Ask Our Experts: Breast Cancer
Skip to content

    WebMD Live Events

    Ask Our Experts: Breast Cancer

    Cleveland Clinic oncologist Jame Abraham, MD, and breast cancer survivor and blogger Heather Millar joined us on Monday, October 17th, to answer readers' breast cancer questions.

    • Hello and thanks for joining us. We’ll be kicking off the chat in just a few minutes, but if you have a question, you can go ahead and get it in queue.
    • We’re joined today by Cleveland Clinic oncologist Jame Abraham, MD. Dr. Abraham is the Director of Breast Oncology Program at Taussig Cancer Institute and co-director of the Comprehensive Breast Cancer Program of Cleveland Clinic.
    • Hello, nice to be here. Looking forward to learning from you and answering your questions.
    • And joining us with the patient’s perspective is Heather Millar. Heather completed treatment for breast cancer five years ago, and as a healthcare journalist, now writes frequently about advancements in research and treatments as well as patient advocacy issues. Heather is a regular contributor to WebMD’s cancer blog.
    • Hi everyone, it's great to be here. I'm looking forward to a great discussion.
    • One of the greatest fear of a breast cancer patient could be having to undergo mastectomy, is there any way to allay this fear? Is there some sort of substitution for the breast when lost ( by this, I mean plastic surgery or something of such sort, not bras and some other nonliving stuff). Thank you.
    • Ujam, that is such a great question. First of all, yes, there are prosthetics that you can use if you don’t want to go the mastectomy route. The medical prosthetics tend to be expensive, but they are covered by insurance. There are also lots of non-profits that give away homemade prosthetics, Knitted Knockers is one: There are also videos on YouTube:
      There are lots of options. Just Google breast prosthesis.

      But I’d also like to talk about fear:

      Once you are diagnosed with cancer, fear will always be a challenge. Right now, you are afraid of the possibility of mastectomy. After mastectomy, you may be afraid of side effects of surgery. After that, you may be afraid that the cancer will recur.

      Fear will always be there. Remember, though, that the cancer diagnosis just reminded you about mortality. Mortality is always there. We all have different ways of dealing with this. I find it useful to try to live in the moment. That’s a cliché, I know, but it really works. Concentrate on what’s going on now. Enjoy your kids or grandkids, notice the beautiful sunset. Find joy in the little things. If the fear gets really bad—in the beginning, I was terrified of MRIs—close your eyes and focus on your breath. In. Out. In. Out. It’s a meditation technique, and I’ve found it to be really useful.

      None of this will make the fear go away, but it may make you able to cope, able to enjoy each day as it comes.
    • My fathers side has heavy cancer, including breast cancer. I get checked every year and this is the first year the letter said I was clear but that the breast tissue was very dense. So now I was wondering if I should have the gene test? When is that your next step?
    • Excellent question. If you have a strong family history of breast cancer and ovarian cancer, especially at a young age (under the age 50) you should see a genetic counselor. Or if you have family members with prostate, and pancreatic cancer. After genetic counselor go through your family history, she/he can decide, if you need genetic testing.
    • Have had radio therapy and due for check up in January 2017. Have sharp pain about once or twice a week is this normal?
    • Wendy, I can’t tell you the number of times I’ve heard people in support groups regret not asking about this pain or that pain. It may be nothing. But it could also be SOMETHING. Listen to your body. If you have pain, call your doctor. Only a doctor can tell you whether that pain is normal. Go to the doctor!
    • Which is the best test to find and diagnose breast cancer when it still in very first stage? When the patient had a mastectomy, will the cancer recur? Is it worse?
    • The best screening test for breast cancer is still mammogram. We recommend once a year mammogram for a woman of average risk factors starting from 40 years. But talk to your doctor about your risk and benefit. In some patients, genetic testing or MRI may help. That depends on the risk factors and family history.
    • I want to have second opinion on breast cancer of my wife
    • Krishnan, I’m not a doctor, but I can tell you emphatically that you should always get a second opinion. Ask friends for recommendations. If you know some doctors, ask them. If you don’t know anyone who can make a recommendation, check out local support groups. Fellow cancer patients are always ready to help other patients in this way.
    • Good afternoon! What special diet is recommended after remission from breast cancer?
    • Stroughton, there are a million, million theories about diets that help prevent remission in breast cancer patients. Some people recommend low protein, or turmeric, or shark cartilage, or kale or any of a number of other things. Not much of this is backed by strong scientific data, with one exception: there is pretty clear evidence that drinking alcohol is not great for breast cancer patients,

      Other than that, the American Cancer Society pretty much recommends the same advice we’ve all be hearing for years: Eat a healthy diet with lots of green vegetables and whole grains. Avoid processed foods. Try to keep your weight within normal parameters.

