The Breast Cancer & Women’s Health Institute of Central Pennsylvania (BCWHI) provides a variety of services to support breast health. It opened in April 2012 as a service of Tyrone Hospital with the mission to screen, diagnose and treat breast cancer in a supportive and understanding atmosphere. The facility’s goal is to treat every patient that enters through its doors as a special individual with a unique problem. The BCWHI strives for a level of service and compassion that allows women to feel comfortable and confident in their breast care. The key is to provide the knowledge and tools women need to make decisions regarding their care, whether it is for a routine screening or treatment of a breast cancer.
Breast cancer is one of the most common cancers among women, with about 1 in 8 (13%) women expected to develop breast cancer during their lifetime. By educating the community on the importance of early detection methods like mammograms, clinical breast exams and breast self-assessments, the BCWHI hopes to be able to diagnose and treat any breast abnormalities as early as possible.
Dr. David Arbutina, M.D., FACS, serves as medical director of the BCWHI. He is a board certified general surgeon with focused expertise in breast cancer surgery, having dedicated his career to the treatment of breast cancer. He has treated and cared for well over 1,000 breast cancer patients and is known for his exceptional ability to distinguish between benign and cancerous breast disease.
Ask the Doctors
Q. I am in my 80’s. Do I still need to have mammograms?
A. If you are 80 and in good health a screening mammogram is still a good ideal. If your health is failing then it may not be of any benefit. The older you are the higher the risk of breast cancer, however, people die from other diseases so the actual number of cases of breast cancer in the elder declines. If you are healthy, by all means get a mammogram. If you develop a cancer you still want to find it when it is small and easily treated.
The standard of annual screening mammograms for most patients beginning at age 40 is based on several large studies that show a significant reduction in breast cancer deaths among women who undergo regular mammograms. These studies did not evaluate the benefit of mammography for women ages 70 and older. So, as far as hard scientific data goes, we cannot say that screening mammography beyond age 70 prolongs life. If you’re 80 and in good health, then a mammogram screening is still a good idea. If your health is failing, then it may not be of any benefit.
The older you are, the higher the risk of breast cancer. With that said, many women over 70 continue to be diagnosed and successfully treated for breast cancer. The reason it is difficult to show a benefit in a study is that women begin to die for other reasons beyond 70, such as heart disease. I believe screening should be based on a simple question: If a breast cancer were detected in you, would you have it surgically removed? If the answer is no, then you should not bother with screening. If the answer is yes, then keep coming for your annual mammogram. If you are unsure of your answer based on other illnesses or your overall condition, talk to your primary care doctor and decide together how long to continue screening.
Q. I heard that consuming soy products increases estrogen in the body and can therefore increase the risk of breast cancer, is this true?
A. Eating soy products will not increase a woman's risk for breast cancer. In fact, studies of breast cancer survivors show that eating soy products may reduce the risk of cancer recurrence in some cases. Soy supplements, on the other hand, have not been studied sufficiently, so the use of these more concentrated soy metabolites would be discouraged in cancer survivors until more is known.
Q. When or at what age should I talk to my daughter about breast health?
A. During puberty is a good time to address breast health with young women. Discuss monthly breast exams and how breasts change through the month and during menstruation. They should be made aware that any mass in the breast should be evaluated if the mass persists. A transient mass during a period is no of concern.
Q. How often should I perform breast self exam and at what age should I start?
A. Breast exams should be performed once a month. The self exam should be done the week after a woman's period, since this is when the breast will be least swollen. Post-menopausal women should perform their self-exam the same time each month.
Exams should start as soon as the breasts are fully developed after adolescence. This will promote a good lifetime habit and lets women become acquainted with their own breasts. If any changes occur or lumps develop they can be addressed early.
Q. If a woman develops breast cancer while in her child bearing years, will the cancer affect her fertility?
A. Breast cancer in itself does not affect fertility. If a patient requires chemotherapy, however, this may stop ovulation in some but not all cases. If there is any chance that the cancer has metastasized then pregnancy is not advised. The hormones which a woman's body develops to support a pregnancy may also promote growth of the cancer and help the cancer spread.
Q. I heard that some ingredients in deodorant/antiperspirant can cause breast cancer. Is this true?
A. There are no ingredients in deodorant or antiperspirants that cause breast cancer. People can become allergic to aluminum chlorohydrate which can cause painful inflammation of glands in the skin of the under arm. But there has been no scientific studies to show a link to breast cancer.
Q. How is ultrasound used in the detection of breast cancer?
A. Ultrasound is almost exclusively used as a diagnostic tool to perform a targeted study, meaning to evaluate a specific location in the breast based on an abnormality seen by mammogram or MRI. It can also be used to assess a site of pain or a palpable lump. It is an excellent tool for differentiating solid masses from fluid filled cysts, something that a mammogram can't do. It is also the preferred tool for image guided biopsy, as it is far easier to use ultrasound than either MRI or mammogram when sampling tissue.
Some clinicians advocate ultrasound as a screening tool, but this is not broadly accepted by the breast imaging community. The reason is that ultrasound evaluation can be very operator dependent, meaning two different examiners can perform a screening ultrasound on the same patient and get different results. Ultrasound screening can also lead to a higher number of false positive findings, which can result in additional unnecessary diagnostic studies.