Episode Transcript
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(00:00):
Mixed when I was six five.Good morning, it's Christina Wolford. It's
just after ten o'clock, so it'stime for Lady Parts with doctor Richard Villareal.
And doctor Villareal. We've got avery special guest in here today.
I'm not sure I think you knowher quite well. I know her very
well. Introduce your guest for ustoday. Today we have my wife,
doctor Kathleen Villarreal. She's an internistand a pediatrician at a Dean Origional Medical
(00:25):
Center. We met in medical school. I went through residencies and she's the
love of my life. Oh howsweet. She's here to talk with me
about breast cancer. So that's whyshe's here today. She wants all the
women to hear how important this is. And you know, and that goes
around the whole thing with breast cancerawareness. Why do we celebrate? Why
do is this so important? Youknow? Because these are the people we
(00:47):
love. These are our wives,our mothers, our grandmothers. These are
the people you take care of everybody. You make sure that the family goes
on. So we want to makesure that you get in, you get
taken care of, you get seen. We don't want you to be embarrassed.
We don't want you to be ashamed. We want you to know that
we're here for you, we loveyou, and we want you to take
care of yourselves. So that's whywe're talking today to get everybody in here.
(01:08):
And I think it's important. Sowe're gonna get started. She's gonna
shoot me, but we're gonna keepWe're gonna get going here. Let's start
with what we're gonna do today.First is we're gonna start with statistics so
everybody understands why this is so important. So, Kathy, breast cancer affects
a lot of women. Yeah.So it is the most common cancer in
(01:34):
women that we have, and itis the number two cancer killer in women.
Wow. One. Every woman hasa one in eight lifetime risk of
getting cancer. So when you realize, you know how many people you've talked,
oh, I had breast care andI had breast cancer, it's because
it's one in eight risk. Andthat's one thing that we want people to
(01:55):
realize. You know, when Itold people that I had breast cancer,
the comment was, well, well, I don't really need to worry about
that. That's not in my family. I'm like the average risk person has
a fifteen percent chance of developing breastcancer in their lifetime. Wow. Well,
if you think one in eight,that probably is somebody in your family
anyway, I mean not right,wow, But and then you know,
if you've got a family history,then it may be even more than that.
(02:19):
But the general population has to realizeit. One in eight women are
going to have breast cancer at somepoint in their lives, and so we
all have to take this very seriously. We have come a long way in
therapy and so it's not even thoughit represents that many cases of cancer in
women across the United States, it'snot the number one killer anymore. Lung
cancer has passed that up because we'vegot really good treatments and if we can
(02:44):
get out there, we can gettested early, and we can get the
diagnosis made. You're not going todie from this. You're gonna live many,
many years after the diagnosis. Sothat's the goal. And you know
the women that come into the officeand they say, well, there's nobody
in my family with breast cancer.But you know what, it has to
start somewhere. There's always that firstperson in the family that starts. You
(03:04):
know, the tradition it's there.So it starts with somebody. So you
may be the first one, sowe want to make sure you're okay,
so let's start. Usually what wedo is we start with the self press
examinations, and I start a littlebit earlier because I see some of these
women a little bit sooner than mywife does. She's an interness, and
I'm the gynecologist and obstetrician, andyou know, I start my women and
(03:27):
the young women when they come inat age between sixteen and eighteen, because
I've already had a young woman dieat sixteen and one die at eighteen of
breast cancer. So it starts veryearly, and it can and the problem
with these two is that they wereafraid to tell anybody about it. And
that's the importance of this whole thing, is that we want the women to
be very comfortable with themselves, tobe comfortable with our breasts, particularly when
(03:49):
they're young. And it's the mom's, you know, job to teach them
this is okay, there's nothing wrongwith your body right right, And it's
it's more than just saying, oh, once a month, I'm gonna check
my breast to look for cancer.It's being comfortable with your body and the
changes every day. So it's notnecessarily that women don't always find breast cancer
(04:11):
just because on this particular day ofthe month. You know, on the
third of the month every year theycheck the breast. But every day they're
paying attention to their body as they'reshowering and what are the changes that you're
gonna have there. But you dohave to have a systemic way to evaluate
the breast too, so not justwhen you're showering, and how you do
that's how we have to teach people. There are different two different ways that
(04:38):
people have made recommendations for it.Traditionally, it's always been to start in
a circular pattern. When I teachyoung women how to do it, it's
not to use the tip of yourfinger. That's the most sensitive part and
you're going to feel everything, soevery little bump and bump that's there,
and then you're gonna be freaked out, right, But if you feel what
the second part of your finger,it's a little bit less sensitive. But
(05:00):
if you push a little pressure ina circular motion starting from the outside of
the breast and then going in circlesuntil you get all the way into the
nipple, and then if you feelany regularity, pay attention to it.
