Your Guide to Some of the Most Common Questions About Breast Cancer Diagnosis and Treatment

Oct 8, 2021 | Breast Cancer, Women's Health, Your Health

There have been many significant advances in the treatment of breast cancer that have helped patients to diagnose cancer earlier and to provide a range of treatment options. But patients still have many questions about what’s best for them.

In this Q&A, Michael Zeidman, MD, Assistant Professor of Surgery at the Icahn School of Medicine at Mount Sinai and a breast surgeon at Mount Sinai Brooklyn, answers some of the most common questions he gets from patients, including why it is critical to get regular mammograms, how doctors determine the stage of disease, and, if you are looking for a second opinion, the importance of visiting a leading medical center such as Mount Sinai.

Michael Zeidman, MD

How do mammograms help patients and doctors?

Mammograms are the only imaging method that’s been proven to save lives. If we go back to the early 1970s, before screening mammograms were widely implemented, the only way that a patient could discover that she had breast cancer is if she felt it. Now that we have the capability to diagnose breast cancer before it becomes symptomatic, we’re catching it much sooner. So it’s not surprising that survival rates have dramatically improved, while at the same time, we’ve been able to significantly cut back on the amount of treatment needed, which results in a better quality of life after breast cancer.

Why is it important not to delay a mammogram because of concerns about COVID-19?

We are only now starting to see the effects of the public’s general hesitancy of getting mammograms during the pandemic. It’s unfortunately increasingly common for patients who were normally very regular about getting their screening mammograms to skip getting one last year, and now they’re presenting to me with breast cancer that’s likely at a later stage than it would have been if it were discovered a year earlier. If there’s one message I want to get across is, come in, get your screening. The sooner we catch this, the sooner we can deal with it, the less treatment you need, and the better your prognosis will be.

How do you determine what stage breast cancer a patient has?

A very common question that I get from patients with a new diagnosis of breast cancer is “What’s my stage?” I explain that I can’t tell you your stage until after surgery. Determining the stage is made up of a three items: the size of the tumor, whether or not the cancer has spread to the lymph nodes under the armpit, and whether or not the cancer has spread to a distant part of the body. The pre-operative imaging does a fairly good job of estimating the size. But we won’t know the precise size of the tumor until it’s been removed. In fact, unfortunately sometimes the imaging can significantly overestimate or underestimate the true size of the tumor. The only way to tell whether or not the cancer has spread to the lymph nodes is to actually sample a few of them during the operation. We do that with a technique called a sentinel lymph node biopsy. In the operating room, we are able to determine if cancer were to spread to the lymph nodes, what are the few lymph nodes that would be the first to receive that cancer. So we identify and remove those nodes. And if the pathologist tells us that there’s no cancer in those nodes, we can safely assume that there’s no cancer in the rest of your nodes.

What do I need to know about the different stages of breast cancer?

  • Stage one breast cancer means that the tumor is two centimeters or less, and there’s no spread to the lymph nodes. Our goal is to catch breast cancer at this stage, because the five-year breast cancer specific survival from stage one breast cancer approaches 100 percent, which means that nearly all of those treated are alive five years after diagnosis. Also, the amount of treatment that a patient would need with stage one is much less than for later stages. It may result in smaller surgery, and patients at this stage are unlikely to need chemotherapy.
  • Stage two and stage three breast cancer means that the tumor is larger and it has spread to the lymph nodes. If this is the case, patients need more surgery and are more likely to need chemotherapy. Their five-year breast cancer specific survival is between 80 to 90 percent. This highlights the importance of coming in to get your screening mammogram because even though you may survive your breast cancer with a later stage, you’re going to need a lot more treatment to do so.
  • Stage four breast cancer is if the cancer has spread to another part of the body, other than the lymph nodes. At this stage, I tell patients that I can no longer cure them of breast cancer. The five-year survival rates drop to less than 30 percent. We can certainly treat it and, depending on how aggressive the cancer is, we can keep the cancer at bay for many years. But this is what we are trying to avoid.