      But also, remember, weight gain is quite common among breast cancer patients. Even if you gain weight, remember it’s important to eat a balanced diet.
    • [I've been diagnosed with] ductal carcinoma estrogen positive (80%), progestorone positive (20%), HER-2 PROTEIN: 1+ membranous staining, Ki-67: Positive in 20% of tumor cells. Moderate nuclear pleomorphism is identified (2 points); no tubular differentiation. Foci of low grade ductal carcinoma in situ, the tumor has a lobular carcinoma-like growth pattern, but trabecular growth is noted in areas and the E-cadherin is positive.
      Doctors differ: The tumor cannot be seen on a mammogram or sonar. One says we must take out the cancer and another one says we treat it with it cannot be seen. Where do we cut? What do we take out? What is your opinion on this please?
      by I've been diagnosed with... edited by Kim Richardson, WebMD 10/17/2016 4:13:50 PM
    • Sorry to hear about your diagnosis. You have ductal cancer, which is the most common type of breast cancer. The good news is that it is ER positive/PR positive. Prognosis of ER/PR positive tumors are better than ER/PR negative tumors. Her-2 is negative. That is excellent news. Ki 67 is 20% that is intermediate risk.
      Now you need to go for surgery to remove the tumor and lymph nodes. Your surgeon and oncologists can tell you about the type of surgery you can have. Removal of the whole breast (mastectomy or lumpectomy). That will tell us the exact stage. Once we know the stage, we can finalize what other treatment you need, such as taking pills and taking chemo.
    • What are the first things you should do after getting diagnosed with breast cancer?
    • Hello,
      I don't have breast cancer but I have dense breasts and a family hx of breast cancer. I have asked my local (Maryland) doctor about molecular imaging but he doesn't know anything about it. Suggeston on whether to pursue that or not>
    • Thank you for your question. I am glad you are trying to understand your risk and trying to prevent breast cancer. It is important for you to talk to your doctor to see what is your risk of having an abnormal gene (that is only 5-10% of breast cancers) or risk of having sporadic breast cancer(that is 80-90%) of breast cancer. Your doctor should be able to help you with that.

      Depending upon your age, risk factors (as above) breast density, the doctor can decide about mammogram, versus Tomosynthesis or breast MRI. Those are three most commonly used and proven screening techniques.
      Molecular imaging still under study.
    • Kelly, there are SO many things you need to do when you just diagnosed with breast cancer. You’re the target of a fire hose of information, plus you’re freaked out, your family and friends are freaked out. It’s beyond stressful.

      Here’s my advice:

      1) Take a deep breath. Breast cancer grows and spreads, but usually not like lightning. You have time, a week or two, even a month, to figure out what to do.

      2) Go to the American Cancer Society website, or to WebMD, and read the information there about breast cancer. Both give a great overview of the disease and its treatments.

      3) Run your connections. Get in touch with anyone you know who’s had breast cancer. Get in touch with all the doctors you know, if any. Check out local support groups. Ask all these sources whom they would recommend as doctors. Make appointments with at least two doctors to discuss your case.

      4) See those doctors. Listen. Remember there is no such thing as a stupid question. Ask as many questions as you can.

      5) Finally, take a friend or family member to your appointments. You’ll be too overwhelmed to take notes. Have someone take notes.