Don't be freaked out at first,because everybody's got some irregularity. If that
irregularity changes or gets bigger, that'swhat we're looking for. Then you of
(05:24):
course want to look at the skinfor any dimpling or changes where the skin
kind of pulls in, or isthe nipple itself pulls in. But don't
be freaked out if you have that, because there are a lot of women
who have an inverted nipple on oneside. It's been like that all their
life, so it's a change thatwe're looking for too, So we're gonna
have to look for changes if itwasn't there and now it is, you
(05:46):
know, you want to watch.So what do we tell people you find
a lump? So do we tellthem to call us immediately or is there
a difference between somebody who's young andfinds it and somebody who's postman a puzzle.
Absolutely, First of all, yourrisk for cancer is going to go
up to the age of forty.Now. You know, Richard unfortunately has
had that horrible experience of making thediagnosis at sixteen and eighteen, but that's
(06:08):
not very common. Most of thewomen are going to be diagnosed are going
to be after the age of fifty, but we see it fairly common in
the forties also. But if youare premenopausal versus postmenopausal, is a big
discriminator because fibercystic disease is something thatwill often scare people and they will find
(06:30):
changes in their breast and that tendsto be hormonally mediated. So depending on
the time of the cycle you arecoming on to your period, those hormone
release are going to affect the breastand so fibercystic disease may be worse in
the days upcoming to your period,and so that's going to change in time.
So typically, particularly in women whoare still menstruating, the recommendation is
(06:55):
if you find something at around thetime of your period, just keep paying
attention to it for a couple weeks. If it's persistent as your body's changed
through the cycle of the month,then you need to be seen in a
post mental puzzle person because that changeisn't going to be there much or not
having that hormonal fluctuation. If youfind something, just go be seen right
(07:18):
away. So you mentioned something,so fibrocystic changes, fibricistic breast disease,
fibrocystic, there's all kinds of namesfor it. So what is that,
Well, they are benign swelling inthe duck. So if you think of
the breast, what was its purpose? Its purpose is to make milk and
(07:41):
secrete milk for when we breastfeed babies. But all of those little tiny ductuals
that from where the breast milk potentiallyis created and then is passed down through
to the nipple, they can getplugged. They can swell in a relationship
to hormonal stimulation to the body andyou'll feel these little lumps and bumps.
(08:01):
Those can change not only based onperiod, there are other things get can
affected, things that we eat orthings that we do. Caffeine is not
a wives tale, but it is. If you drink a lot of caffeine,
it's going to make you have moreproblems with fiber acistic breast disease.
So these are chocolate but nine,yeah, I like chocolate, good thing.
You're not a woman, I know. I mean it's a good thing,
(08:22):
but usually we do. And likeshe's saying, with the caffeine or
the chocolate. Licorice is another one. You know, usually if they find
lumps and bumps. We tell themto cut back on their caffeine, cut
back on their chocolate, things likethis, and then wait and see what
happens the next month. So keepgoing, you're doing great. The fibroccistic
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breast disease also tends to be painful, and those cysts, those lumps tend
to be tender as opposed to canceris usually a painless thing. The nodules
associated are typically not. So ifit's painful or tender, it's more likely
to be fiberistic breast disease, andthere are recommendations what we can do to
(09:03):
help with that. Vitamin E supplementationcan be helpful. It doesn't really make
the cisco away, but it canhelp with the tenderness it's associated with this
systs. And that's another thing womencan do for fiber cistic breast disease.
And sometimes we'll give them moral contraceptivethings like that which will help with their
cycles because it's all hormonally mediated andit can sometimes alleviate some of the pain.
