Family doctor answers basic questions about breast cancer

[Editor’s note: The links to other breast cancer resources in this story were selected by the author of this article, not provided by the physician interviewed. Every reasonable effort was made to select reputable, reliable and fact-based resources; however, these outside links are supplemental information, and we urge potential or diagnosed breast cancer patients to rely on the advice of their health care professionals.]

Dr. Allie Tinnin

Breast cancer patients often talk with their primary care patients if they have questions or concerns about breast cancer, according to Dr. Allie Tinning, a family physician in practice with Saint Francis Medical Partners in Cordova.

The most common sign people find and bring to their attention is a painless lump in a breast, she said. “I tell patients if it’s something new and they’re concerned, it needs to be investigated.”

Because breast cancer can go undetected, it’s important for women to self-check monthly and to follow guidelines on how often they should get mammograms, Tinnin said.

According to the American Cancer Society, a woman at average risk of breast cancer and age 40-44 should talk with her doctor to make a decision about when to start mammograms. She should get it annually for ages 45-54, and then every two years starting at age 55. Recommendations change for women who have risk factors such as advancing age, smoking, a family history of the disease and other indicators.

Newly diagnosed breast cancer patients can find plenty of misinformation as well as reliable information online. To find the latest and most accurate information, Tinnin recommended sticking to mainstream sources such as the American College of Obstetrics and Gynecology’s website at acog.org or the American Cancer Society’s site at cancer.org.

FAQs about breast cancer

Tinnin answered general questions about breast cancer.

What do the different stages of cancer mean?

Stages are a way to describe how far it’s spread when it’s first diagnosed. A lot of staging has to do with the cancer’s size and how far it has spread (such as being limited to surrounding tissue or already spreading to the lymph nodes. (Click for details about breast cancer stages.)

She noted that patients can have hope at any stage of cancer, however. “Technology and research is happening every day, and absolutely there is always hope.”

Are there different types of breast cancer?

There are multiple forms, and the only way to get an accurate diagnosis is with a tissue sample that can be examined under a microscope. (Click for explanations of the different types of breast cancer. Click here for details on triple-negative breast cancer, when cancer cells lack certain receptors, making some treatment options ineffective.)

Should I compare my breast cancer treatment to someone else’s?

No, there are many variables. Tinnin said, “Depending on the type, depending on the stage, depending on when treatment began, there are going to be multiple factors that are going to affect outcomes. So comparing one person to another, the treatment may be very, very different. It’s not all in the same category. There are multiple different types, and there are multiple different stages, as well as treatment options. It’s not always necessarily a right or a wrong option.” (Click for more information on different breast cancer treatments. Click here for information on treatment of breast cancer by stage.)

What do you counsel patients to expect about any non-surgical treatments for breast cancer such as chemotherapy and radiation, which may be scary for patients?

“With every treatment, we know there are going to be side effects, so we do counsel patients,” Tinnin said. “We are aware we are putting them at certain risks. A lot of times that’s going to be kind of a risk/benefit analysis, to say, ‘We know we are putting you at a risk for certain things, especially with the chemotherapy, the nausea. With the radiation, later complications down the road.’ But the benefit obviously usually outweighs that.”

The goal is to give them reassurance that we know there are certain side effects, she said, but the patient’s medical team would not go through certain procedures if the benefits didn’t make them worthwhile.

The diagnosis can be a stunning surprise. What do you advise patients to ask?

Question what the next step is, what treatment options are available, and have a discussion, Tinnin said. The patient’s oncologist will have a lot of experience and knowledge about what to expect.

Click below for more information:

Downloadable and printable question sheets that patients can use as guides when learning about risk factors, testing, procedures, side effects, lymphedema, clinical trials and more. Provided by the Susan G. Komen website.

As a front-line medical contact with patients, how do you communicate with them about their cancer with minimum panicking for them?

“It’s a very difficult conversation to call somebody,” she said. “it definitely is anxiety provoking. It can be a pretty devastating phone call to make. The good news is that with most of these cancers, if caught early enough, we have great treatment options. And that’s the biggest reassurance I can give patients: That we can’t cure everything, although that’s our goal eventually to be able to cure all cancers, but right now we do have great treatment options and there’s always hope with that.”

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What does the patient’s medical team include?

Most of the time, the patient’s oncologist is going to be the primary person with the treatment plan, Tinnin said. If the patient needs surgery, she will have a breast surgeon. If radiation is needed, she will have a radiologist. “It’s definitely a big team approach for treatment.”

Are there different types of mammograms?

Yes. For most women with average risk of breast cancer, an annual “screening” mammogram is the appropriate tool, Tinnin said. For those who have found a lump that needs to be examined, a “diagnostic” mammogram is typically used. The patient’s healthcare professional can advise on what type is appropriate. (Click for more information on types of mammograms. Also click here for information on the 3-D mammograms available at Saint Francis Hospital in Bartlett.)

Some women have a hard time telling the difference between the normal contours of the breast and a lump. Should they still do breast self-exams?

Detection of a potentially cancerous lump can be harder for women who have more cystic breast tissue (with benign bumps) and for younger women with more dense breast tissue, Tinnin said.

“We don’t have a lot of good evidence that says the self-examinations really are that great at detecting … but it’s still a good thing to be aware of your body and any changes.”

Tinnin continued, “I think early detection is the biggest plug that I can make, because the outcome tends to be so much better when we detect it early. Right now, mammograms are our best tool for detecting that, so there are many different guidelines on when to start: Ideally, at age 40, at the very latest age 50. Any woman over the age of 50 needs to be getting regular mammograms. Whether that’s yearly or every other year, that’s a decision you can discuss with your doctor or provider.”

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