Participants: Allan Handysides, Mollie Steenson, Stoy Proctor
Series Code: WM
Program Code: WM000345
00:36 Hello, welcome to "Wonderfully Made"
00:39 My name is Stoy Proctor 00:40 and today, we're going to be discussing the topic 00:44 "Breast Cancer" 00:46 I'd like to welcome as our guest Dr. Allan Handysides 00:50 and he'll be answering questions today for us on this topic. 00:54 Thank you, Stoy, it's a pleasure to be with you here today. 00:58 Allan, what are some of the risks of breast cancer? 01:04 Supposed you're diagnosed with breast cancer, 01:08 what happens? 01:10 Well, I think perhaps what the 01:11 question that you have in mind is... 01:13 Are there predisposing factors that give rise to breast cancer? 01:18 The risk of breast cancer, of course, is of dying... 01:20 and that's why it's very important to diagnose it early 01:23 But, people who take an intelligent look at themselves 01:28 and their families, they may know whether they are 01:31 at increased risk or not. 01:32 There are many, many factors, for instance... 01:34 As women get older, and as men get older, 01:37 because we should remember that this is a disease that 01:38 can affect both men and women... 01:41 Although maybe 99%, 99.5 or more percent are in women. 01:47 A small number of men also get breast cancer. 01:51 And men who find a lump in their breast 01:53 should take particular care about it because 01:56 it can be very serious for men too. 01:59 Basically, as women or men age, they are more predisposed. 02:04 Women over the age of 60 are the group that are more likely 02:08 to have breast cancer. 02:10 In addition to this, younger women have to be 02:13 aware of their genetic history 02:15 because there are certain families in which breast cancer 02:19 is much more common. 02:21 For instance, if a mother, and her sisters, and maybe 02:24 a couple of your siblings have breast cancer, 02:28 they you really need to take special care, 02:31 because you may be carrying a GENE that predisposes 02:34 to breast cancer. 02:36 There are other factors... environmental factors 02:38 For instance, a person that becomes obese... 02:40 Obesity has a very distinct relationship to breast cancer. 02:46 Dietary factors have been 02:48 difficult to tie into breast cancer.. as you know. 02:51 But it's also important if there has been a history of radiation 02:57 ...excessive radiation. Exposure 03:00 Exposure, you know that can also be associated with 03:04 increased risk of breast cancer. 03:06 Now suppose a woman is being told that she has a tumor... 03:11 is this synonymous with cancer? 03:13 I think this is something that we should really 03:15 say at the outset of our program 03:17 A tumor means an overgrowth of cells. 03:20 A growth of cells that are probably in excess 03:23 to those that are required for the function 03:25 of that particular tissue. 03:27 Now if those are relatively normal cells... 03:29 their growth is not wild, but is somewhat regulated 03:33 just that there tends to be overgrowth, 03:34 that may be a benign tumor. 03:37 So you can think of a tumor as a lump. 03:39 ...9 out of 10 lumps that women are going to find 03:42 are going to be benign. 03:44 So, if there are women watching this program, 03:47 you need to understand 03:49 that if you find a lump in your breast, don't panic because 03:52 ...90% of the time, it's just a benign tumor. 03:56 And so, really, the detection of breast cancer 04:01 is what's most important. 04:03 So now, could you tell us more about self-detection... 04:06 self-examination? 04:08 The diagnosis from a physician... Yes 04:11 Self-examination has been studied and some people have 04:15 said... that regular and routine self-examination 04:18 does not result in fewer deaths from breast cancer. 04:23 On the other hand, we must acknowledge that the MAJORITY 04:27 In fact, the VAST majority of breast cancers 04:31 are detected by women themselves. 04:33 And so it would seem that regular vigilance 04:38 and an awareness of one's own body 04:41 is very important. 04:43 I often say, that one should get up and first thing 04:46 in the morning and look at yourself in the mirror and say.. 04:48 "Hello beautiful!" Lift up your arms like this, you know, 04:50 and see how your breasts ride on the chest... 04:53 to be sure that there's not any puckering, or pulling 04:56 of the skin... to be sure that the breasts 04:59 are looking well and fine. 05:02 In fact, at this point, I would like us to bring to us for 05:06 an interview, Mollie... 