Epworth HealthCare
🔴 Epworth Live: Breast Health Awareness | Women’s Health Series
On this #EpworthLive we were joined by specialist breast cancer surgeon, Dr Chantel Thornton & breast care nurse, Sarah Morrison to talk about breast health awareness, breast cancer diagnosis, treatment & more.
[Music] my name is Louisa and I'm here today with specialist breast cancer surgeon dr. Chantal Thornton and breast caner Sara Morrison and we're going to be talking about all things breast health if you have any questions throughout the video please feel free to pop them in and comment below and we'll try to get to them this morning or otherwise get back to you as soon as possible with a comment and I guess I'll just start by getting you each to introduce yourselves and tell us a bit about what you do thanks Louisa I'm dr. Chantal Bonta and I'm a specialist breast cancer surgeon which means that I specialize in the surgical management of breast cancer which involves both breast conservation also in mastectomy with immediate reconstruction and I also use oncoplastic techniques to reshape the breast after surgery the breast cancer surgeon is responsible most commonly also for diagnosing breast cancer for treating also benign breast disease and for also leading the multi-discipline team in the management of patients with breast cancer hi Louisa I'm Sara and one of the breast care nurses working here at at birth Richmond I job share with another breath care nurse Victoria Bridal we here to support women that are diagnosed cancer and support breast surgeons as well and we support women from diagnosis right through to survivorship through their surgical treatment and then through their medical treatment right through to getting them back to some form of normality after having a cancer diagnosis so I guess I'll just start from the very beginning what is breast cancer very good question ELISA and breast cancer is basically the breast cell and starts growing outside its normal boundaries so normally cells in the body if they start to grow wildly or bizarrely there are special checkpoints or mediators that will recognize that and they'll switch off and destroy this so what happens in all cancers is that the individual the patient cells so the breast cell starts to grow widely and abnormally and those checkpoints or Big Brother cells that would normally be watching to turn off or switch off the abnormality in the cell don't work and therefore the breast cell then grows abnormally and breast cancer itself comes in a few forms but the most common is ductal breast cancer so it comes from the milk ducts and then you can also have lobular breast cancer and there are multiple other subtypes but the most common is the ductal cells the breasts growing abnormally to reduce the cancer okay and some people have a higher risk of being diagnosed with breast cancer yes they do so women that have a strong family history of breast cancer and we're talking about women that have more than three relatives first or second degree abilities on the same side of the family women who have a history family history of ovarian cancer women have had a male in the family with breast cancer women that carry a genetic mutation or of Ashkenazi Jewish background have an increased risk and then from a community perspective we know that women particularly the postmenopausal sitting sitting that are overweight women who have had prolonged exposure to estrogen therapy women who may have had ionizing radiation to the breast previously saying things like treatment of Hodgkin's lymphoma and the like and then obviously just being female increasing age mostly it's actually nothing that women have done it's it's just being a woman and being in the Australian community it's very very common disease so any way you can reduce your risk yes having lots of babies and having their number four before the age of 30 breast feeding your children before longer than six months of age exercising regular exercise 240 minutes a week looking at you know twenty minutes of aerobic style exercise and then the rest of that core body conditioning style exercise producing your alcohol consumption increasing fresh fruit and vegetables in your diet keeping your body weight and healthy weight range reducing your exposure to Easterns and not taking hormone replacement therapy for a prolonged period of time okay so living a healthy life absolutely yeah so for those of you who have just tuned in if you have any questions throughout our video please feel free to pop them in a comment and we'll try and get to them before the end all right so when should you start checking your breasts I would suggest probably that you know from a 17 age girl not so much checking your breasts but being aware of what your breasts look like and then as you as you grow into a woman it's more about just making sure that you it's you know checking them in the mirror looking at yourself and taking note of any changes that might happen and sometimes you know just actually doing a breast check and feeling is not sort of really what the direction that we we hope to go and it's more about you know changes and you know thinking or changing the size or just anything different to what normally you see so it's probably from you know puberty onwards okay and when you're checked checking your breasts yourself you should be looking for those changes rather than yeah yeah okay and what symptoms should you be looking out for and when should you go see your doctor very delighted to see that anytime but normally what we're talking about is breast awareness so we're