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Southern Ocean County Hospital would like to thank everyone who e-mailed questions for this edition of Ask-The-Expert and would like to especially thank Dr. Chung for taking part in the program.

September: Breast Cancer

Question 1
I have a lot of cysts in my breast. My mother has breast cancer. I worry about getting breast cancer. I have a cyst that is a bit of a problem. Recently I had a follow up on it. Can cyst become cancerous?

Cysts can be benign (noncancerous) or malignant (cancerous). Cysts should be drained and the fluid aspirated must be examined for cancerous cells. If you have a recurrent cyst then you may want to have an excision (surgical removal) rather than just a needle aspiration (drainage).

Since your mother has breast cancer you are at higher risk for having breast cancer than the general population. Furthermore, the higher number of breast biopsies and aspirations you have also suggests that you are at higher risk than the general population for breast cancer.

You should have a clinical breast exam every 6 months to a year. You should review with your surgeon or primay care physician other risk factors you may have for breast cancer. Furthermore, an extensive review of your family history for cancer should also be done. Feel free to make an appointment with me or any oncologist so that you can have all of your questions answered.

Question 2
Hi, my questions are - what is a papilloma? I have a brownish/red fluid coming out of the right breast nipple. It only comes out when pressure is applied. I was told it is a virus, if so, how long does it last & what can be done for it? Also what is a ductal wash? I've had a ductalgram too.

You must be referring to an intraductal papilloma. This is a small benign (noncancerous) tumor of the milk duct of the breast. This is the most common cause of benign nipple discharge in women.

If you have an intraductal papilloma it should be surgically removed and examined for the prescence of cancerous cells. Also, fluid or blood that is expressed should be evaluated for cancerous cells.

A ductal wash is the introduction of a small catheter into the ducts through the nipple. Washing of the ducts will capture cells lining the ducts which can be reviewed for the prescence of cancer.

An intraductal papilloma is very different from a papilloma (otherwise known as a wart). Warts are caused by the virus Human Papilloma Virus (HPV). If you have an intraductal papilloma it must be surgically removed, do not wait for it to go away by itself!

Question 3
Other than tumor, what symptoms (major & minor) develop when one has breast cancer (early stage & late stage)? NO use of chemo or radiation.

Unfortunately, symptoms of breast cancer can vary between patients. Symptoms can be as minimum as fatigue to as major as skin thickening of the breast. The key is to follow up closely with your treating oncologist. Initially you should be seen monthly and a thorough breast exam should be done each time. Then as you and your oncologist review your family history and general health, exams can be stretched out to every 3 mos then 6 months then annually. Remember to have annual mammograms, annual bone density scans, annual pap and pelvic exams and finally a colonscopy.

Question 4
Two years ago my nurse found a lump the size of a filburt that a mammogram didn't pick up. UNC Hospital wanted $865 to aspirate, not to mention $250 for another xray. It hasn't changed, but I found a bump the size of a pin head next to it. My mother and sister had benign lumps. Should I be concerned? My son's going crazy. I know what you're going to say. You're going to try to scare me into getting it checked out.

You are right! This must be checked by a physcian and it must be aspirated or excised. Cancer doesn't follow many rules. Just because it hasn't changed in size doesn't mean it is not cancer. Prove it to yourself and your son that it is benign and go have it biopsied.

Question 5
How important is diet and proper nutrition when undergoing chemo?

Diet and nutrition is very important when undergoing chemo. Chemo is like running a marathon. Your body is completely stressed and it needs to be in tip top shape. Patients with problems keeping up their weight during chemo should be more concerned about taking in any calories.

If you can eat during chemo then eat a well balanced diet. If you are have problems because of loss of appetite or loss of taste then justt eat what you love and eat lots of it. Even if it is chocolate cake or strawberry shakes, just keep the calories high!

Question 6
Besides family history, what are some other leading causes of breast cancer in women?

Family history is the most importanat risk factor for breast cancer. You must be aware of the history of your extended family as well (not just your mother and sisters). Furthermore, you must be aware of all types of cancer in your family especially ovarian. If you are concerned please review it with your family doctor.

Smoking and alcohol consumption are linked to breast cancer so avoid them especially if you are at high risk. Other risks such as modern day birth control pills and a high fat diet are unfounded.

If you have had a previous breast biopsy with atypical hyperplasia or if you have had radiation to your chest for the treatment of lymphoma then you are at high risk for breast cancer.

Question 7
Is the birth control pill a leading cause of breast cancer in women? What about alcohol?

see #6

Question 8
In the year 2000, I was diagnosed with DCIS. A lumpectomy was performed and showed intraductal carcinoma, intermediate grade, with cribiform structure. Ductal carcinoma in situ, micropapillary and cribriform types, small foci,.3 cm.There was some calcification, minute, present in association with benign acinus. My doctor is a surgical encologist in whom I have the utmost faith. My follow up treatment is to take tamoxifen for five years. I moved since the surgery and had to find new doctors and many of them seem surprised that I did not have any radiation treatments. Given the information that I have just presented, do you think that radiation should have been prescribed?

It is very controversial whether radiation is needed for DCIS<0.5cm after lumpectomy. Many oncologists feel that any size DCIS should be treated with radiation after lumpectomy followed by tamoxifen for 5 years. The most important thing that you stated was that you have the utmost faith in your oncologist and that is important. Please feel free to see me in the office and we can review your case in more detail.

Question 9
Doctor - I am a 5 yr survivor of breast cancer. I still have my port in - how long do you think I should keep this in and if I didn't flush it what would happen. And when I get it out I was wondering if that's going to be a problem. Isn't it going to be hard to dig out being in alll this time. What if I just left it in? If so do I need a RX to get it flush at SOCH. And do I need to be your patient, as of now I go to my Dr's in Toms River(oncologist).

As a 5 year survivor I would have the port removed before complications arise.
If you didn't flush the port it would become clogged and nonfunctional. Getting it out shouldn't be a problem but it is imperative that you go to the surgeon who placed it. Every surgeon has their own technique for putting ports in and it helps to know that upon removal.

If you decide to leave it in you will need a RX to have it flushed monthly. I can write that for you but you really should see me first. I hope you still follow up annually with your oncologist! Make sure that you keep up to date with surveillence tests such as annual mammogram, colonoscopy, annual bone density scan, and an annual pap and pelvic exam. Finally, make sure you review with your oncologist a thorough family history of cancer.

Dr. Chung's answers are informational only and should not be used as a diagnosis or for treatment. Please talk to your physician about official diagnosis of your condition and treatment.