05:08 Mollie has a very interesting story that I would like 05:12 her to share with us at this time. 05:17 Mollie, I'm so pleased that 05:19 you could be with us today... Well thank you! 05:21 You have a wonderful story to tell, and I think that 05:23 our viewers will love to hear it. 05:26 You actually had breast cancer. Yes, I did... 05:29 Would you like to tell us how you found that? 05:32 Well, I had gone for my yearly checkup in April, 05:35 and they didn't find a thing. 05:36 And, in June though, as I was doing a self exam, 05:40 I found what I thought was a lump, but it didn't really 05:43 ALARM me... but I thought, you know, probably I should 05:46 go have a mammogram. 05:47 And so, I called the local lab, and they took me in 05:51 and sure enough, they found a lump as well. 05:55 And they referred me then to a surgeon in Marion, 05:59 and they sent my lab work over to him... 06:02 and he did a biopsy... 06:04 He's the one that, after the needle biopsy, I think is 06:08 what he did initially... 06:09 He said, "You know, you do have something that 06:14 looks quite cancerous. " 06:15 How did you feel at that moment? 06:17 It just STUNNED me! 06:19 It just absolutely did not occur to me that I 06:22 could have cancer. 06:23 I was the HEALTHY one in my family. 06:25 I was the one that ate healthy... 06:27 and was NEVER sick! 06:30 Actually, I can tell people now... 06:31 I've rarely ever been sick... 06:33 OH! Except that time I had cancer! 06:36 So what happened after that? 06:38 Well, he took me in, first of all, for a lumpectomy 06:42 and came back and told me, 06:44 "You know, we're going to have to go even further 06:47 than this. "We're going to have to do 06:48 a mastectomy because the lumpectomy, there was still 06:51 1 little tentacle that ran a little too far. " 06:55 And I didn't want to have such major surgery... 07:00 to me, it was major... without a second opinion. 07:03 So we sent the results, all of the lab reports and everything 07:07 off to Chicago to someone there... 07:10 A very, very smart thing to do. 07:11 And they conferred that what I REALLY needed to do 07:16 was have a mastectomy. 07:18 And so, you know, I went into the doctor's office 07:22 Dr. Voss, and he told me... 07:24 "You know, we've got to schedule you for a mastectomy... 07:27 this is definitely cancer, and the other doctor has confirmed 07:32 my initial diagnosis that you needed to have a mastectomy. " 07:36 And I said, "Well, you know, probably I could work this 07:39 into my schedule... maybe the middle of February. " 07:42 Now this was October... 07:43 And he said, "No, you don't understand, 07:45 we need to do this next week. " 07:48 THAT just floored me! 07:49 I wasn't psychologically prepared to do it that quickly. 07:52 I needed time, but you know those doctors 07:55 just won't let you wait... 07:56 Not when you've got a problem like cancer! 07:58 And so, we went ahead and had the surgery done... 08:02 And, you know, that was quite a while ago. 08:06 How long ago was all this? 08:07 I was just thinking about that, 8 years and 3 months ago 08:11 And what I have to do, of course, every year 08:14 is go have all of my lab work done, 08:16 my blood work done, and so forth... 08:17 And once a year, I can walk away from my doctor's office 08:20 after he looks over all the results, and he tells me... 08:24 "You're ABSOLUTELY cancer-free!" 08:26 So once a year, I can walk away from that doctor's office 08:29 and say... "I'm cancer-free and I can prove it" 08:32 It DOES feel good! 08:33 Wonderful, it really is wonderful! 08:35 Did you have any reconstructive surgery afterwards? 08:38 Yes, as a matter of fact, I felt like I was 08:40 young at the time, and I thought 08:42 "You know, it's not so much vanity-sake, other than 08:46 "I just want to look normal in my clothes. " 08:48 Besides that, the insurance covered it. 08:51 And I thought, "Why not?" Go for it! 08:53 And so, I did have reconstruction done. 08:56 But, you know, that was more painful than the actual surgery 09:01 itself... the reconstruction, it takes a while 09:04 and they actually go UNDER the muscle, 09:07 and then they s-t-r-e-t-c-h it out, 09:09 and that can be quite painful. 09:11 On this side of it, I'm glad that I did, just simply because 09:14 my clothes look normal. 09:16 I just wanted to look normal. 09:17 I didn't want to look abnormal... and God blessed me. 09:21 Well, you couldn't look more normal today than that... 09:25 And, of course, 8 years and 3 months, 09:26 or nearly going on 9 years... 