It's Breast Cancer Awareness Month — What Women Need to Know

Promoting Breast Health Education and the Importance of Early Detection

Dr. Brian J. O'Hea reading a mammogram.

October is National Breast Cancer Awareness Month and a special time for us to promote breast cancer awareness and provide information on the disease.

Established in 1985, this awareness month, now an international health observance, has from the start aimed to promote mammography as the most effective weapon in the fight against breast cancer. Since then, breast cancer research has also become an important weapon in this fight.

At Stony Brook Medicine, breast cancer is the focus of a comprehensive, academic program — the only one of its kind on Long Island. At its core is our multidisciplinary breast cancer team.

Here, Brian J. O'Hea, MD, chief of breast surgery and director of Stony Brook's Carol M. Baldwin Breast Care Center, answers some of the frequently asked questions women raise after they have been diagnosed with breast cancer. The bottom line is that every woman's situation is different, and treatment needs to be tailored to the type of cancer, personal and family history, tolerance levels for treatment, and personal preferences.

Dr. O'Hea's perspective, as one of the area's premier breast cancer surgeons, gives women information to serve as discussion points with their doctors.

Q: What is a lumpectomy and is it safe?

A: A lumpectomy is the removal of a tumor from the breast along with some of the surrounding normal tissue.

When a lumpectomy is recommended, many women consider whether a mastectomy might be a safer choice in terms of recurrence and survival. Long-term studies have demonstrated that a lumpectomy provides survival rates equivalent to a mastectomy while preserving the breast.

A lumpectomy is often recommended to treat a single tumor that is small to medium in size. Patients with a large tumor or multiple tumors are often treated with a mastectomy. Also, the location, type of tumor, and other factors all must be considered with your doctor when making this important treatment decision.

Q: Why do lumpectomies require follow-up radiation?

A: Even when lumpectomies show totally “clean" (cancer-free) margins after surgery, radiation is required because of the natural distribution pattern that breast cancer takes. Not all the cancer stays together.

Some tiny, isolated cells may migrate to other parts of the breast beyond the scope of the surgery. This has nothing to do with the skill of your surgeon, but everything to do with the nature of breast cancer and how it manifests.

Q: Is chemotherapy after breast cancer surgery always required?

A: No. Although some women may also need chemotherapy, many may not. A special test called Oncotype DX can now be performed on a patient's tumor after surgery. The Oncotype DX test can help decide whether or not chemotherapy is needed, although the test is mostly only useful in patients with estrogen-positive tumors and negative lymph nodes.

The results of the Oncotype DX test may identify women who were traditionally offered chemotherapy, but really don't need it. The test analyzes the activity of 21 genes that can influence how likely a cancer is to grow and respond to treatment. It's a form of personalized medicine.

Q: If a doctor recommends a mastectomy on just one breast, wouldn't it be safer to have a bilateral mastectomy (removal of both breasts)?

A: Long-term studies show that there is a 15% risk of a woman developing cancer in the opposite breast. However, women at higher risk may need to consider the bilateral mastectomy because their odds of developing cancer in the healthy breast are much higher.

These risk factors include a strong family history of breast cancer and the presence of the BRCA gene, which indicates a genetic disposition to breast cancer.

Q: Are there any new options when it comes to reconstruction?

A: Fortunately, because of dramatic improvements in imaging and screening technology, we are more able to find cancer in its earliest stages, which offers some women an opportunity for breast conservation instead of mastectomy.

At Stony Brook, 65% of the women treated for breast cancer have breast preservation surgery. Our surgeons work closely with plastic and reconstructive surgeons to maximize cosmetic outcomes.

Techniques include inserting AlloDerm®, a type of collagen, along with the tissue expander to give a more natural shape to the breast; smaller and more limited incisions that preserve as much of the natural breast skin as possible to facilitate a more natural reconstruction; and a new total skin- and nipple-sparing technique that leaves all of the breast skin in place, which also helps achieve the most natural result available.

However, the nipple-sparing technique is possible in only a small group of highly selected patients requiring a mastectomy [see our FAQs about nipple-sparing mastectomy].

As an academic medical center and accredited breast care center, Stony Brook works to continually refine techniques to make them more widely available for more patients.

Learn more about breast cancer and how to avoid it from the American Cancer Society. Find out how to help find a cure for breast cancer: The Carol M. Baldwin Breast Cancer Research Fund.