(09:24):
So if we can try to regulateit a little better so that does
not increase your risk of breast cancer. Though having fiber sistic changes correct it's
not a pre malignant condition. Thatis absolutely correct. So if you have
fiber sistic changes, it's not aproblem. You still need to do your
exams, you still need to becareful, but it's not a forbear.
It's not going to become a cancer. So what are some of the risk
(09:46):
factors for breast cancer? So you'vegot some things that you can't change,
and you've got some things that youcan change. Absolutely, So let's start
with the things that you can't change. Okay, you can't change that you're
female. But let's also remember mencan have breast cancer. And so I
don't know if a man might belistening to this program with his wife,
(10:09):
but you know, a woman alsoneeds to realize that men can sometimes find
the lumps and bumps in their breastsand that we should not ignore those.
It's a little harder to do amammogram on a man, but those things
can be done too. But beingfemale, that's first our biggest risk.
As we get older, their riskassociated and we can't control either of those,
(10:30):
and family history we can't control thateither. There are a whole host
of genes now that we're finding thatare associated with breast cancer. Most people
have heard of BRCA one, br C A two, brack of one,
and brack A two. Those arethe most common that are associated with
(10:50):
a really high increase the risk.There's only about one in five hundred women
are going to have one of thoseparticular genes, but they go from having
a fifteen percent lifetime risk to havinga sixty percent lifetime risk, So that's
a whole different situation. Most familyhistory aren't even going to be the bracas
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though, and there's just a lotof people who have the genetic testing and
they don't have BRAKA, but there'ssome minor ones out there. We can't
tell those families what is their lifetimerisk as well as we know the bracut.
But we are learning in medicine withall of the advances in genetics that
there are more and more genes beingidentified. So what are some other things?
(11:35):
For example, race, ethnicity,does that have anything to do with
it? Yes, so Caucasian womenare at higher risk than African American who
are at higher risk than Asian forHispanic or Hispanic Native American at the lowest
risk. What about dense breast tissuedoes that increase your risk? Doesn't increase
(11:56):
your risk. It makes it moredifficult to find the breast cancers, and
so sometimes the modalities that we useto screen for breast cancer are going to
be a little bit different. Andthe women that have very dense breasts,
and what about maybe starting your mensiesearly or having menopause late. So the
longer that your body is being exposedto estrogen. If we say that these
(12:20):
cancers are oftentimes hormonally stimulated, it'show long you were. So if you
were one of those people that startedtheir periods very young, I mean,
the average age is twelve and ahalf, but it can be as young
as nine and as old as fifteenand still be considered normal. So if
you were that young child that startedat ten and then you didn't go through
(12:41):
menopause until year or later, there'sa lot longer time period your body was
exposed to estrogen. There's also aprotective event of pregnancies and breastfeeding. So
women who've never had any children areactually at higher risk for breast cancer.
Women who didn't have their first childtill after the age of thirty or at
(13:01):
slightly higher risk. And those womenthough that did have several children and who
did breastfeed are at lower risk.Okay, so what about you know,
some people have early cancers or havethe other things that get radiation. So
radiation to the chests, things likethat can predispose you, right, and
that's one of the biggest other thanthe family history with the brackagenes. Radiation
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exposure to the chest between the agesof ten and thirty significantly increase your risk.
And so that's oftentimes children who hadchildhood cancers or malignancies are now going
to be at higher risk for secondarycancers, including breast cancer. And there's
nothing we can do about any ofthese things that we've talked about. So
let's talk about some lifestyle changes thatcan be related to your risk actors how
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you can reduce your risk. Forexample, alcohol, alcohol is going to
increase, so particularly excessive use forwomen we don't metabolo as well as men.
