(March 2, 2009 - Insidermedicine) Dr. Gretchen Kimmick MD, MS, discusses what she would do if she had breast cancer in one breast and had concerns about the health of the other breast. Dr. Kimmick is Associate Professor of Medicine at Duke University School of Medicine. She is also a medical oncologist with the multidisciplinary Breast Program at Duke University.
At the 2008 San Antonio Breast Cancer Symposium (SABCS), we had a chance to speak with Dr. Gretchen Kimmick, who is Associate Professor of Medicine at Duke University School of Medicine. Dr. Kimmick is a medical oncologist with the multidisciplinary Breast Program at Duke University.
If I had breast cancer in one breast, how concerned should I be about my other breast?
Dr. Gretchen Kimmick: If I had breast cancer, and I did not have a family history of breast cancer and I were not young enough to get genetic testing – we usually test people who are younger than 40 to try an figure out what’s going on with the other breast. The fact is that most women only get breast cancer in one breast. The problem is they worry about getting cancer in the other breast, so it depends on how much they worry and what they choose.
So if I had breast cancer and I were 40 or younger, I would consider getting genetic testing to see if I had a predisposition for having cancer in both breasts, and that would help me choose the type of surgery that I had. If I were over 40 or post menopausal, I would treat the one breast and get my yearly mammograms for screening for breast cancer on the other side.
How might risk for cancer in the other breast be assessed?
Dr. Gretchen Kimmick: It depends mostly on age of diagnosis and what the family history is. Most people decide on prophylactic mastectomy based on their fears. If there isn’t a family history and they aren’t very young, because if the other breast is normal there is no reason to remove it.
Having prophylactic mastectomy is a surgery and there are complications and not everybody is happy with it, so we try to avoid doing that. The risk of getting cancer in the other breast in women who have breast cancer in one breast depending on what study you look at is 1% or less per year, so it’s very rare. One problem you get when you have breast cancer is a boatload of doctors. You’ve got radiation oncologists, you’ve got a surgeon, you’ve got a medical oncologist, so we’re all on a team to take care of that person and make sure that they’re doing ok, but it is doctors visits, and it increases anxiety and some people do better with that than others
How can I prevent recurrence or spread of my breast cancer?
Dr. Gretchen Kimmick: What I tell me patients with hormone receptor positive breast cancer is that the hormonal therapy for the breast cancer they have decreases the chance that they’re going to get another one in the same breast, if they still have their breast, or one in the other breast. We’ve recently seen publications on the fact that good diet, low fat diet, getting 5-7 servings of fruits and vegetables a day, and exercising on a regular basis decrease the chance of breast cancer and recurrent breast cancer. And those are difficult things because they change your life. It decreases heart disease, it decreases risk of stroke and it decreases the risk of recurrent breast cancer, so it’s a good thing.
Dr. Gretchen Kimmick: So if I had breast cancer, I would make sure the other side was evaluated fully so when I’m going through surgery, I don’t have to worry about something going on in the other breast that they might pick up soon. And if everything looks ok I would make sure that I get yearly mammograms.
There are certain cases where MRIs are done. MRIs are done to monitor women who are young, who have very dense breasts and we can’t see things adequately on mammogram. Sometimes in women who have a family history, because they can see smaller areas of abnormality on MRI. But it does lead to more procedures and that’s not simple either and having a biopsy, it’s a procedure and I always say, “Procedures are minor to the people doing them, not to the people getting them.”
MRI is a nice way to evaluate women who are at higher risk if they don’t want prophylactic surgery because we see smaller things and find earlier cancers that are more curable. I would concentrate on getting yearly screening mammograms.