn, your primary care doctor and that’s the advice they give you. That is very reasonable, because knowing whether or not that lump went away after your period is valuable information to us, if you do end up being referred to us, I think

Unknown Speaker 5:14
it’s important also that

Unknown Speaker 5:19
patients and women with problems such as breast pain or a new breast lump advocate for themselves, you know, most women kind of know what their normal menstrual cycle brings as it relates to their breasts. And when something falls outside of that, and it’s persistent, and that three, four weeks go by and the lump doesn’t go away, or seems to be getting even a little bit bigger, you kind of have to push it a little bit too, because even our colleagues in other specialties understand how uncommon breast cancer is in younger women. And we all need to kind of be a little bit more aware, and maybe have a little bit quicker trigger to get some type of assessment done. Because younger women not only tend to have more aggressive breast cancers, but they also have later stage breast cancers at presentation, which obviously makes sense because they’re not doing screening mammograms when they’re in that age range. But it’s also because, you know, we kind of let those go a little bit, thinking that it’s just that lumpy breasts and drum.

Unknown Speaker 6:35
That concept is also very true for ladies with diagnosed with breast cancer during pregnancy. So we will frequently see ladies that will be diagnosed in late stage pregnancy or even after having a baby that they will think that the changes in their breasts are related to lactation, or their pregnancy overall, and those symptoms will go undiagnosed. So we also stress the importance of kind of pushing a primary care doctor, especially related to pregnancy changes in the breast.

Unknown Speaker 7:03
That’s a great point too, in the sense that we see some patients that are younger than present with one of the more aggressive types of breast cancer, where they’ve been diagnosed with mastitis or a breast infection. And most of the time when a young woman has a breast that’s red and has a painful mass it is mastitis. But mastitis should follow a certain pattern of improvement with normal interventions. And when it doesn’t, you have to start thinking something different.

Unknown Speaker 7:37
Well, that can lead us into an additional topic of another myth where finding a lump is the only way to detect detect breast cancer. As you just mentioned, oftentimes, signs of infection may be a precursor to breast cancer and ladies. So it’s not always a palpable lump on clinical exam that may be the first symptom of breast cancer. Absolutely. So, ladies, it is really important to actually look at your breasts in the mirror. You know, when you get out of the shower, when you’re changing in your bedroom, whatever it is, because there are some subtle signs that might give you a clue there’s an issue. If you stand in the mirror with your hands on your hips, push your shoulders forward pushing back, you can sometimes see some slight indentation or pulling or retraction of the skin. Or maybe you can see some asymmetry, right? Like one breast looks a little funnier shaped or different shaped than the other. Those are subtle findings. But they are things that can tell us that there might be an issue

Unknown Speaker 8:43
or you’re abroad doesn’t fit the same. We’re one breast seems to be like it should be in the other breast seems to be different where you bought the bra two years ago, and they both fit just fine.

Unknown Speaker 8:54
I also had a lady recently told me that her seat belt started to hurt her where she was always worn the seat belt in the same spot. It always lays the same way. And she just noticed that every time she got in the car, she always had this discomfort and that’s kind of what prompted her to do an exam and look in the mirror and find her cancer. Yes, excellent point a lots of people will tell us. I was told that, you know, breast cancer is not painful. I would say that the vast majority of time that probably is true. But don’t knock divine intervention, right because I fully believe that there are times that you have pain in your breast which may or may not be related to a cancer but it draws your attention to your breasts. You do an exam and find something there. And of course every woman’s makeup is different. So some people may have some tenderness. It’s certainly not a common presentation of breast cancer. But again, not something We just write off Oh, it can’t be because it’s paying well, and I will say how many times I know all three of us have heard this, that an older lady will come in and say, their dog jumped on their breast. They thought the tenderness was from the dog and ultimately, they did have an underlying malignancy. I mean, I can count it more times than not where they they have a similar story of such

Unknown Speaker 10:20
I just had a patient like that as as a matter of fact.

Unknown Speaker 10:23
Yes. I we also hear a lot that you know, I had a lot of stress in my life, and that brought on my breast cancer or all kinds of things can happen, that will draw your attention to doing a breast exam to noticing something nipple discharge is is a big thing that we get sent patients to see. Most nipple discharge is nothing, actually the most common cause of nipple discharge is not a cancer. When we ladies develop nipple discharge, that will generally prompt a visit to a healthcare provider, definitely reasonable, who then generally appropriates order image imaging, which then finds the cancer, it’s pretty uncommon for nipple discharge itself with no x ray abnormality to be the cause of cancer.

