Breast Surgical Oncology

Providing You With Comprehensive Breast Care

Millennium Physicians is proud to add Breast Surgical Oncology to the services we offer. We are committed to providing comprehensive breast care for women. We are dedicated to diagnosing and treating diseases and disorders of the breast - both cancerous and benign.

Our patients can receive breast imaging and diagnostics, surgical therapy, and complete cancer treatment services, all within the same team of physicians. We believe in higher standards of care, from treatments to technologies.

Types of Breast Cancer

  • Ductal Carcinoma in Situ (DCIS)
  • Lobular Carcinoma in Situ (LCIS)
  • Invasive Ductal Carcinoma
  • Invasive Lobular Carcinoma
  • Medullary Carcinoma
  • Inflammatory Breast Cancer
  • Tubular Carcinoma
  • Mucinous Carcinoma
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Risks associated with breast cancer include:

  • Older age
  • Earlier age when your period starts
  • Older age when you first become pregnant
  • Use of hormone replacement therapy (HRT)
  • Having dense breast tissue
  • Having other people in your family who have had breast cancer
  • Genetic mutations such as BRCA1 and BRCA2
  • Having radiation to the chest
  • Having breast cancer in the past
  • DES (a synthetic estrogen) use
  • Drinking more than 5 drinks (beer, wine, liquor) per week
  • Being overweight
  • Not exercising

Breast cancer can also occur in men, although it is uncommon. Risk factors for breast cancer in men include:

  • Family history of breast cancer
  • Having Klinefelter’s syndrome
  • Being of Jewish decent
  • Having mumps orchitis (swollen testicles)
  • Estrogen (hormone) treatment
  • Obesity
  • Having radiation in the past
  • Drinking a lot of beer, wine or liquor

Signs & Symptoms of Breast Cancer

The early stages of breast cancer may not have any signs. As the mass grows in size, it can cause problems like:

  • Lump or hard area in the breast or armpit
  • Change in size or shape of the breast
  • Fluid from the nipple or the nipple turning inward
  • Redness or scaling of the skin or nipple
  • Ridges or pitting of the breast (looks like an orange peel)
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Tests Which Give Us More Information

  • Mammogram
  • Breast Ultrasound
  • Biopsy
  • MRI

Staging

Breast cancer stage depends on the following:

  • Size and where the tumor is
  • Whether cancer cells are found in the lymph nodes
  • Whether cancer cells are found in other parts of the body

Stage ranges from Stage 0 (called carcinoma in situ) to Stage IV (tumors that have spread to other parts of the body). The stage and type of breast cancer will help your provider plan your treatment.

Treatments

There are many ways to treat breast cancer, but the main types of treatment are local or systemic. Surgery and radiation are used to treat only the cancer. They do not affect the rest of the body.

This is called local treatment. Chemotherapy and hormone treatment drugs go through the whole body. They can reach cancer cells anywhere in the body. They are called systemic treatment.

Local and systemic treatments are both used to treat breast cancer. The treatment which is best for you will depend on the following:

  • The stage and grade of the cancer
  • If the cancer is in just one area of the breast or more than one area
  • Your age
  • Other health problems you have
  • Your feelings about the treatment and the side effects that come with it

Surgical Procedures:

  • Lumpectomy: Removal of only the part of the breast with cancer and not the entire breast. The mass is removed along with a small area of surrounding normal breast tissue.
  • Mastectomy: Removal of the entire breast. This includes the nipple, areola, breast tissue and some of the lymph nodes from under the arm.
  • Reconstruction – When the entire breast is removed, the Plastic Surgery team rebuilds it so women can be confident after their breast cancer treatment has been completed

Radiation Therapy:

Radiation beams are aimed at the breast from a machine outside the body, called external beam radiation. Radiation treatment typically takes 20 minutes daily from Monday to Friday for 4-6 weeks.

Chemotherapy:

Chemotherapy is a systemic therapy, which means that it travels throughout the whole body to kill cells. These drugs may be given as an infusion or taken as a pill. Chemo is given in cycles or rounds; each round of treatment is followed by a break. Most of the time, two or more chemo drugs are given, and treatment usually lasts for 4-6 months.

Hormone Therapy:

Some cancers are fueled by hormones and may rely upon them to grow. In these cases, blocking the action of these hormones can prevent the recurrence of the cancer in the breast and all over the body. Hormone therapy is taken as a pill every day for 5-10 years and is a systemic therapy.