      6) Also, start a cancer binder: Put in dividers for research, appointments, medications, results. Take it with you to every appointment.
    • This may be a silly question, but I do regular self exams -- I have pretty dense breast tissue and I'm honestly not sure what I'm looking for. What would a worrisome lump feel like? Does it hurt?
    • Knowing your breast, what is normal, what is changing, what is new is important (breast awareness). If there is anything different or new, you should report that or see your family doctor. New pain, skin changes, new lump, nipple changes need to be addresses.
    • info on triple negative breast cancer and is lumpectomy and radiation ever sufficient for a very small tnbc tumor (I'm resending because I'm not sure if this question was received the first time). thanks again
    • In triple negative breast cancer, in general we tend to use chemotherapy, in addition to lumpectomy and radiation. The benefit from chemotherapy is higher, when the risk of recurrence is higher. Means, larger tumor (0.5 cm or higher) or lymph node involvement or grade 3. If it is a small tumor or lower grade, the risk of recurrence is less and less benefit from chemo. Please talk to your oncologist for details.
    • I have an anxiety/depression disorder and am struggling with the increased anxiety and sadness effects of aromatase inhibitors. I've been on the only four months. . I really dont think I can live this way for five years. Are there any options? I see a therapist and psychopharmacologist and am taking meds but the anxiety is intolerable. I have increased drinking as a coping mechanism.
    • I am really sorry to hear about all the troubles you are having. You are not alone. We hear this from many patients. Some of the side effects related to fluctuating hormonal levels (mood changes) are more common in patients who are perimenopausal. In some patients, once your body is adjusted to the low estrogen levels, some patients get better.
      Looks like the symptoms are pretty significant for you. Usually in similar situations, I ask my patients to take a break for 4-6 weeks to see if these symptoms are really due to the pill or due to natural changes in hormonal levels. That will give you time to find some solution or treatment to address those mood changes.
      Always remember that alcohol can cause other serious health problem and it is not the real solution.
    • Sianne, from sitting in support groups and talking to other breast cancer patients, I’ve concluded that it’s pretty common to have an intense emotional/psychological response to aromatase inhibitors. I’ve known several women who have discontinued them because they just couldn’t take the emotional roller coaster.

      As with everything in cancer, you just have to do the cost benefit analysis. How much does your doctor think an AI will help decrease your risk of recurrence? Are the emotional side effects worse than that the prevention benefit?

      Remember that the answer is different for everyone. There really isn’t a right answer. Talk to your doctor about the percentages, take stock of your life, and make your own decision.
    • I had a right side mastectomy in 2006 with a tram flap. In 2012 cancer returned in the same breast. Following radiation my breasts now have increasing hardened areas making it difficult to know what is normal. Lobular carcinoma was not identified on mammogram. I have a internal cardiac device and can no longer receive mammogram anyway. What is the best way for me to detect cancer again? Thank-you.
    • In patients with dense breast, or patients with lobular cancer, which is not seen on mammogram, we usually recommend breast MRI or Tomosynthesis. Since you had TRAMP you can talk to your surgeon or oncologist about these two screening modalities.
    • A close friend of mine is beginning treatment for breast cancer. I want to be there for her but I'm not sure how. I don't want to bring food in case she is sick from chemo. I don't know what to do.
    • Shelley, your friend is lucky to have someone like you in her life. I, too, was lucky to have good friends who wanted to help.

      As for the food, just ask her. She may be hungry. She many not feel like eating anything but Onion-chive potato chips. (Salty foods often appeal during chemo.) Follow her lead.

      But there are lots of things you can do to help your friend. Here are the things I found most useful when I was sick:

      • Friends who came to medical appointments with me to support me and to take notes. Often, the patient is too flipped out to think clearly, and to really absorb what the medical team is saying. This is especially true in the beginning.

      • Friends who helped get my then 9-year-old where she needed to go: carpools, school plays etc.

      • Friends who cleaned my house. I’m a neat freak, but my standards slipped precipitously when I was in treatment.