I just had a COVID-19 vaccine. Should I delay getting my mammogram?

You do not have to delay your mammogram if you are receiving the vaccine, but you should make your radiologist aware which arm got the shot. There has been a lot of talk in the news about how the vaccine can mimic breast cancer. This is not entirely true. The purpose of the vaccine is to activate your immune system to produce antibodies that fight the virus. The cells that make these antibodies are located in small organs throughout your body called lymph nodes. The closest group of lymph nodes to where the vaccine is administered is in the armpit. These are called the axillary lymph nodes, and they are the first group of lymph nodes where breast cancer will typically spread. After receiving the vaccine and activating the cells in the axillary lymph nodes, they will grow in size. This may result in the radiologist wanting a closer look at the lymph nodes with an ultrasound to better delineate if these nodes are large due to the vaccine or if they are concerning for cancer.

What is the difference between a biopsy and surgery?

When we talk about a biopsy, we’re mainly talking about a core needle biopsy. This is where we get a small snippet of tissue in the area of concern, as discovered by the imaging. It’s usually done under the guidance of imaging, such as an ultrasound guided biopsy or something called a stereotactic biopsy, which is done under mammographic guidance. Usually the needle biopsy is done before we do the surgery because it helps us guide what type of surgery the patient needs and because it allows us to determine if chemotherapy is the first step, rather than surgery. For surgery, you are actually coming to the operating room and we remove a large area of tissue around the cancer. If we already know that it’s a very large cancer, we may perform mastectomy to remove the entire breast.

If I am looking for a second opinion, why is it important to go a leading medical center like Mount Sinai?

The treatment of breast cancer has become increasingly complex, as we’ve learned more about it, and so it’s now more important than ever to have a team that works in a collaborative way to tailor a specific treatment program for you.  The Dubin Breast Center at Mount Sinai is a true multidisciplinary Cancer Center with specialists concentrating on one problem, breast cancer.  The facility is beautiful, and that produces a sense of calmness that translates to patient care and to the patients themselves. While I generally recommend that patients go for a second opinion, because of how complex breast cancer treatment is, I think it’s imperative to go to a center where that’s the primary focus, where that’s all they do.

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Is It Safe to Seek Screening and Treatment for Breast Cancer During the Pandemic?

Oct 19, 2020 | Breast Cancer, COVID-19, Your Health

Managing breast cancer screening and treatment can be worrisome in the best of times. During the COVID-19 pandemic, you may be even more uncertain. Elisa Port, MD, Director of the Dubin Breast Center of The Tisch Cancer Institute at Mount Sinai, answers some of your questions.

I’m due for my annual mammogram but I’m scared of getting COVID-19. Should I delay until there’s a vaccine?

At the height of the pandemic in New York City, we were not recommending women come in for screenings. We asked women seeking elective care and routine follow-up appointments to wait. But the number of cases in New York has dropped dramatically, and we have instituted stringent protocols making our hospitals and medical facilities extremely safe. We hope everyone will get back on track with routine screening tests, including mammograms.

I feel a lump in my breast. Should I get it checked out or wait and hope it goes away?

Any woman who thinks she might have a lump in her breast should get it checked out. While many lumps are benign, women of all ages and backgrounds can get breast cancer. It’s important not to dismiss your concern and assume a lump will go away. I recommend that you make an appointment with your primary care physician to receive a full evaluation. Your doctor might perform a physical exam and order imaging tests such as mammograms or ultrasounds or even a biopsy.     

I successfully completed my breast cancer treatment. Am I immunocompromised and at increased risk of developing COVID-19?  

A history of breast cancer does not increase your risk of contracting COVID-19 and neither does receiving cancer treatment—including hormonal therapies and other medications. However, women who are actively receiving chemotherapy and who are immunocompromised, may be at higher risk. The signs of COVID-19 are generally the same for breast cancer patient as they for anyone else. At Mount Sinai, we screen everyone coming into our facilities for issues such as fever, cough, and travel from an area with a high positivity rate (“red zone”).

