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breast cancer
—it takes a team
By Marie Wolf

Fighting

You have breast cancer. Now what? The diagnosis, no doubt will set your mind reeling with painful questions. How bad is it? Will I need chemo? What about my hair—will I lose it? How do I tell my children? Will I live? To ease your fears and put you on a path to healing, an in-depth conversation with a breast cancer surgeon should follow. Together, you can create an individualized treatment plan. Here, Chief of Breast Surgery for the North Shore-LIJ Health System, Dr. Karen Kostroff, offers an overview of what should be discussed in a pre-operative evaluation: Surgical Options: Essentially, the first physician you meet with is a surgeon. After reviewing your mammogram and sonogram results, the surgeon will decide if further imaging is necessary. Then there will be a discussion about whether you are a candidate for a lumpectomy or a mastectomy. If the tumor is very large, neo-adjuvant therapy (pre-operative chemotherapy) to shrink it may be recommended. With this treatment, many patients can be converted from a mastectomy to a lumpectomy. This is an important option to discuss. Sentinel Node Biopsy: Once it is decided which surgeries will be performed— lumpectomy, mastectomy, breast reconstruction—many patients will also undergo a sentinel node biopsy. This is an advance-

Now What?

When it comes to breast cancer, the scenario typically goes like this: It begins with the word “suspicious.” You tell your doctor you feel great, healthy as ever, that you just want to schedule your usual, annual screening mammogram. Afterwards though, the radiologist reports that something looks “suspicious” and needs a closer look. So, you move forward with more diagnostic testing. Once it’s clear that there is, in fact, an abnormality in the breast, a needle biopsy will be recommended. According to the American Cancer Society, “a biopsy is the only way to tell if cancer is really present.”

Breast Cancer … Me?

ment in which fewer (one to four lymph nodes) are removed from the armpit to see if the cancer has spread beyond the breast. For the surgeon, it means a smaller operation. For the patient—less arm swelling and risk of infection. BRCA Gene Testing: When there is a family history of breast cancer, it’s important for the patient to undergo testing for BRCA gene mutations, which increase a patient’s lifetime risk of developing breast cancer up to 87 percent, with another 60 percent chance of developing cancer in the opposite breast. Therefore, that patient may choose to have a double mastectomy, rather than risking future breast cancer in the other side. Post-Surgery Treatment: During the postoperative visit, the patient will be referred to a medical oncologist to discuss adjuvant therapy (chemotherapy and/or hormonal therapy) to reduce the risk of recurrence. Some may also consult with a radiation oncologist. Radiation is indicated in the majority of patients who choose lumpectomy, as it reduces the risk of recurrence in the breast from 30 percent to five percent. Radiation may also be recommended for women who have had a mastectomy if the tumor was 5cm, or they had four or more positive lymph nodes. Some patients will require Herceptin—a targeted therapy for the treatment of aggressive tumors. Know This: Dr. Kostroff says women should be aware of the following: Pathology: If your needle biopsy was done in a non-hospital environment, results must officially be reviewed again by the hospital pathologist, to confirm the diagnosis. Reconstruction: If you are a having a mastectomy, same-day reconstruction should always be offered. “However, no one should be made to feel they need to be reconstructed,” says Kostroff, “but they should be educated about it to make the best decision.” Fertility: Women of childbearing age, who require chemotherapy following surgery, may want to discuss harvesting their eggs before treatment begins.

Your Cheering Squad
Eileen Nicoletto

I

t’s “Think Pink” month. Walks, runs, golf outings and galas will be held across the nation in an effort to raise funds to cure breast cancer. Yet, nothing symbolizes hope more than stories of survivorship. According to the American Cancer Society, millions of women are surviving breast cancer today due to improved treatment and early detection. Eileen Nicoletto, of Greenlawn is one of those survivors. She has been cancer-free for eight years. Nicoletto says she is grateful to her surgeon for her medical expertise and guidance, as well as the hospital staff and support services for keeping her afloat physically and mentally during her double mastectomy, breast reconstruction, chemotherapy treatments and recovery. To this day though, she cannot figure out how she wound up with breast cancer. “I always exercised and ate right and I never ever liked junk food.” In fact, she says most of the women in her support group were just as healthy and just as puzzled by their diagnosis. Yet, Nicoletto admits that many of the women led stressful lives and she believes that stress may have been a contributing factor. So, with a balanced lifestyle already in place, these days she focuses on not sweating the small stuff. And, instead of dreaming big dreams about far off destinations, she travels to them. This month, she and her husband are celebrating another year of survivorship along with her 60th birthday aboard the Oceania on a 10-day, culinary cruise across the Mediterranean. For women newly diagnosed with breast cancer, Nicoletto says, “Take a deep breath, step back and think about what you should do before you get shuffled around.”

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