      • And yes, friends who cooked for my family. Even if I didn’t feel like eating, my family needed to eat. And meals can always be frozen.
    • Re aromatase inhibitors. THank you. That was my thought too: to take a break and establish my baseline emotional state again. Will ask on oncologist later his week.
    • I worked at CCF for 25 years. I know live in Richmond VA and underwent a double mastectomy at VCU Massey with Dr. Harry Bear. I had 4 tumors (Type 2A,ER+, HER2-), Oncotype 8. I've been prescribed Letrozole and have been offered to be on a study for using Palbociclib as additional adjuvant therapy. I wondered what your thoughts on Palbo would be.
    • Karen, Thank you for your question. Dr. Bear is an excellent surgeon and breast cancer expert. The trial he is discussing is (PALLACE) for patients who have high risk for recurrence. Palbociclib, is a highly active new drug FDA approved for Estrogen receptor positive, stage IV breast cancer patients. These trials are trying to see if patients with early stage (II/III) will benefit from this new drug. If you meet the criteria for the trial, I think it will be an excellent option.
    • I'm terrified of losing my hair from breast cancer treatment. Is there anything I can do?
    • Molly, when I first cried about my diagnosis, I was crying about my hair.

      You do NOT need to lose your hair during chemo. It’s rather new, but there’s a system called Dignicap, which cools your scalp. The cooling makes the blood vessels in your scalp constrict, blocking the chemo from affecting your hair follicles. I was in the feasibility study for Dignicap six years ago, and I lost only about 10 percent of my hair. It was just approved for general use by the FDA this year. There’s also another system called Penguin Cap.

      Check them out. You have options. I loved that with all the misery of cancer treatment, I didn’t have to deal with staring at my bald head.

      A caveat: These systems don’t work for every patient, but they work for the vast majority. They’re worth a try, I think.
    • My relative was just diagnosed with DCIS, and she got radiation to treat it. I thought with DCIS they didn't need to be that aggressive? I'm worried about her but don't want to interfere.
    • Usually after lumpectomy we recommend radiation therapy for patients with DCIS. The absolute benefit depends upon the risk of recurrence, overall health and age of the patient. I am sure her radiation doctor recommended radiation since her recurrence significant.
    • My friend has breast cancer. I want to ask her how she is, but I feel awkward asking about it. I don't want to make her discuss it if she doesn't want to. What's the most compassionate way to bring it up, or should I let her be the one to mention it?
    • Linda, follow her lead. Some patients want to talk about their cancer all the time. (I was one of those.) Some patients do not want to talk about it at ALL. Just tell your friend that you’re there for her when she needs it, and then wait for her to bring it up.
    • Not sure if my question got lost in the shuffle early on-----47 y/o----annual mammograms, and last Spring had a abnormal L mammogram with "faint well-circumscribed densities" in central portion. U/S was done and read as "normal". 1) why does mammogram show an abnormality and U/S is "normal" and was assigned a Bi-rads 3. Going back for 6-month follow-up diagnostic mammo and possible U/S tomorrow and very worried. I have scattered fibroglandular breast density. If there are no changes, would you recommend continuing the wait-and-see or should I ask for a biopsy and can a biopsy be done when an ultrasound is showing "normal"? Sorry if this is a duplicate question.
    • Thank you for the question. Once an abnormality is noted in a mammogram, usually we recommend additional testing. That could be an ultra sound, compression views (additional mammograms) or breast MRI. If you have dense breasts, and you are worried about questionable findings, you can always ask your breast radiologist about other potential screening options in addition to mammogram. Biopsy is needed only if any of the above screening modalities detect an abnormal lesion.
    • My mother is battling breast cancer. I have small children. How do I talk to them about this?
    • Christine, talking to kids about cancer is always difficult. If your kids are young, I would keep the explanation short. “Grandma has cancer. Doctors are doing everything they can to help Grandma, and we need to help her as much as we can during this time.” Then ask them if they have any questions. They may have none, or they may have a lot.

      If your kids are older, you might want to add a few more details, such as staging, kinds of treatments etc.

      But remember, kids are naturally self-centered. They probably only want the Cliff Notes version. In retrospect, I think I was too honest with my daughter, and told her more than she probably wanted to know.

      I would also say that I think it’s a mistake to say nothing. Kids can always tell when something is wrong. The monster in the closet is always worse than the monster you can see.