Really more than one glass a day, we can increase our risk of
breast cancer. Wow. Overweight,overweight obesity because obesient in itself. People
(14:11):
don't realize that fat cells can actuallymake estrogen, and so that increases a
hyper estrogen in the state when you'resignificantly overweight. So managing our weight and
trying to keep a healthy body massindex of under twenty five can make a
huge difference in what our risks are. And that goes along with not being
physically active. So the more physicallyactive you are, the less you're going
away, You're going to take offsome of the fat, you're gonna have
(14:33):
less estrogen in your body. Andthen you already mentioned a couple of them
not having children. There is one. Nothing I'm encouraging everybody to go out
and get pregnant. But you know, it's great for you know the obstetrician
great and breastfeeding. Breastfeeding is veryimportant, so it really produces your risk
of breast cancer. So that's amazing. Now, what about hormones, So
(14:56):
there's a lot of I know you'regoing to you know, this is a
tough one. This is a toughone. Where hormones are not taking hormones
in younger ages, the risks associatedwith it are not as significant, but
we still can worry about long termexposure to hormones and does that increase your
risk over time for breast cancer.Really where we worried about it is in
(15:16):
the postmenopausal women, So particularly estrogenreplacement or people women over age of forty
who are still still menstruating but aregetting to that time peri where they're higher
risk. Being on estrogen after theage of forty may give you a little
bit more of a risk factor associatedwith it. So there were some studies
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very early on when we were firststarting out our practices that you know,
encouraged us to stop using hormones inthe postmenopausal women. So we went through
that whole phase, you know,twenty years ago, and so we're starting
to show our age a little bitor even thirty years ago, and then
it's kind of faded away and we'reusing them again. We're finding well,
it's not as bad as well whatthey thought in these studies, and so
(16:00):
we're using them again. But Ithink that the women are smarter now because
they know, they do their exams, they get their mammograms, they let
us know if there's an issue,and we always discussed the risks and benefits
whenever we start any of these medications, so everybody knows going into it how
important it is. I think alsothe products that we have available to prescribe
patients now have a lot lower estrogencontent in them when they first came out
(16:23):
with the burst control in the sixties, and that's way before we were practicing.
We were born, I was born, but about it, but those
were that amount of estrogen was amuch higher risk. I mean, the
products that we're able to prescribe forpeople have much lesson so the risk goes
down associated with that too. Okay, so let's move on. Then let's
talk about some symptoms of breast cancer. How do we know what is it?
(16:45):
Like? What are some of thesymptoms that you would think I have
breast cancer that you would distinguish betweenfibercystic change and a cancer, so meaning
like the lump, the shape.Well, first of all, the one
we already mentioned was the tenderness.Typically cancers until they get very large or
(17:07):
there's certain subtypes are not going tobe tender. They're just going to be
a lump that you found. FiberCystic tends to be more tender if they
are firm and fixed, so youfeel it and there's it doesn't wiggle at
all, it doesn't have any jiggleto it. You know, a cyst
is going to be a little fluctuin. It's going to feel like a
(17:29):
water balloon, a little blottable sensationto it that the cancer is going to
be a hard consistency. Oftentimes,when that cancer is sitting a little bit
below the surface, it's what's goingto pull on the skin. And so
we're did we talk about dimpling ortinting in the skin where there's this regularity
where the skin goes down, you'regoing to look for something like that.
(17:52):
There are subtypes of cancers that canactually have changes to the nipples too and
have a very irregular look to it. We use a term called poe to
orange, but basically means the peelof an orange. It has that kind
of bumpy irregularity. If you seethat on the surface of the skin,
that's another concerning love. You wouldsee a discoloration of the skin. And
then she also mentioned about the retractionof the nipple. Though it can be
(18:14):
normal, if it changes, that'ssomething that we want to look into.
And a nipple discharge, but thatis not always going to be cancer.
Women with fiber cistic breast disease canhave colored nipple discharges like a blue green,
like a bluish green, and thatis from the cyst. It's not
cancerous. So you know, don'tbe alarmed, but it's something that we
do have to be part of thesymptom to a bloody discharge is going to
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be more concerning, or all ofa sudden you see a change in the
shape of the breast, you haveone breath, all of a sudden it's
grown, or you find a largermass, there's something not right. You're
looking in a mirror that wasn't likethat before. You know, that's why
it's important and you want to beseen. Okay, So we've talked about
you know what you do. We'vetalked about what you're looking for. So
you do this, you go tothe doctor, and then what does a
(19:00):
doctor want to do. Well,they're going to do and exam themselves and
get a better feel and then takeyou into overall consideration. They're not only
going to feel the breast. They'regoing to feel in for the lymph nodes,
so in the area above your collarboneand into your armpit, and if
they're going to feel any little lumpsor bumps there that may make them more
(19:21):
concerning. They're also going to takeinto consideration though your age. Like I
said, if it's a twenty fouryear old comes into me and tells me,
she just got off a period andI feel it was a lumpy bumpy.