Unknown Speaker 11:22
I think it’s interesting too, as it relates to breast imaging and specifically mammogram because there are a number of myths that center really around the mammogram itself. For example, as you said, Ashley, you feel something in the breast and the mammogram is normal, it must be okay. Well, that’s a myth. That’s not true. There’s kind of a three phase evaluation of a lump in the breast including a mammogram and ultrasound, and of equal importance as a clinical exam. And I always tell patients, we always go with what we think might be the worse. So in other words, my mammogram is normal, my ultrasound is normal, but boy, I don’t like the way this feels biopsy. This feels just fine. But boy, that mammogram doesn’t look good biopsy. So that three tiered approach is very important. So the myth of the mammogram was normal. Despite my being able to feel something in my breast, really is one that kind of leads to a lot of delayed diagnoses.

Unknown Speaker 12:28
a mammogram is an excellent screening tool. However, it certainly is not perfect. We know from decades and decades of studies that mammograms will miss approximately 10 to 15% of cancers, that’s not an insignificant number, it certainly will capture and pick up our earliest form of breast cancer, but it’s not perfect. So just like both Rick and Ashley, were saying is, it’s important to put the entire picture together, right, we don’t just treat a breast right retreat, the whole patient with her imaging with her history with her physical exam, to arrive at a, you know, index of suspicion that there’s a problem and maybe move forward. And oftentimes, that’s how patients end up in our office, you know, they’ll see their primary care doctor, they’ll still feel a mass, but all their imaging is negative, and so they’ll send them on to our office for further evaluation. We have the tools and the education in order to formulate the appropriate appropriate treatment plan to work up. Like Greg said, whether it needs a biopsy, additional imaging with a breast MRI. So it should not always raise anxiety to come to our office, but know that the primary care is sending you for appropriate treatment. One of the other most common myths that I hear, I would say, probably two, three times a week in newly diagnosed breast cancer patients is I don’t understand how this happened. I don’t have anybody in my family that has breast cancer. Well, that’s because the majority of people who get breast cancer actually don’t have a family history. It’s approximately 70% who do not have a family history. So that is a very, very common myth. Again, you just have to have breasts. So family history is important to us, because the hereditary forms of breast cancer, the kind that you do inherit an abnormal gene. Those we have to be aggressive about finding and screening women for but it is not necessary part of your history in order to be at risk,

Unknown Speaker 14:41
but what is very interesting about that is there are many people in fact a good percentage that thinks that the amount of radiation is not only significant, but causes breast cancer which again has never ever been shown to be true. And there was a study of both men and women having to rank in order the amount of radiation exposure to 10 different items. And in that study, they showed that over 50% of participants rated mammography is radiation exposure higher than it actually was on the list when you look at the actual radiation dosage?

Unknown Speaker 15:30
Yeah, radiation is a big one. There is quite minimal radiation exposure, actually, with a mammogram. You know, there’s environmental radiation, so you are exposed to ionizing radiation, just when you take an airplane flight from, say, New York to LA, that’s really the same exposure as when you get a mammogram. So there’s no evidence ever to suggest that routine mammograms, even when you have to get some extra ones for diagnostic imaging over time, leads to an increased risk of breast cancer, it’s simply not true. I think when you put it into perspective, for patients, such as Lindsey did, I use the same example about an airplane flight from New York to California. If you give them very simple examples, then they can kind of hone in on. While this is not as bad as I thought it was. And people unfortunately, just as this whole podcast circles around, there’s a lot of myths out there. So our job is to try and give them the truth. In order for them to understand why we recommend the things that we do. Another common myth that we hear pretty regularly is that breast cancer has to be removed immediately, oh, my God is spreading as we speak, everybody wants their surgery. Tomorrow, we most certainly can understand the anxiety around a new diagnosis. But the vast majority of breast cancers not only take quite a long time to form, but they also take a long time to, you know, spread and do any type of damage. So when you’re seen, even though you mentally and emotionally want it out of you, if you have to wait a couple of three, four weeks till you know your surgery date for a whole host of reasons, that does not change your outcome that does not harm you. It’s nothing is spreading, as the days are going by like that. So you have time to you know, collect your thoughts, do whatever you need to do prior to surgery and not freak out. So basically, breast cancer is not a medical emergency. It’s an emotional emergency, which of course, we have a deep appreciation for.

