Tag Archive for: breast surgery

Pain Outcomes Among Black Women With Early Stage Breast Cancer After Mastectomy

Pain Outcomes Among Black Women With Early Stage Breast Cancer After Mastectomy from Patient Empowerment Network on Vimeo.

What do studies show about early breast cancer after mastectomy in Black women? Expert Dr. Demetria Smith-Graziani explains research into discrimination, trust, and pain outcomes in this patient group.

Demetria Smith-Graziani, MD, MPH is an Assistant Professor in the Department of Hematology and Medical Oncology at Emory University School of Medicine. Learn more about Dr. Smith-Graziani.

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Lisa Hatfield:

Dr. Smith, you’ve done extensive research in this area. Can you talk a little bit about your recent research investigating the association between discrimination, trust, and pain outcomes among Black women with early stage breast cancer after mastectomy?

Dr. Demetria Smith-Graziani

Sure, so I am very passionate about racial, ethnic and socioeconomic disparities in breast cancer risk treatment and outcomes, and most recently, I’ve been doing research looking at disparities in pain outcomes, so unfortunately, it’s well-documented that Black patients as a whole and women, and then particularly Black women, often have their pain not properly assessed and then not properly treated compared to their white counterparts. So I initially looked at a study of women who were undergoing different types of breast surgery, we compared women who were either getting what we call breast-conserving surgery, which is also called a lumpectomy, compared to those who were getting their entire breast removed, mastectomy.

Compared to those who were getting both breasts removed, what they call a bilateral mastectomy, and we looked at how much pain patients had after that surgery, how long it lasted, and other factors that were associated with their pain and how they felt after surgery. Now what we found is that regardless of the type surgery Black women were reporting more severe pain compared to white women, and so that’s what prompted me to engage in my most recent research project, in which I am looking at the association between perceived discrimination in the healthcare setting, trusting one’s healthcare provider and pain outcomes, particularly the severity of pain and how much that pain interferes with one’s life for Black women after they’ve had a mastectomy surgery to remove the entire breast for the treatment of their breast cancer.

So I have recruited some patients, and I am in the process of getting ready to enroll more patients on this study, and I’m hoping to get some good information about whether or not that discrimination that people receive in the healthcare setting affects the way that…how much their pain interferes with their life and how severe their pain is, and whether part of the reason that the discrimination affects their pain is related to the amount of trust that they have in their oncologist or their oncology team. And the reason that I’m looking at that specific…the reason that I’m looking at those specific set of factors is because there are a number of psychological components to the way that we feel pain, such as anxiety, depression and yes trust that are linked to the way that we experience pain and how severe that pain is and how much that pain affects our lives. 

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How Can Breast Cancer Genetic Testing Empower Women?

How Can Breast Cancer Genetic Testing Empower Women? from Patient Empowerment Network on Vimeo.

Dr. Stephanie Valente explains how breast cancer genetic testing results can help women learn about their breast cancer risk and guide prognosis and treatment choices.

Dr. Stephanie Valente is the Director of the Breast Surgery Fellowship Program at Cleveland Clinic. More about this expert here.

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Dr. Valente:                

So, genetic testing in this day and age is really empowering to a lot of women. So, it allows women to take control of their health from the beginning. So, if somebody has a strong family history of breast cancer, and that woman doesn’t have breast cancer but wants to know if she’s at an increased genetic risk for developing breast cancer in her lifetime – Knowing that risk and if a gene is identified, that woman could undergo high-risk screening.

So, saying if she develops breast cancer, it would be caught early, and she can go into a high-risk program. Or she can elect to prophylactically – meaning before cancer – remove her breasts. That would be both of the breasts with a mastectomy – Again, with or without reconstruction. And so, that decreases the risk.

Nothing in life is 100%. But it essentially decreases the risk of getting breast cancer. Some of the genes, like the BRCA gene – that’s a very common gene – is a 60% to 80% lifetime risk of developing breast cancer. And so, that would take that lifetime risk down to about 5% risk of developing breast cancer. And so, that’s empowering for a lot of women. And so, some women do elect to have that procedure.