I may tell her to stay awayfrom the caffeine, take some vitamin
E, and come back and seeme in three weeks so that we're in
a different part of your cycle andjust re examine it if it's concerning.
(19:44):
And it almost always if you're goingto be older, anybody over the age
of forty, we're going to sendyou straight for a mammogram. And typically
the diagnostic mammogram that's when we're actuallylooking for something that we can feel is
going to be associated with an ultrasoundat the same time. So that's why
a lot of the time, whenthe women come in for their annual examinations,
they usually will call the office sometimes, well, I want to get
my mamogram ahead of time, butif we find something on an examination,
(20:07):
it's a different mammogram, So that'swhy we'd like to wait until we see
you instead of riding ahead of timebecause it's different. Makes sense. Yeah,
With the diagnostic mammogram, they're goingto use sometimes an extra visualization,
a different size or shape, andoftentimes, if we were to find something
ahead of time, the diagnostic mammogramis always going to be done at the
(20:32):
hospital where we know that they're goingto have easy access to the radiologists,
so the radiologists can actually come intothe room while you're still there and say,
oh, there is something here,let's get an extra visualization, whereas
a screening mammogram can be done inyou know, the traveling vans, right,
Yeah, yeah, Dina has allkinds of sites that you can do.
You're all over the place, youknow, in Columbus they have them
(20:52):
at the mall so people can goshopping and all buy on the way,
go have my mammogram with those arefor those screening mammograms, and that's going
to be a little bit different.But I think you know, with Kathy
coming in here today, it's justsomething we wanted to share and we wanted
to let the people know, andthe women in particular to know, don't
be scared. Get out there,do it for your families, Do it
for yourself, get your mammograms,do your breast exams and be checked,
(21:17):
and you know and love your families. Just do it for them. And
of course, doctor Villarela, ifwomen are hearing this and they're scared,
you know, they maybe there's somethingirregular. Maybe they're like, I'm long
past two, I need to getchecked. So I'm sure they can call
Adeena and get an appointment set upif they don't have a doctor. You
guys still accepting new patients. We'reall accepting new patients, all the gecologists,
(21:38):
all the family practitioners, you know, the internists. The law gets
you in now. And the onething that's changed as far as screening goes
to is that you actually don't youcan sell for refer yourself. If you
call Adina and self refer, they'rejust going to ask you who do you
want the results sent to. Soif they have an abnormality, they've got
(21:59):
to reach out and find somebody that'sgoing to get you follow up. But
even if you don't have a primarycare and you make your appointment, those
breast care specialists that we have,if they find something, they're gonna find
you a doctor for follow up.So that's important. So you don't have
to wait. If somebody can't getyou into somebody who you want to see,
just call, get your mammogram andthey'll take care of you. All
right, great, thank you somuch again, Kathy. Thank you doctor
Richard Villarreal. This has been ladyparts with doctor Villarreal.
Mixed when I was six five.Good morning, it's Christina Wolford. It's
just after ten o'clock, so it'stime for Lady Parts with doctor Richard Villareal.
And doctor Villareal. We've got avery special guest in here today.
I'm not sure I think you knowher quite well. I know her very
well. Introduce your guest for ustoday. Today we have my wife,
doctor Kathleen Villarreal. She's an internistand a pediatrician at a Dean Origional Medical
(00:25):
Center. We met in medical school. I went through residencies and she's the
love of my life. Oh howsweet. She's here to talk with me
about breast cancer. So that's whyshe's here today. She wants all the
women to hear how important this is. And you know, and that goes
around the whole thing with breast cancerawareness. Why do we celebrate? Why
do is this so important? Youknow? Because these are the people we
(00:47):
love. These are our wives,our mothers, our grandmothers. These are
the people you take care of everybody. You make sure that the family goes
on. So we want to makesure that you get in, you get
taken care of, you get seen. We don't want you to be embarrassed.
We don't want you to be ashamed. We want you to know that
we're here for you, we loveyou, and we want you to take
care of yourselves. So that's whywe're talking today to get everybody in here.
