COVINGTON, Ga. – Dr. Erica Scott, a breast specialist and general surgeon with Piedmont Newton Hospital, sat down with The Covington News to talk through breast cancer as a diagnosis and the month of October as Breast Cancer Awareness Month.
The News: Can you provide us with a basic walkthrough of a woman can conduct a self-exam?
Dr. Scott: I always recommend that breast exams be done. First of all, it depends on if you’re pre-menopausal or post-menopausal. Post-menopausal women don’t really have as much of a hormonal swing as pre-menopausal women.
Post-menopausal women, I would say just pick a day of the month and set your phone alarm or whatever and they can do it that way.
For pre-menopausal patients, the best time to do a breast exam is usually either at the start of their menstrual cycle or shortly thereafter – within the first few days – because all of the hormone levels are low and you have less of a lumpy, bumpy feel. You can get more of a true exam at that time.
For techniques, I’m sure you’ve heard it a lot, but do it in the shower or lie on your back. There are two methods. One, being the circular method where you start at the nipple and work your way around in a circle towards the periphery just to cover all bases. You also want to check the armpit and I would even recommend checking the neck and just above the clavicle – or the collarbone. You could also do what we call more of a radial method, where you just start in the middle and work your way out toward the periphery – kind of like the radius that way.
The News: What would you say are some of the tale-tell signs of breast cancer that patients can recognize in the early stages and what they need to come in to get checked out?
Dr. Scott: Usually, we recommend that you seek medical attention anytime you have a lump because it could be as simple as a cyst, but then there could be lumps that start off very small that could be a small breast cancer. Any new lump that hasn’t been worked up is a reason to come in.
Also, we look for changes in the skin. Any thickening or itching in certain places, especially around the nipple, those can sometimes be suggestive of an underlying disease.
As far as nipple discharge, we are usually concerned with nipple discharge in a single breast from a single duct. If you have bilateral nipple discharge, we don’t get worked up about that. Milky discharge? No. But usually, if it is on one side and it is spontaneous – meaning it is not expressed – we will usually work those up.
The News: Let’s talk about some of the misconceptions of breast cancer. One of the biggest misconceptions I hear is about family history, is there actually a connection there?
Dr. Scott: The overall risk is one in eight across the board, but breast cancer can be genetically related, but the majority of them are spontaneous – meaning not familial or not hereditary. The majority of breast cancer patients diagnosed, may not have any family history.
Another misconception is that, although you are diagnosed with breast cancer, not all breast cancers are the same. We do additional testing to sort of classify each person’s breast cancer to come up with a treatment plan, which is another misconception. A lot of people come in thinking they’re going to lose their breast, which is not necessarily true because of we have a lot of breast conservation treatments. Everyone doesn’t need chemotherapy. Breast cancer is usually treated by surgeons, by the a radiation oncologist, a medical oncologist and then there’s also a plastic surgeon depending on what surgery you choose.
Another misconception is that breast cancer is usually painless. A lot of women come in complaining of pain to the breast and are very worried about breast cancer. Usually, most patients that are diagnosed with breast cancer, it is painless. So, painful is more of a positive finding. The only time breast cancer is really painful is when it erodes or attacks adjacent organs – so if it is into the muscle – other than that it is painless.
The News: What does Breast Cancer Awareness Month mean to you as a doctor who sees this every single day?
Dr. Scott: You know, I treat patients the same way if it is October or if it is any other day of the year, but it is just nice to have awareness celebrated and survivors accounted for and celebrated. It is just a very refreshing time of the year to make sure we remind patients about breast cancer and it gives us a venue to communicate more.
The News: Can you talk to me about what all your practice covers and if someone was interested in coming to see you what they would need to do?
Dr. Scott: So, in my practice I see both benign and malignant breast cases. I treat cancerous and non-cancerous patients.
Usually, patients that are sent to me are referred by their primary care provider. It can be either at the stage where a workup has been completed or sort of started and they want me to complete it.
I would also keep in mind, that during annual visits or clinical exams by the primary care doctor are very important in addition to their monthly self-exams.
The News: What would be your message to a woman who had just received that diagnosis?
Dr. Scott: I would say, the diagnosis of breast cancer is a very personal diagnosis. Women take it to heart and I would just want to remind patients that although we may not want to have the diagnosis of breast cancer, we’re finding breast cancers very early and most breast cancers are very treatable and most patients get through it without any issues. It’s sort of just like a bump in the road in their life.
We’re finding breast cancers as small as like four millimeters – that’s less than a centimeter – so we have very good radiologists that are identifying these breast cancers particularly with the newer digital mammography. That’s another reason why it is very important to stay on top of mammograms and self-exams because the earlier the diagnosis, the easier the is to treat is.
I would just say, it’s hard not to worry, but the majority of breast cancers are very treatable and don’t have a major impact in their long term.