I’m feeling stressed because of the pandemic. Do you have any suggestions on how to cope?

Stress management is very personal. Coping mechanisms, too, are very personal. The most important thing is to make sure that you don’t spiral into negative behaviors, such as overeating or drinking too much. Try to find healthy outlets for your stress. That can include physical activities like walking your dog or exercising; social activities such as spending time with friends and family; or doing things that bring you joy, like reading, listening to music, or playing a musical instrument. For more on how to cope during the COVID-19 pandemic, read this article on resiliency featuring Rachel Yehuda, PhD, Professor of Psychiatry and Neuroscience at the Icahn School of Medicine at Mount Sinai.

Do you have any other thoughts about breast health?

Remember that breast cancer is an extremely treatable and curable cancer—and early detection and diagnosis are key to successful treatment. The best way to find a cancer early is by getting regular screenings. Starting treatment when a cancer is in the early stages is most effective as it can also mean using less aggressive treatment.

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What Patients with Breast or Gynecologic Cancer Need to Know About COVID-19

Updated on Jun 30, 2022 | Breast Cancer, COVID-19, Gynecologic Cancer, Your Health

People with breast or gynecologic cancer may be at increased risk for COVID-19. This may be because of the cancer itself or due to cancer treatment weakening the immune system and making them more susceptible, or because they have more encounters with the healthcare system. Elisa R. Port, MD, Director of the Dubin Breast Center and Chief of Breast Surgery for The Mount Sinai Hospital, and Stephanie V. Blank, MD, Director of Gynecologic Oncology for the Mount Sinai Health Stem and Director of Women’s Health at the Blavatnik Family- Chelsea Medical Center at Mount Sinai, discuss what you need to know about breast and gynecologic cancer and COVID-19.

Is it safe to go to my oncology appointment?

Dr. Blank: Whether you should keep your appointment depends on the purpose of the visit. If you are having a routine mammogram or an annual check-up, you may be able to reschedule your appointment for later. It is a matter of weighing the risks and benefits of going to the appointment with possibly exposing yourself to the virus. Talk with your doctor to see what he or she recommends.

The Centers for Disease Control and Prevention has recommended that people do not go to the doctor for non-essential appointments. They want to protect you from people who might have or be carrying COVID-19. While we do our best to keep our offices as safe as possible, we cannot guarantee that someone who is asymptomatic has not been in the waiting or exam room. That said, we do limit the number of people entering the facility, so waiting rooms are empty and very few patients are on site.

The other question is how to get to the appointment. I would try to avoid public transportation if possible. If you do not have another option, I would encourage you to wear a face mask, carry hand sanitizer, wash your hands frequently, and be careful about what you touch. You would also want to distance yourself from people. Luckily, public transportation is a lot less crowded than usual, so it should be easier than usual to keep your distance from others.

Why did my doctor cancel my appointment?

Dr. Blank: If your doctor cancelled your appointment, chances are your doctor considered the reason for the appointment and the risk of exposure to COVID-19 and determined that the benefits of the appointment did not outweigh the risks. But, if you are concerned, contact your doctor and ask. The first question is whether the appointment was cancelled altogether or delayed for a period.

If you really want to talk to your doctor sooner rather than later, telehealth is an option in most health care systems. This allows you to discuss your concerns with your doctor without physically being in the same space. If your doctor does not have telehealth capabilities, try setting up a telephone conversation.

I think I might have COVID-19. What do I do?

Dr. Port: If you develop symptoms that suggest COVID-19, such as cough, fever or difficulty breathing, you should call your doctor. Discuss these symptoms with your doctor and get his or her advice. Availability of COVID-19 testing varies across the county, so your ability to be tested will depend on where you are. In addition to talking to your doctor, you should isolate yourself in your home to avoid possibly spreading the virus. Keep away from others in your home to protect them as well. Your doctor should be able to provide additional advice.