09:28 We can DEFINITELY say you're cured... Absolutely! 09:30 But you know, I think that the essential element 09:33 that I would like our viewers to take away from this is 09:36 that YOU found the lump. Yes, I did 09:39 And that actually is the common way that breast cancer is found 09:44 And it was a small lump, but what I didn't do was 09:47 say... "Oh, that's nothing. " Exactly 09:49 Even though I didn't want to believe 09:51 that it could be anything... there was still that possibility 09:53 And so, I did go ahead and have further testing done. 09:59 Now Mollie, we have a model of breasts, and this model 10:05 of breasts has, within the left breast, some lumps... 10:09 And I would like it if you would, for our viewers, 10:12 show how we examine the breasts... Okay, be glad to 10:17 Here's the model, and what you're doing right there, Mollie 10:21 is NOT the way to examine the breast... 10:23 and I'm sure that's what you know... 10:25 We don't stab the breast with our fingertips... 10:27 Instead, we use the flat portion of our fingers, 10:31 the palps of our fingers, and we want to be 10:34 very methodical and cover the whole of the breast area. 10:38 So that means, we must start up at the clavicle, 10:41 which is the collarbone, and we can go in a radial fashion 10:45 in circles, or as we're doing here, go up and down 10:47 methodically crisscrossing the breast. 10:51 Now, I think you found something right there... 10:53 That must give you a funny feeling... 10:55 Yes, there's a lump. 10:56 But this breast here, as we do it, has several lumps. 11:00 As we come over the nipple area, it's important 11:02 NOT to be afraid to examine beneath the nipple... 11:06 And, indeed, in this model, there is, as you're going 11:10 back to it there, a lump underneath the nipple. 11:14 Also, just to show that breast lumps can occur ANYWHERE, 11:18 they have placed another lump, 11:19 and you're feeling it right there. 11:21 Now, a breast examination is not complete without examining 11:25 under the armpit, as you are doing 11:27 with your fingers right there. 11:28 And I believe... there you found something. 11:30 You have found a lymph node. 11:32 We would hope that people would not find a lymph node 11:36 in the axilla. 11:38 So Mollie, you've shown our patients how to 11:42 examine a breast, and you have also shown them 11:45 that regular examination, being alert, 11:49 and taking care of yourself 11:50 results in you looking so well today... 11:52 Well, thank you very much. 11:53 Mollie, thank you so much... You're very welcome 11:57 It's been a pleasure having you here... thank you. 12:00 Some of you who watched this last segment may be wondering... 12:03 "What happens if I find a lump in my breast?" 12:08 Let's ask Dr. Handysides... 12:10 Dr. Handysides, what is the next step? 12:13 Well, the next step is to go and visit your health professional. 12:16 You really want to get a professional opinion 12:18 on this lump. 12:20 And the lump needs to be examined clinically, 12:23 because there are certain consistencies, mobilities, 12:27 attachments and features about a lump that a 12:30 health professional will be able to identify as being 12:34 reassuring, or possibly suggestive that things need 12:37 to be further investigated. 12:40 It may be that an ultrasound would show whether this 12:43 was a cyst or not, because it might show fluid in there. 12:46 Depending on your age, and depending on your 12:50 predisposing factors, he may want to do mammography. 12:55 Even CT and MRI of the breast have been shown to be 13:01 very, very good. 13:03 But in a situation where there is a lump... 13:06 that cannot be positively identified, 13:09 I can't stress how important it is that there should be 13:14 a definitive diagnosis, and that is usually made by biopsy. 13:18 One can't just say... 13:20 "Well, let's watch it and see... or PERHAPS 13:25 it's this or perhaps... " 13:26 You REALLY NEED to make a definitive diagnosis. 13:28 And as Mollie said, her doctor was not prepared to wait 13:31 until next February from October 13:34 They wanted to move ahead. Next week... 13:35 It doesn't make a difference of a week... 13:38 but certainly months begin to count. 13:41 So, a biopsy is the first step. 13:44 Now what about mammograms? When do they come in? 13:47 Well, mammography has been used, and is being used 13:50 as a screening device. 13:52 There's been a lot of controversy about mammography 13:54 because, first of all, the studies have sometimes 13:58 differed as to its effectiveness as a screening tool. 14:02 It does not detect all cancers. 