The other thing for genetic testing is that for women who are diagnosed with breast cancer, sometimes the triple-negative breast cancer – finding out whether or not they carry a BRCA gene. We know that certain genes in triple-negative breast cancer allow patients to have better treatment outcomes with certain chemotherapy. So, the medical oncologist may opt to add a specific chemotherapy based on whether or not that patient actually carries a genetic mutation.

What Should You Know About the Role of Surgery in Breast Cancer Treatment?

What Should You Know About the Role of Surgery in Breast Cancer Treatment? from Patient Empowerment Network on Vimeo.

Dr. Stephanie Valente explains how surgery approaches, including mastectomy and lumpectomy, are used in treating breast cancer, and addresses common misconceptions about mastectomy.

Dr. Stephanie Valente is the Director of the Breast Surgery Fellowship Program at Cleveland Clinic. More about this expert here.

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Dr. Valente:            

So, breast cancer patients have the option to remove their whole breast, which is called a mastectomy. And if they pick that option, they could choose to have reconstruction or to essentially go flat. Yes, we have even done reconstruction in metastatic breast cancer patients. Metastatic breast cancer patients live for a really long time, so giving them reconstruction to make them feel whole and kind of put them back together after a mastectomy is definitely a good option.        

The other option is to just remove the cancer. So, if the patient has a small breast cancer, and it’s metastatic, we can just say – Hey, you don’t have to have the whole breast removed. So, we can do a lumpectomy, as well.

So, a lumpectomy is essentially a surgery that removes the cancer with a normal rim of tissue around it. We also call it a partial mastectomy, meaning you’re removing just part of the breast. Or it’s also called breast-conserving surgery. So, it’s any method that removes that cancer with a normal rim of healthy tissue around it but allows the woman to keep her breasts.

So, when it comes to surgical choices and a cancer coming back, some women think that if they pick the most advanced surgery, such as a mastectomy, it helps prevent cancer from going somewhere else in the body. And that’s actually not true. Removing both breasts, doesn’t make you live one day longer. At that point, a mastectomy or a lumpectomy is a choice.

And prognosis – meaning whether or not the cancer’s gonna show up somewhere in the body – is based really on two things – the stage at which the breast cancer presents itself and what type of breast cancer it is – meaning is the cancer outside of the lymph nodes? How large is it? And if it’s a triple negative or some other type of breast cancer? Those determine the higher likelihood that somebody could develop metastatic breast cancer later in their life, even though small, early-stage breast cancers, unfortunately, can also develop metastasis later on in life.

But women sometimes think that if they pick the most aggressive surgery, it’s helping prevent metastatic spread later on in life. And that’s actually not the choice.  Breast cancer surgery is the option that women choose to surgically remove their breast cancer. But again, choosing a mastectomy or a lumpectomy for an early-stage breast cancer is a choice of how they wanna remove the breast cancer. But it doesn’t improve the chances that they won’t have metastatic spread later on.

So, the role of surgery for metastatic breast cancer is mainly for what we call to remove the cancer or sometimes for local control. So, the number one treatment if somebody is diagnosed with metastatic breast cancer is systemic therapy. That might be chemotherapy or endocrine therapy. But it’s really to get the metastatic disease under control.

So, where does breast cancer usually go? Bones, liver, lungs, brain. So, surgery to remove the breast or the breast cancer in the breast doesn’t really take care of those problems. But a lot of times for metastatic cancer, the one reason would be for local control. So, if the cancer is causing issues in the breast – swelling, coming out of the skin – where it’s a wound issue, then we’ll remove that to get better control of the area in the breast.

The other reason is if somebody has metastatic cancer, and their cancer in the other area of their body is controlled with the therapy, then we say – Hey, chemo’s working, or the systemic therapy’s working. The only thing that seems to be left is the area in your breast. Then for a conversation with medical oncology, we say you don’t have to come off your medications. This is a good time to remove the breast cancer to control that problem.