(01:08):
And I think it's important. Sowe're gonna get started. She's gonna
shoot me, but we're gonna keepWe're gonna get going here. Let's start
with what we're gonna do today.First is we're gonna start with statistics so
everybody understands why this is so important. So, Kathy, breast cancer affects
a lot of women. Yeah.So it is the most common cancer in
(01:34):
women that we have, and itis the number two cancer killer in women.
Wow. One. Every woman hasa one in eight lifetime risk of
getting cancer. So when you realize, you know how many people you've talked,
oh, I had breast care andI had breast cancer, it's because
it's one in eight risk. Andthat's one thing that we want people to
(01:55):
realize. You know, when Itold people that I had breast cancer,
the comment was, well, well, I don't really need to worry about
that. That's not in my family. I'm like the average risk person has
a fifteen percent chance of developing breastcancer in their lifetime. Wow. Well,
if you think one in eight,that probably is somebody in your family
anyway, I mean not right,wow, But and then you know,
if you've got a family history,then it may be even more than that.
(02:19):
But the general population has to realizeit. One in eight women are
going to have breast cancer at somepoint in their lives, and so we
all have to take this very seriously. We have come a long way in
therapy and so it's not even thoughit represents that many cases of cancer in
women across the United States, it'snot the number one killer anymore. Lung
cancer has passed that up because we'vegot really good treatments and if we can
(02:44):
get out there, we can gettested early, and we can get the
diagnosis made. You're not going todie from this. You're gonna live many,
many years after the diagnosis. Sothat's the goal. And you know
the women that come into the officeand they say, well, there's nobody
in my family with breast cancer.But you know what, it has to
start somewhere. There's always that firstperson in the family that starts. You
(03:04):
know, the tradition it's there.So it starts with somebody. So you
may be the first one, sowe want to make sure you're okay,
so let's start. Usually what wedo is we start with the self press
examinations, and I start a littlebit earlier because I see some of these
women a little bit sooner than mywife does. She's an interness, and
I'm the gynecologist and obstetrician, andyou know, I start my women and
(03:27):
the young women when they come inat age between sixteen and eighteen, because
I've already had a young woman dieat sixteen and one die at eighteen of
breast cancer. So it starts veryearly, and it can and the problem
with these two is that they wereafraid to tell anybody about it. And
that's the importance of this whole thing, is that we want the women to
be very comfortable with themselves, tobe comfortable with our breasts, particularly when
(03:49):
they're young. And it's the mom's, you know, job to teach them
this is okay, there's nothing wrongwith your body right right, And it's
it's more than just saying, oh, once a month, I'm gonna check
my breast to look for cancer.It's being comfortable with your body and the
changes every day. So it's notnecessarily that women don't always find breast cancer
(04:11):
just because on this particular day ofthe month. You know, on the
third of the month every year theycheck the breast. But every day they're
paying attention to their body as they'reshowering and what are the changes that you're
gonna have there. But you dohave to have a systemic way to evaluate
the breast too, so not justwhen you're showering, and how you do
that's how we have to teach people. There are different two different ways that
(04:38):
people have made recommendations for it.Traditionally, it's always been to start in
a circular pattern. When I teachyoung women how to do it, it's
not to use the tip of yourfinger. That's the most sensitive part and
you're going to feel everything, soevery little bump and bump that's there,
and then you're gonna be freaked out, right, But if you feel what
the second part of your finger,it's a little bit less sensitive. But
(05:00):
if you push a little pressure ina circular motion starting from the outside of
the breast and then going in circlesuntil you get all the way into the
nipple, and then if you feelany regularity, pay attention to it.
Don't be freaked out at first,because everybody's got some irregularity. If that
irregularity changes or gets bigger, that'swhat we're looking for. Then you of
(05:24):
course want to look at the skinfor any dimpling or changes where the skin
kind of pulls in, or isthe nipple itself pulls in. But don't
be freaked out if you have that, because there are a lot of women
who have an inverted nipple on oneside. It's been like that all their
life, so it's a change thatwe're looking for too, So we're gonna
have to look for changes if itwasn't there and now it is, you
(05:46):
know, you want to watch.So what do we tell people you find
a lump? So do we tellthem to call us immediately or is there
a difference between somebody who's young andfinds it and somebody who's postman a puzzle.