looking for example a lump or thickening or changing contour size shape for the breast that lasts longer than a menstrual cycle so that's exactly what Sarah's saying it's normally being aware of the normal changes in your breasts and knowing what's normal for you and if you have a symptom like a nipple discharge changes in the skin so a thickening or crusting of the skin over the nipple and your discharge a lump in the breast thickening in the breast tissue or something that doesn't feel right and that lasts for longer than one minstrel cycle and it continues to be there and you should say see your doctor or pain in the breast it's also a very common a common finding although pain in the breast is extremely uncommon ly associated with breast cancer okay and how often should you have a mammogram and what does the mammogram feel like well you should have a mammogram and probably every couple of the years trees or biannually a mammogram can be uncomfortable but it's not painful it's a done through radiology and it's a machine that you've put your breasts into the Machine and it squashes it down so it gets a lovely picture of the breast from top to bottom and side to side and those images are then reviewed by the radiologist and then if there's any concerns the G people will refer you on to a breast surgeon to review anything that may be you know hopefully benign but they take the most beautiful pictures of the inside of the breast so you know it is uncomfortable but at the same time I think it depends on the size of your breasts I think it doesn't make any difference yeah and also a tip work now we have this beautiful machine which combines time and synthesis with the mammogram and so it not only increases the sensitivity of the investigation but it also reduces the amount of compression required and really that's what ladies find most uncomfortable compression and now with this thing called CT timer synthesis that we combined with a routine digital mammogram the compression of flight is a lot less and so we even find a lot less uncomfortable as as it's minimal compression required and we also get not only those 2d images of the you know head to toe and the side to side view that was Sarah was talking about but we also get these fabulous 3d image that goes through the breasts that the radiologist can see and to improve the sensitivity particularly in ladies that have dense breasts I normally recommend that women get breast imaging on a biannual basis sarah said and you can start from age 40 breast screen Australia will allow women to enroll from age 40 they would have to self remind and self repair until 1850 and then from 50 onwards they would remind the patient now the caveat to that is that unfortunately BreastScreen only have digital imaging and so it is not the I suppose most sensitive imaging it doesn't they don't have imaging with time and synthesis unless of course a patient gets a callback and then they'll be sent to a center where there is timer synthesis so in ladies that a young that have dense breasts or that have a strong family history they are now being recommended to have their imaging done through the private sector okay and you mentioned dense breast then what does that mean yes so that means that the breasts are full of ducks and lobules so I've got this lovely daughter loves diagram and so we've got a breast this is our national 101 for everyone we've got an Ducks here which then come into lobules and surrounding fat so when you've got very dense breast tissue what you have is a lot of ducks and lobules which means that when you do the mammogram the mammogram won't be very see through the mammogram will be very very white and so when we're looking for a breast cancer on mammography we're looking for a little white dot and and so when you've got lots of ducks and obvioulsy camouflage is the problem and it makes it more difficult for things to be seen on imaging secondly it makes it more difficult for you to examine your breasts because your breasts will often feel very dense foreign nodular very lumpy and thirdly we know that breast density is an independent risk factor for breast cancer not just merely due to the fact that there's a camouflage or a false negative effect with the imaging so we always tell women and their difference density so that they can be aware that you know mammography is going to be more difficult clinical exams going to be more difficult and they need to be obviously more vigilant in their breast imaging breast examinations okay and how it's breast cancer diagnosed about 50% of breast cancer actually is diagnosed through breast screen it's totally asymptomatic and the other 50% may present with a symptom the most common being a small lump or a small figure an area of thickening in the breast how is it treated and treatment well that's actually very common it will mainly involve the surgical side so removal of the cancer which will either be in its entirety ie the entire breast with an immediate breast reconstruction at the ladies wish or just a mastectomy if they don't wish to have a reconstruction up front or removing the actual cancer with the surrounding margin of normal tissue called a lumpectomy whenever we do a cancer operation with also sample the lymph nodes under the armpit and the most commonly performed procedure now it's called a sentinel lymph node biopsy and that's really just to make sure to determine how aggressive the cancer is and to see whether or not the cancer cells have had the ability to spread from the breast to the armpit to determine further treatment and then further