14:05 It maybe will give very positive results in 90%. 14:09 That's very good... and you couple that with 14:12 self-examination, clinical examination, 14:15 ultrasound and so forth... 14:17 And the detectible cancers rise even more. 14:21 So vigilance is very important, 14:24 and mammography today has a very, very low 14:26 amount of radiation. 14:28 The modern technology has reduced the amount of radiation 14:31 Probably the most uncomfortable thing about it is 14:34 that the breast has to be squeezed between 2 plates, 14:37 and so we usually advise younger women who are still 14:40 menstruating that they go AFTER the menstrual cycle 14:43 so that their breasts are not sensitive and tender. 14:46 Don't they have some new machines now that make 14:50 that less comfortable... Oh yes! 14:52 All the time, techniques are improving... 14:55 so it's becoming less of a problem... 14:57 And it's certainly nothing excruciating that women 15:00 couldn't have a mammogram. 15:02 I can hear some of our viewers saying... 15:04 "Oh... it's good for him to say, he's never had to have one. " 15:07 But it is true that good technique in the hands of a 15:10 very supportive staff can be done very, very nicely. 15:15 You know, every year over 200,000 women hear these words 15:20 "I don't like the looks of that, we need to do a biopsy. " 15:24 And after they've done that, the doctor may say... 15:27 "I believe you might have an aggressive, or you might have 15:30 a cancerous tumor. " 15:31 What kind of treatment do you recommend? 15:35 There is not the slightest doubt in my mind... 15:39 and I don't believe that there's any doubt in the 15:42 literature either... that a cancer in the breast 15:46 caught early should be removed... 15:48 because it can usually be removed in its entirety. 15:52 Are you talking about a total mastectomy or... No 15:56 You know that again, there's been a lot of change... 16:00 Forty years ago, when I was a medical student, 16:04 they were doing radical mastectomies... 16:08 dissecting glands out behind the sternum, 16:12 really defacing the people. 16:16 Today with early detection... 16:18 and this is one of the beauties of doing routine mammography 16:21 with early detection, oftentimes a simple lumpectomy 16:25 In fact, there are people who have had an excision biopsy 16:29 that has been wide enough that it excised 16:32 the whole of the tumor... 16:34 and when that takes place, they may be cured! 16:37 And so, a lumpectomy may be all that's required. 16:41 Of course, the treatment has to be matched to the stage. 16:45 And you haven't talked about staging... 16:47 I haven't talked about staging, maybe we should talk about that 16:50 Cancer begins usually in a duct of the breast... 16:57 The breast is a gland, so in one of the gland ducts, 17:01 or in the acinar portion that makes the milk... 17:04 we start to get these abnormal cells that divide... 17:06 When they progress BEYOND the actual basement membrane, 17:13 they go from stage 0, which is just the abnormal cells 17:17 or in situ, to an invasive cancer... 17:21 But if it's a very small cancer, less than a centimeter, 17:24 it's just a stage I cancer... 17:28 and at that stage, very seldom has it spread to lymph nodes. 17:32 Now USALLY, in the biopsy or lumpectomy, they will examine 17:38 for lymph nodes in the axilla. 17:40 This is a test, as much as anything else, to see whether 17:43 it has spread to the axilla. 17:45 They currently are still removing, maybe 10-15 nodes 17:50 from the axilla... lymph glands from the axilla. 17:53 However, it has become increasingly obvious that the 17:56 sentinel node... that is the first node in the drainage area 18:02 can be biopsied, and it's looking very promising 18:06 in the studies that are being done... 18:07 that sentinel node biopsy, which would be simpler than 18:11 a total dissection of the axilla 18:14 will be sufficient to say whether or not 18:17 it has spread or not spread to the axilla. 18:19 If the sentinel node is NOT involved, 18:21 then the likelihood is 97-98% that no other nodes are involved 18:27 Of course, people, women or men, can ALWAYS have 18:30 the right to choose if they want a complete 18:32 dissection or otherwise. 18:35 Today, a simple mastectomy maybe required for a 18:39 more extensive cancer... 