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I’m Concerned I May Have Cancer. Can I See A Doctor During the COVID-19 Pandemic?

Updated on Jun 30, 2022 | Breast Cancer, COVID-19, Gynecologic Cancer, Your Health

The business world may be on pause due to the COVID-19 pandemic, but that does not mean medical conditions have taken a reprieve. If you are worried that you might have breast or gynecologic cancer, you need expert advice. Elisa R. Port, MD, Director of the Dubin Breast Center and Chief of Breast Surgery for the Mount Sinai Hospital, and Stephanie V. Blank, MD, Director of Gynecologic Oncology for the Mount Sinai Health System and Director of Women’s Health at the Blavatnik Family- Chelsea Medical Center at Mount Sinai, discuss what you need to know about breast and gynecologic cancer and COVID-19.

I have symptoms that make me worried I might have cancer. Should I see a doctor or wait until the pandemic subsides?

Dr. Port: If you feel a lump in your breast, have unexplained weight loss, unusual bleeding or bloating, changes to the color or texture of the skin on the outside of your genitals, or other concerning signs, you should definitely get checked out. Do not delay seeing medical attention due to the pandemic.

Most doctors, including those in the Mount Sinai Health System, are open for business to evaluate potential patients. We encourage patients to reschedule non-essential visits such as routine annual mammograms and check-ins. This helps us keep the office (and waiting room) mostly empty so we can see new or potential patients while maintaining and allowing you to maintain social distancing. When you come into the office, we take you immediately into a private exam room to limit the risk of exposure. We continue to perform imaging tests, biopsies, and other key diagnostic examinations.

If I am diagnosed with breast cancer, will I receive treatment now, or will I need to wait until after COVID-19 has subsided?

Dr. Port: The short answer is: It depends.

It’s important to remember there are dozens of types and subtypes of breast cancer. There are also a variety of treatment options; there’s no one-size-fits-all approach. We can safely delay treatment for some types of very early breast cancers. Others respond to medication that can prevent growth of the cancer until the threat of COVID-19 has decreased and we can more safely proceed with treatment. But the first step is to get an accurate diagnosis.

Fortunately, there are very few emergency situations where you need surgery or treatment within a day or two to prevent a bad or worse outcome. In most cases, we have the luxury of being able to delay treatment without affecting your overall prognosis and survival rate. It is all about balancing the risks and benefits in your individual case.

Some cancers grow very slowly, so we can safely delay care for one to three months. Others may respond to a medication, such as an anti-hormonal drug, that can allow us to hold off on care for a while. If you have a more aggressive type of cancer, we may decide to do surgery or start chemotherapy.

Of course, receiving these treatments in the setting of a pandemic carries certain risks of immunosuppression and we don’t take those risks lightly. Even just coming to the hospital carries some risk. So, we will talk with you about the risks and benefits of each care option and decide together on the most appropriate approach for your individual situation.

Is it safe to have chemotherapy now?

Dr. Blank: Again, there is no blanket answer to this question. You and your doctor need to consider your individual situation. First, it depends on the purpose of chemotherapy. Is it going to cure you? If so, you may not want to interrupt it. If it is controlling your symptoms, that may be a different conversation. You may be able to increase the time between treatments, or there may be another way to help with your symptoms.

At Mount Sinai, we test women for COVID-19 before we start chemotherapy because we know that women who have the virus and are in treatment may get significantly sicker than others. We also take measures to boost patients’ blood counts during this time to help patients fight the disease should they contract it.

Is it safe to have surgery now?

Dr. Blank: Here, too, the answer is not simple. In general, we are trying to delay all the surgeries that we believe can be safely postponed. The reason is that you really don’t want to be in a hospital right now. There are a lot of COVID-19-positive patients there and you may well be exposed to the virus. We look at the risks and benefits and discuss the issues with our patients. We are not delaying the procedures permanently, just until we have a safe environment for our patients so we can perform procedures again. This is not unusual. We often delay surgery when it is safe to do so. Sometimes a patient wants to delay so she can attend a daughter’s wedding or a grandson’s graduation.