treatment will involve both the chemotherapy could could involve chemotherapy radiotherapy or drug treatment and that's where Sara talked about her side of things Sara not only works at the brick breast caner but she also works at output in the oncology ward so she gets the added benefit that she saves the patients in the rooms with me when we when we diagnose the patient when we do the little biopsy to make the diagnosis and then she's able to follow them through their journey and support them when they go through their chemotherapy if they need Kenneth area because not every lady needs come in therapy so you want to say something about yeah so what often when you said that how is breast cancer diagnosed it it all starts I guess in this room so when we get the images it chantal them or you know biopsy and send for more scans and we'll do a much more thorough investigations the woman has used that you know he's told of course and then treatment options start from there and there are many nary many different ways it's like a big recipe book and it says which recipes third set person and you know the treatment options range from yes chemotherapy radiotherapy and hormone therapy and now it's becoming more and more popular theme you know in therapies which are making a lot of headway in the breast cancer sort of the field the other you know the other guess the other people that would be involved in the treatment you know we we fit with Chantelle's or the surgical teams sort of end I guess well not in but they perhaps sort of a complete from the time being the patients have been referred on to other specialists mainly medical oncologists radio oncologists and they will take over the systemic care of the patient so the hormone therapy hopefully that I have to have too much therapy afterwards but it's a one of those cancers that doesn't get treated and then finish with even sort of six months it can be ten years and then it's constant surveillance and the track so it's um it's a long time for women they're not thick all that time or they're not you know often they're living a very well and healthy life but they are it's it's chronic disease having it so it's something that we therefore from the very start right through the very and and that's why we're going to talk about survivorship it's about getting them and back into the back into the world you know what their normal lives yeah I think it's important to also touch on the fact that we have a very highly-skilled multidisciplinary team I think it's very important for ladies to know particularly women who might be living in rural and country areas that it is very important that your case is disgusting and mobsters meeting meeting and so while I say you know I diagnose the breast cancer I take the patient to the operating theatre and you know I removed the cancer none of that is done before the case is discussed in emotions meaty meeting with all of a specialist involved so I'm going we're going off at lunchtime today to talk about our cases from last week so we talk about the patients in the meeting we review their pathology under the microscope with the pathologists we review all their imaging before we make any decision top right the patient it's very important that everything is discussed in that team meeting because we know that that improves that impacts on survival for patients so that the oncologists will already know the story about the patient's they've already seen the pathology under the microscope and then I'll certainly look my plan is this I'll say great I'll catch up with the patient on the ward after you finished her surgeries Chantal and then we'll take it from there and we'll go back once we've done the operation and again we'll review the pathology review the imaging we'll say okay what did we find do we do need to do further surgery or do we now move on to further special treatment and so that's really done as a joint with multiple specialist and that's what really has improved significantly improved the survival of ladies of breast cancer and it's international gold standard that you know your surgeon shouldn't be solely working alone and to treat that patients case they should be working a team type environment how common is breast cancer yeah it's extremely common the Victorian things about one in eight its most common cancer in females and it's the frightening statistic really is no 1 in 8 women at some stage in their life will get breast cancer that one in a two figure though really is in the ladies in their older age group so you know in their 80s and the like so women in their earlier ages do not need to feel alarmed by that but as we said just being breast aware is very important and knowing your family history is important too and all the other stuff that we talk about it's not rocket science I mean you know the healthy lifestyle buddy is alive and you know important in the prevention of cancer as it is in as for heart disease and other chronic illnesses advice do you have for managing fear of cancer recurrence oh I had that one over – yeah yeah I think one of the biggest things and it's very it's probably the most prominent question that I get asked as a breast care nurse from many patients years and years later how they've been had their diagnosis have been treated for breast cancer and it is a absolutely you know normal question and it's a it's a normal feeling to have and quite often I just say to ladies you're being constantly surveyed so you're you know you're more aware you're hyper vigilant about your checking and from your diagnosis you'll be constantly