18:41 And then, of course, if the cancer is beginning to grow 18:45 through to the fibrous overlying the pectoralis muscle 18:49 on the chest wall, or is becoming more... 18:51 then a more radical procedure may require to be done. 18:55 But, by and large, we are seeing VERY FEW radical mastectomies 19:01 and, with early detection, far more is lumpectomy 19:05 followed in many cases by irradiation because 19:10 irradiation will mop up any localized cancer cells, 19:15 or cells that might be beginning to migrate 19:18 and the success rate with a local irradiation 19:21 has been just excellent. 19:22 What about systemic therapy that goes beyond radiation maybe 19:27 Somebody who has disease confined to the breast, 19:31 probably does not require very heavy chemotherapy. 19:36 Chemotherapy is reserved for people in whom 19:39 distant spread, or dissemination throughout the body... 19:43 stage III, stage IV, has taken place. 19:47 I should mention "tamoxifen" 19:50 because tamoxifen or these estrogen-blocking substances 19:54 ...These are substances which plug the estrogen receptors 19:57 And the idea there is that if you can plug 19:59 an estrogen receptor with tamoxifen, 20:02 then estrogen won't work on it. 20:05 The tamoxifen doesn't stimulate cellular division 20:07 it just blocks the receptor. 20:09 So that is sometimes recommended for a period of 4 to 5 years 20:12 AFTER there has been a treatment such as a lumpectomy, 20:19 followed by radiation. 20:20 Now, who makes the choice on whether the simple, 20:26 or more complicated, or more radical things are done 20:33 to the woman's breast? The patient. 20:37 Always the patient? The patient makes the choice. 20:40 We are responsible for our own bodies. 20:43 Now an intelligent patient, listens to good advice, 20:48 and weighs it, seeks out all kinds of 20:52 information, and then makes her or his choice 20:56 based on that information... 20:58 And that's why second opinions are VERY important. 21:01 Any of you who are watching this program... who may HAVE 21:05 a lump at this time, I would advise you STRONGLY 21:10 that you get as MUCH information as you possibly can. 21:14 One of the things that I sometimes feel we need to stress 21:18 particularly from this station, because we do an awful lot 21:23 of talk about lifestyle, and disease prevention... 21:28 we need to understand that there is a DIFFERENCE 21:30 between PREVENTING a disease, and CURING a disease. 21:35 I sometimes say that if you have a child who is wanting to put 21:38 his hand on a hot stove, and you pull the hand away, 21:41 you have prevented a burn! 21:44 But once the burn has taken place, it doesn't really help 21:47 to pull the hand away once the burn has taken place. 21:51 In the same way, our lifestyle is very, very important 21:56 for giving us the BEST chance possible to AVOID these diseases 22:01 But if we GET the disease through no fault of our own, 22:03 perhaps through genetics... 22:07 The fact is that we don't understand, nor know, 22:09 THEN, yes, those good lifestyle measures are still important 22:14 to help us FIGHT the disease, 22:17 but we really should get rid of it because we have no 22:20 evidence whatsoever that they will CURE the disease 22:24 unless we actually surgically remove or irradiate 22:27 somehow KILL those cancer cells. 22:30 And then, of course, the preventive measures are to 22:32 help us prevent getting cancerous change in tissues. 22:36 Do we really know some of the causes of breast cancer? 22:40 This has been looked at a great deal. 22:42 I've talked about the predisposing factors... 22:44 For instance, it may be estrogen exposure is important. 22:47 We know that young women who begin menstruating very early 22:50 ...maybe 9 years old, and then menstruate through 22:52 until they're 55 years of age, exposed to endogenous 22:56 body-made estrogen for a long time, 22:59 we know that they have an increased risk... 23:02 So the earlier age of menarche, and the long period of time 23:09 is the risk factor... IS a risk factor! 23:11 But does a woman have a choice? 23:12 She doesn't have a choice! Okay... 23:14 But there ARE some choices For instance... 23:17 AFTER the menopause, we also know that taking hormonal 23:21 replacement therapy, which can be justified in 23:25 certain situations, but we know that there is an 23:28 increased risk of breast cancer in the woman who continues 23:32 taking estrogens after the menopause... 23:36 because she is lengthening that exposure. 23:38 There is a little bit of evidence that 23:40 birth control pills MAY be related to breast cancer, 23:45 but it's not strong evidence. 