Source: Sarah Cannon Cancer Institute and American Cancer Society

Answers from Dr. Jambhekar

Do I really need a mammogram?

Even members of my family have asked me this. Preventative care is not as important in other countries as it is in the US or as readily available. “But do I really need a mammogram? I don’t FEEL anything.”

The answer is YES. Early detection saves lives and improves survival - and this is supported by multiple studies. Catching cancer when it’s Stage 0 or Stage I dramatically decreases the chance of it spreading to the lymph nodes and other parts of the body.

“But. . . It will hurt,” my family members then say.

Yes, I can’t deny that getting a mammogram is uncomfortable. I recommend my patients take Tylenol ahead of time and apply ice packs at home. But it’s still painful. Worth it though.

Because here’s the dirty secret: your hands cannot FEEL if a lump in your breast is a cancer or not. Neither can mine - NO ONE’s can. If you wait until you feel something, you’re going to need that mammogram anyways!

So, save yourself the hassle, and remember that mammograms save lives - schedule your mammogram today.

And more than that - empower the ladies in your life to schedule their mammograms too. Call your family and friends and share this message - I know I’ll be calling mine!

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Why do I need a biopsy?

So, you got your mammogram, you went back and did extra views and/or an ultrasound, and you received a letter from the radiologist which says you need to schedule a biopsy.

Why?

The radiologist sees something abnormal and needs to take a sample of the tissue so the pathologist can look at the cells under the microscope and tell us what it is. Together the radiologist and pathologist can give us the whole story of what’s going on in that abnormal area. Without a biopsy, the radiologist can only make an educated guess. You deserve better than a guess - you need to KNOW.

If you’re scared, remember just because you need a biopsy does not mean you have cancer.

More than 20% of women will need a biopsy at some point in their lives and of those, 80% will NOT have cancer.

What happens after the biopsy?

After the biopsy one of your doctors will give you the results and decide if you need to see a breast surgeon - me!

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What causes breast pain?

The real answer is . . . We don’t know. But we do know there’s a 99% chance it’s NOT cancer.

Breast pain is extremely common and as many as 70% of women will experience it at some point in their lifetime. Sometimes it‘s a dull ache, like increased heaviness and sensitivity that corresponds with the menstrual cycle. Sometimes it’s in both breasts, sometimes only one. We call that cyclical pain. What scares women is when it’s a sudden, sharp pain in one area in one breast. We call that focal pain. Focal pain is more likely than cyclical pain in women in their 40s and 50s.

In multiple studies conducted in women with focal breast pain, only 1% were found to have breast cancer. Breast cancer is far more likely to present with an abnormal finding on a mammogram or a lump in the breast. That’s the good news but we ALWAYS double check with imaging tests.

The best test is an ultrasound to check the area(s) of pain and sometimes a mammogram as well. Occasionally the ultrasound will show a cyst in the area which is causing the pain, but most of the time, there’s nothing there.

“So, what’s causing my pain then, Doc? Can you fix it??” is the conversation which starts as soon as I tell someone we didn’t find any cause for the pain. The truth is hormonal changes in the breast are complicated and we don’t know the exact cause or the best treatment for breast pain. There are ongoing studies and theories, but we are still working on understanding the interactions between breast tissue and the rest of the body.

Even if we haven’t figured out the cause and an easy fix for breast pain (yet), we do have treatment options. Studies have shown that over 70% of women wear improperly fitting bras and switching to a more supportive bra or a sports bra will help. Non-steroidal anti-inflammatories like Ibuprofen have also been shown to be effective in 80% of women. For focal pain, there is a topical version of Ibuprofen which works better than other treatments. Relaxation techniques such as meditation and acupuncture which work for other forms of pain may also help.

But as you probably noticed, none of these are treatments designed to treat only breast pain. Studies on breast specific pills such as evening primrose oil and danazol have not had convincing enough results to recommend them for everyone.

Most of the time breast pain goes away on its own, especially as women get older and the breast tissue becomes less active. If not, changing bras and/or taking Ibuprofen may help. If none of the above works, there are other medications which are worth trying. Before taking anything, please discuss the risks and benefits with your doctor and decide on a plan which works for you.

So, after reading this if you develop breast pain, what should you do?