Unknown Speaker 17:54
Absolutely. And I know we have a podcast coming up talking about the importance of second opinions, but kind of leads into the kind of perspective that I try to throw out at patients and their families is you know, take a second, take a deep breath, understand the information, understand what your options are. If that entails a second opinion, then so be it. But there isn’t a need to run from the consultation room to the operating room. because inevitably, when you make a rushed decision, one day, you’ll look back and regret it and wish that if you would have known that then you would have done something different. And I know that the three of us have the same philosophy is that goal of patients not looking back and wishing they had more information, we want to provide them with as much and all the information that we have, so that we can help patients make a good decision and the right decision for them.

Unknown Speaker 19:00
And breast cancer treatments a very multidisciplinary approach. So oftentimes, it’s not just the breast surgeon they’re saying, but also the medical oncologist and the radiation oncologist. And sometimes there’s an additional imaging workup prior to proceeding to surgery. And all of that takes time. So we just take extra effort to explain this all to the patients and ultimately, we do get them to the operating room as quickly as possible, but ensuring that everything is taken care of before we go to the operating room. And I think one of the final myths we can touch on is that if you remove your breast, then your cancer won’t come back. And when I hear that so frequently, I say you know what, I wish it were just that easy, cuz I would be the most popular doctor ever. People would be lined up out my door if I could cure everybody that way. And let’s be honest, if you could, if a surgeon could make sure a woman’s cancer never came back by simply removing her breasts. I mean, wouldn’t all women choose that? Right? Nobody wants their cancer to come back. So unfortunately, that’s just not the way the biology of breast cancer is not any cancer for that matter. But it just doesn’t work like that. So if it were so simple, we would, we would give you that option and say, here’s what’s going to work. But that is, in fact, a myth.

Unknown Speaker 20:23
I think that the one thing that we try to instill on patients during the consultation is kind of dividing the treatment into local treatment and systemic treatment. And basically, systemic treatment means the risk of something spreading, and when and when push comes to shove, that’s the most important treatment that patients will have, the treatment that’s done to the breast has very little if any impact on the risk of them living to be 105 years old. So the mastectomy, which certainly in the past was thought to be the go to operation for breast cancer, not only a mastectomy, but take everything and anything that was in your way. Now, as we look back 40 years ago, it is that being the standard of care treatment, we now know that that makes absolutely no difference into the long term survival of women with breast cancer. So as we alluded to earlier in the podcast today, the biology of the tumor is so critical. And so we actually try to dissuade women from me pursuing this deck to me, in most circumstances.

Unknown Speaker 21:35
And finally, there are lots of silly things out there in the media, such as, don’t put your cell phone in your bra, because it will cause breast cancer. You know, deodorant causes breast cancer, underwire bras cause breast cancer. That is, those are all myths. And don’t believe a word of them. They’re just silly. Truly, they have zero data to support any of them. So none of those things will increase your risk for breast cancer.

Unknown Speaker 22:09
I think we really just touched on it. As I look at, you know what we talked about today, there are a lot of myths out there. And part of it is, you know, when you get diagnosed, you want to be able to blame something, you want to be able to blame something that caused this to happen. And when your friend gets diagnosed, you want to be able to point to something that they did that you don’t do. So you’re okay. Unfortunately, it just doesn’t work that way. So the more that we can dispel some of these myths. Maybe we will see less advanced breast cancers and greater stage breast cancers, because women will follow the golden rule of catch your mammograms every year starting at age 40. And don’t ignore a lump or a symptom that you have.

Unknown Speaker 22:58
Well, we’d like to thank you all for joining us today. If you have any questions about the information we shared and I breasted everything podcasts, please send the questions to cut breast care. com.

Unknown Speaker 23:08
Thanks for joining. You’ve been listening to the breast of everything podcast with your hosts and board certified breast surgeons, Dr. Eric Brown, Dr. Lindsay gold and Dr. Ashley Richardson of comprehensive breast care. If you have a subject you would like the surgeons to discuss, please submit your suggestions online at comp breast care. com. That’s co mp breastcare.com. The views thoughts and opinions shared in this podcast are intended for general education and informational purposes only and should not be substituted for medical advice, treatment or care from your physician or healthcare provider. Always consult your healthcare provider first.

Transcribed by https://otter.ai


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