Sometimes we can change our treatment approach to avoid or delay surgery. We can change the order of treatment. For instance, if someone was recently diagnosed with ovarian cancer, we may start with chemotherapy instead of surgery. Then we can perform the surgery later, when it is safer. We know that’s safe cancer-wise; we have a lot of data that show this.  Sometimes we can use a different treatment approach. For example, we can treat certain endometrial cancers with hormones. Talk with your cancer doctors; they can tell you what the options are in your individual situation.

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Dubin Breast Center Honors Three Individuals at Sixth Annual Benefit

Updated on Jun 30, 2022 | Breast Cancer, Community

From left, honorees Steven J. Burakoff, MD; Brooke Morrow; and Kara DioGuardi.

The Dubin Breast Center of The Tisch Cancer Institute at the Mount Sinai Health System recently held its sixth annual benefit at the Ziegfeld Ballroom in Manhattan. The celebratory event attracted 520 guests and raised a record $3.4 million to support the Center’s breast health and treatment programs.

From left, Eva Andersson-Dubin, MD; Kenneth L. Davis, MD, President and Chief Executive Officer, Mount Sinai Health System; and Elisa Port, MD, FACS.

The evening honored Kara DioGuardi, Brooke Morrow, and Steven J. Burakoff, MD, Dean for Cancer Innovation at The Tisch Cancer Institute. Eva Andersson-Dubin, MD, founder of the Center and a Mount Sinai Trustee, and Elisa Port, MD, FACS, the Center’s Director, presented the awards.

Ms. DioGuardi and Ms. Morrow, close friends who helped each other through two different breast cancer journeys at the Center, were recognized for their inspirational stories of survivorship and their ongoing support of the Center. Dr. Burakoff was honored for his overall commitment to cancer research and clinical care and for his role in leading The Tisch Cancer Institute to be recognized as a National Cancer Institute designated cancer program. Dr. Burakoff, the Founding Director of The Tisch Cancer Institute, is also Lillian and Henry M. Stratton Professor of Cancer Medicine at the Icahn School of Medicine at Mount Sinai.

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Breast Surgeon Receives Mother of the Year Award

Updated on Jun 30, 2022 | Breast Cancer, Community

Susan K. Boolbol, MD, and her children.

Susan K. Boolbol, MD, Chief of Breast Surgery at Mount Sinai Beth Israel, along with new TODAY show co-host and breast cancer survivor Hoda Kotb, recently was honored with the American Cancer Society’s 2017 Mother of the Year award at a special luncheon held at the St. Regis New York hotel in Manhattan.

Dr. Boolbol’s daughters, Emma and Mackenzie Boolbol, presented her with the award after reading a witty, rhythmic introduction that chronicled Dr. Boolbol’s life as a devoted mother and busy doctor who loves her work and cares deeply about her patients.

Kathie Lee Gifford, Ms. Kotb’s friend and longtime television co-host, presented Ms. Kotb with her award. Last year, Ms. Kotb adopted a daughter and became a mother for the first time after the age of 50.

According to the American Cancer Society, the annual awards luncheon—now in its 22nd year—has raised more than $5 million since its inception. Honorees are chosen for distinguishing themselves as remarkable mothers who inspire others through their abilities to balance parenting with social obligations, careers, and philanthropic activities. Past Mother of the Year honorees include fashion designers Vera Wang, Tory Burch, and Carolina Herrera, as well as Kathie Lee Gifford herself, and philanthropists Anne and Charlotte Ford.

In her acceptance speech, Dr. Boolbol said, “Before I was a mom, I thought about how much I would teach and inspire my children. The reality is that I am overwhelmed by how much I learn and am inspired by them every day.”

 

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