If it’s new and doesn’t go away in a day or two, see your primary care doctor or Ob Gyn. Make sure your care plan includes an ultrasound and/or mammogram and not just a physical exam. Be prepared for the most likely results. Most of the time there won’t be a cause for your pain and sometimes that’s hard to hear. Don’t worry though - even if we don’t know the cause we do have treatment options. The most important thing is we know (and double checked) it’s NOT cancer.

And of course, if you’re over 40 or have a strong family history, make sure you get yearly mammograms and take control of your breast health!

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Will using hair dye give me breast cancer?

Recently NPR published an article about an increased risk of breast cancer with the use of permanent hair dyes. The original study was an observational study of 46,709 women from age 35-74 who all had a sister with breast cancer but who were breast cancer free themselves. Women were monitored for approximately 8 years to see if they developed breast cancer and given questionnaires to fill out on their lifestyle choices.

The results showed 45% increased risk of developing breast cancer in African American women who dyed their hair and 7% increased risk in white women. There was also an increased risk associated with chemical hair straightening. There was less risk associated with semi-permanent hair dye.

Although the results seem frightening, there are several major limitations of this study. First, it was an observational study. Studies in animals have shown chemicals like formaldehyde, which is used in Brazilian blowouts, to be carcinogenic because animals were placed into groups where one was exposed to chemicals and one was not. The difference in the development of cancer between the two groups was significant. However, since we can’t replicate that model in humans, this study only shows that women who develop breast cancer HAPPEN to use more hair dye, not that the hair dye caused the cancer.

The biggest risk factors for developing breast cancer are being a woman, and aging. Over an eight year study period, the study population did age! It is hard to separate the effects of aging from the effects of using hair dye, because as we get older, we get more gray = we use hair dye more. Finally, the greatest risk was seen in African American women, and only 9% of the study population was African American. So, the risk assessment was calculated on less than 5000 African American women.

In summary, hair dye does not CAUSE breast cancer. Certain chemicals may be carcinogenic, such as formaldehyde. We can modify our beauty routines to include natural (think henna!), semi-permanent, and formaldehyde free products when possible. But in order to DEFINITELY reduce our breast cancer risk, we should maintain a healthy lifestyle, get 150 minutes of exercise per week, and get our mammograms every year!

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Do I need an MRI to screen for breast cancer?

The short answer is no. The long answer is...Maybe.

For women with extremely dense breast tissue, finding a breast cancer on a mammogram is like finding a needle in a haystack. The use of 3D mammography, or tomosynthesis, has helped us find those small cancers more easily, but it’s still like finding a pen in a haystack. MRIs are known to be more sensitive, but they also come with more false positives. In other words - they will pick up stage 0 and stage 1 cancers more easily, but they also will pick up benign or NON-cancerous spots which lead to needless breast biopsies. We call any benign spot the MRI picks up a false positive. False positives are why we don’t routinely offer MRIs for breast cancer screening, unless patients have significant risk factors such as family history.

The New England Journal of Medicine just published an article in November 2019 on the use of MRI as supplemental screening for breast cancer (see link below). The study was conducted with over 40,000 women with extremely dense breast tissue (and no other risk factors)  who were assigned to screening mammography alone or mammography with MRI. The addition of MRI was associated with a higher cancer-detection rate of 16.5 per 1000 screenings (compared to 2.5 per 1000 for mammography alone) but resulted in a false positive rate of 8.0%. Adding MRI resulted in earlier detection compared to mammography alone. However, the impact on survival could not be determined. We don’t know if finding those cancers when they’re 2 mm big compared to finding them when they’re 4 mm actually means those patients live longer after they’re treated.

Does this mean MRI is right for everyone as a screening tool? Definitely not! As we discussed above, false positives means more unnecessary breast biopsies, which is stressful for patients and their families.

But those with extremely dense breast tissue can benefit from adding MRI into their regular screening. So, ladies, talk to your doctors! We can make an educated and empowered decision together.

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Resources for Patients:

Canopy Cancer Survivorship Center
American Cancer Society
Susan G. Komen
Bright Pink

Peer Mentorship Program: We have a unique peer mentorship program to connect our patients with other patients who have already beaten a similar type and stage of cancer. Our patients love helping others through the process.

Patient Navigation: We have a patient navigator who will make sure you get to all your appointments and who will make sure your team of doctors works together for YOU.

Millennium Physicians

Meet Our Breast Surgical Oncology Team:

Amani Jambhekar, MD, MBA

Amani Jambhekar
MD, MBA