checked you'll always be checking in with your surgeon your life be checking in with your oncologist so I guess you're having that that constant checkup compared to your friend that hasn't had breast cancer who probably isn't being checked up or hasn't been as proactive is what they are so if there's something does pop up later on which you know cross their fingers and toes that that doesn't happen then we're on to it pretty early so it's um and quite often you know women are on hormone therapy for up to ten years now so they do feel like they're having a bit of an insurance policy with having that done so having that so it does relieve anxiety about 70% of all breast cancers will have sort of receptors on them which means for estrogen and progestin which means that if we block estrogen and progesterone in the body which is what Sarah talked about its hormone it's sort of like it's almost like an ante hormone it lowers the estrogen body to prevent the cancer growing or recurring and we actually sometimes advise that ladies take these anti estrogen or estrogen lowering sort of tablets up to ten years so they're taking a tablet every day to reduce their risk of recurrence and so it's important to you know make ladies understand you know what their actual treatment is doing and the fact is also that there are many other therapies that we have available to treat ladies with with recurrent breast cancer and you know we talk about breast cancer much more as a chronic disease now because we know that it needs a type of cancer that can come back 10 15 20 years later but women a living long long and active life so we've metastatic breast cancer um and many of them will not die a breast cancer they'll die of some other cause which is not associated with breast cancer and the second thing I should say is that you know for us we're actually quite lucky because we're dealing with a cancer that has one of the highest survival rates of all cancers so 94% of all ladies that are diagnosed with breast cancer will leave a very long time and will survive their disease so from from our perspective and you know it makes our job quite rewarding because we get to see our patients for many many many years and we give them very aggressive treatment often upfront because we expect that they are going to live to their 80s and we you know we want to give them absolutely everything in world-class gold standard I call it the rolls-royce treatment to make sure that they are going to be alive for many many years and what would be your advice for looking after your mind body and spirit if you're diagnosed with breast cancer it's that's a really important part of the whole breast cancer journey is it's looking after your mind definitely the mind does funny things that can play funny tricks on people and given a cancer diagnosis particularly breast it's very much hormonal driven so you know women are very can be you know very emotional based on just the fact that they've got breast cancer so we always you know highly recommend you know support groups our support networks in your you know within their families and within their group of friends we all do also have a support group here at birth called boob Club if it's just for young women under the age of 45 that which is you know actually Chantelle sort of demographic is a lot which is where we a lot of women that can anywhere but I have to be able with patients can join the club and it's really really good for them to be able to talk to each other but there's lots and lots of support groups and there's lots of support organisation and think pink counterpart the ODIs foundation who support you know primarily women only with breast cancer it's got a lot of support it does have a lot of community support you know body definitely it's about keeping fit and healthy exercise Chantelle said you know over you know three to four sessions a week we have to think about our bones as we get older you know that breast cancer can so we have bone strength or something so weights and you know lots of meditation yoga is also really important in a healthy diet so that we keep now you know BMI down and now I'm in exercise that but I think a lot of it is to do with having a healthy mind I think they can make it be do what about the yep we've had a fabulous survivorship program which there also helps to collaborate and facilitate with and that's an incredible program after we're going to finish their immediate medical and surgical treatment to help them with this exacting the psychosocial processes of you know in particular you know women who have got a looser breasts femininity sexuality the psychology of particularly if they haven't had children or if they've got children fertility issues etc and we have dedicated psychologists that also help us and dedicated exercise physiologists that help us with our patients because it is a very very stressful time and I think it's just knowing from a woman's perspective that the support is there and that it's not going to be forever that they're going to be feeling like this that they are going to get better and the things are going to improve that it is often quite difficult during the immediate immediate management so it's sort of just getting them through to get back on with their life and you know get back into the community doing things that they love to do well thanks so much for joining us today Chantal yeah thank you so much for your insights and thanks to everyone who joined us this morning and we'll see you next time
#Epworth #Live #Breast #Health #Awareness #Womens #Health #Series
source