23:46 It's just a little suggestion. 23:48 OBESITY is a VERY, VERY STRONG correlate. 23:52 ALCOHOL... the drinking of alcohol has been associated 23:56 with increased risks of breast cancer. 23:58 Now, what if the cancer reoccurs... 24:02 and how likely is it to reoccur after 5 years? 24:06 Is there any Stats on that? 24:08 Well, we can't ALWAYS say that somebody that survives 5 years 24:13 would not have a recurrence... 24:15 But the VAST majority who reach 5 years, 24:18 can clinically say that they are cured 24:21 That's good news! GOOD NEWS! Yes 24:23 Now, some women are concerned about the side effects of some 24:26 of these treatments. 24:28 Could you say just a little bit about that 24:29 in the next couple of minutes? 24:31 Well, I don't think it's a bad thing to be concerned about. 24:35 If you have dissection of the lymph glands, for instance, 24:39 in the axilla, which are very necessary if there is 24:41 cancer there, you may find that there is a swelling, 24:44 or what we call "lymphedema" of that arm. 24:47 ...Now you need to be very careful if that happens 24:50 because the skin will be particularly prone to 24:53 little cuts and scratches that can get infected 24:57 because the drainage is not good... 24:59 So that's an important thing to be aware of. 25:02 Of course, radiation leaves an area that is reddened, 25:07 and burned somewhat. 25:09 And people who have a reddening, you know, 25:13 later goes a little bronze, they may be self-conscious about that 25:17 Some numbness and tingling beneath an area of surgery 25:21 is not uncommon. 25:22 If you're on medications, the medications themselves 25:25 may have side effects. 25:26 Tamoxifen sometimes causes people to feel nauseated 25:30 It sometimes is upsetting to the stomach. 25:33 It can even irritate the lining of the uterus 25:36 and cause little cystic changes within the lining of the uterus. 25:39 So, yes, you have to be aware of these side effects. 25:42 What about losing their hair? 25:45 No, they're not going to lose hair with tamoxiphen. Okay 25:47 They are going to lose hair if they are put on other 25:51 chemotherapeutic agents that are, "cidal" to the cell 25:55 they are killing the cells, and they may lose their hair. 25:58 But the good thing about that is that hair usually re-grows. 26:02 What about reconstructive surgery? 26:04 Is that something you would recommend? 26:06 Reconstructive surgery is something that is really 26:11 a woman's choice. 26:12 It depends on how old they are... 26:15 It may depend on how they perceive their body... 26:18 the sense of body image that they have. 26:20 Some women feel a loss of femininity 26:23 when they lose the breast. 26:24 And certainly, reconstructive surgery can be done 26:26 beautifully... Plastic surgeons are excellent 26:29 at this, and they can do an excellent job using one's own 26:33 tissue, fat... moving it around, mobilizing their own flaps. 26:36 Sometimes putting in an implant which are very realistic 26:40 the implants of today. 26:41 And, by the way, implants have been cleared of some of the 26:45 shadow that was over them in times past. 26:52 So, this sounds a little encouraging... 26:55 that really, breast cancer diagnosis is not 26:59 necessarily a death sentence... 27:00 Oh no... breast cancer diagnosis is not a death sentence 27:03 by ANY MEANS! So it's not like the old days? 27:05 NOT like it used to be in the old days 27:07 And to this, we really owe, I believe, improved technology, 27:12 but very, very much so... EARLY diagnosis 27:16 and getting on with a specific treatment 27:19 at the time of early diagnosis 27:20 And just one other quick question about 15 seconds... 27:23 Should women consider alternative therapy in this case 27:29 Well, when you've had something studied as breast cancer 27:34 has been studied... with thousands upon THOUSANDS 27:36 of thousands of cases, there really is not an alternative 27:40 because they KNOW what is the best therapy... 27:43 and that's what's currently being used. 27:44 SO, we're GLAD TODAY, Dr. Handysides, for the 27:47 GOOD NEWS that you've given us about breast cancer. 27:49 We are happy that... what our viewers have, 27:53 hopefully, learned something more than they 27:55 knew about breast cancer. 27:57 It is not a death sentence. 27:59 There is great hope out there for you. 28:02 But, be sure to get checked up and be sure if you are 28:06 diagnosed... to believe the Lord can help you get through this 28:10 and you will, in the end, be good! |
Revised 2014-12-17