      I’d say: Be honest. Be brief. Be open to questions.
    • I was recently diagnosed with DCIS. After my lumpectomy they found invasive cancer; a tumor 0.6 cm. They removed a total of 3.5 cm but margins were close in 4 out of 6 directions. I'm scheduled for a re-excision and a sentinel node biopsy. I am ER and PR + and HER2 -
      What are the chances of getting clear margins and can you tell me a little bit about the sentinel node biopsy? Thank you
    • It is not unusual to have margins being positive after lumpectomy (about 20-30% of the time this happens). I am sure the re- excision will clear that. If that is still positive, some patients may go for mastectomy.
      Since the tumor is ER/PR positive and her-2 negative, your prognosis is excellent. But it is important for you to complete the surgery with the sentinel node surgery. That is a way of looking at the lymph nodes. If the nodes are negative, you have a stage I breast cancer. In addition to surgery, you will need radiation therapy and anti estrogen therapy. You may benefit from Oncotype testing also.
    • How do you find a Genetic Counselor?
    • Terry D, the best way to find a genetic counselor is to call the nearest major cancer center and ask. All big cancer hospitals have genetic counselors. All you have to do is call and make an appointment.
    • How often do I really need to get a mammogram? I used to go every year but now I hear it's recommended for every 3 years for women over 50 without family history
    • Recommendation from American College of Radiology and NCCN is to do mammogram once a year from the age of 40 for a woman of average risk. You should talk to your doctor about the risk and benefit of mammogram (once a year versus twice a year). After 50 years, once a year.
    • What nutritional safety measures do you take to prevent cancer from coming back? Have you used inositol hexaphosphate (IP-6)l. This vitamin B combo enhances the anticancer effect of conventional chemotherapy, controls cancer metastases, and improves the quality of lives of cancer patients.
    • Diet and exercise plays a key role in cutting down the chance of recurrence. I usually recommend my patient to maintain a healthy weight and healthy diet (more fruits and vegetables, low fat diet). Exercise: 30 minutes a day for 5 days a week (150 minutes per week). I don’t think extra vitamins or vitamin infusion will add any benefit patients who are taking chemo.
    • my sister just got diagnosed. she is freaking out. how can i help her?
    • Marcie, take a deep breath. Breast cancer is terrifying, but every case is different. Every prognosis is different.

      The best thing you can do for your sister is to be there for her. Don’t tell her you’re freaking out. You can bet she’s freaking out as well, and worrying about you will freak her out still more.

      Just be there. Go to doc appointments with her. Shop for her. Talk.
    • Looks like we’re out of time. We appreciate you being with us and hope that you found the chat to be helpful. And a big thanks to Dr. Abraham and Heather for answering questions today!
    • Thanks everyone for your questions.
    • Thank you all for your time this afternoon. Wonderful questions, and I really enjoyed the conversation. I hope you all received some good takeaways. Follow me on Twitter @jamecancerdoc to stay connected! #CleClinicBC
    • If you’d like to access the transcript of this event, it will be available at this URL.

      If you’re looking for more information, visit our Breast Cancer Health Center.
    Powered by ScribbleLive Content Marketing Software Platform

    Hot Topics

    Popular Slideshows & Tools on WebMD

    disciplining a boy
    Types, symptoms, causes.
    fruit drinks
    Eat these to think better.
    bald woman smelling flowers
    Complementary therapies to ease symptoms.
    embarrassed woman
    Do you feel guilty after eating?
    diabetes highlighted
    4 early warning signs.
    birth control pills
    Which kind is right for you?
    Remember your finger
    Are you getting more forgetful?
    sticky notes on face
    10 tips to clear your brain fog.
    Close up of eye
    12 reasons you're distracted.
    Trainer demonstrating exercise for RA
    Exercises for your joints.
    Senior woman using diabetes test kit
    Each one takes 10 minutes or less.
    woman having a good day
    Revitalize your life.

    WebMD is not a substitute for professional medical advice, diagnosis, or treatment. Never delay or disregard seeking professional medical advice from your doctor or other qualified health provider because of something you have read on WebMD.

    WebMD does not endorse any specific product, service or treatment. If you think you have a medical emergency, call your doctor or dial 911 immediately.

    URAC Seal TRUSTe Privacy Certification TAG Registered Seal HONcode Seal AdChoices