Absolutely, First of all, yourrisk for cancer is going to go
up to the age of forty.Now. You know, Richard unfortunately has
had that horrible experience of making thediagnosis at sixteen and eighteen, but that's
(06:08):
not very common. Most of thewomen are going to be diagnosed are going
to be after the age of fifty, but we see it fairly common in
the forties also. But if youare premenopausal versus postmenopausal, is a big
discriminator because fibercystic disease is something thatwill often scare people and they will find
(06:30):
changes in their breast and that tendsto be hormonally mediated. So depending on
the time of the cycle you arecoming on to your period, those hormone
release are going to affect the breastand so fibercystic disease may be worse in
the days upcoming to your period,and so that's going to change in time.
So typically, particularly in women whoare still menstruating, the recommendation is
(06:55):
if you find something at around thetime of your period, just keep paying
attention to it for a couple weeks. If it's persistent as your body's changed
through the cycle of the month,then you need to be seen in a
post mental puzzle person because that changeisn't going to be there much or not
having that hormonal fluctuation. If youfind something, just go be seen right
(07:18):
away. So you mentioned something,so fibrocystic changes, fibricistic breast disease,
fibrocystic, there's all kinds of namesfor it. So what is that,
Well, they are benign swelling inthe duck. So if you think of
the breast, what was its purpose? Its purpose is to make milk and
(07:41):
secrete milk for when we breastfeed babies. But all of those little tiny ductuals
that from where the breast milk potentiallyis created and then is passed down through
to the nipple, they can getplugged. They can swell in a relationship
to hormonal stimulation to the body andyou'll feel these little lumps and bumps.
(08:01):
Those can change not only based onperiod, there are other things get can
affected, things that we eat orthings that we do. Caffeine is not
a wives tale, but it is. If you drink a lot of caffeine,
it's going to make you have moreproblems with fiber acistic breast disease.
So these are chocolate but nine,yeah, I like chocolate, good thing.
You're not a woman, I know. I mean it's a good thing,
(08:22):
but usually we do. And likeshe's saying, with the caffeine or
the chocolate. Licorice is another one. You know, usually if they find
lumps and bumps. We tell themto cut back on their caffeine, cut
back on their chocolate, things likethis, and then wait and see what
happens the next month. So keepgoing, you're doing great. The fibroccistic
(08:43):
breast disease also tends to be painful, and those cysts, those lumps tend
to be tender as opposed to canceris usually a painless thing. The nodules
associated are typically not. So ifit's painful or tender, it's more likely
to be fiberistic breast disease, andthere are recommendations what we can do to
(09:03):
help with that. Vitamin E supplementationcan be helpful. It doesn't really make
the cisco away, but it canhelp with the tenderness it's associated with this
systs. And that's another thing womencan do for fiber cistic breast disease.
And sometimes we'll give them moral contraceptivethings like that which will help with their
cycles because it's all hormonally mediated andit can sometimes alleviate some of the pain.
(09:24):
So if we can try to regulateit a little better so that does
not increase your risk of breast cancer. Though having fiber sistic changes correct it's
not a pre malignant condition. Thatis absolutely correct. So if you have
fiber sistic changes, it's not aproblem. You still need to do your
exams, you still need to becareful, but it's not a forbear.
It's not going to become a cancer. So what are some of the risk
(09:46):
factors for breast cancer? So you'vegot some things that you can't change,
and you've got some things that youcan change. Absolutely, So let's start
with the things that you can't change. Okay, you can't change that you're
female. But let's also remember mencan have breast cancer. And so I
don't know if a man might belistening to this program with his wife,
(10:09):
but you know, a woman alsoneeds to realize that men can sometimes find
the lumps and bumps in their breastsand that we should not ignore those.
It's a little harder to do amammogram on a man, but those things
can be done too. But beingfemale, that's first our biggest risk.
As we get older, their riskassociated and we can't control either of those,
(10:30):
and family history we can't control thateither. There are a whole host
of genes now that we're finding thatare associated with breast cancer. Most people
have heard of BRCA one, br C A two, brack of one,
and brack A two. Those arethe most common that are associated with
(10:50):
a really high increase the risk.There's only about one in five hundred women
are going to have one of thoseparticular genes, but they go from having
a fifteen percent lifetime risk to havinga sixty percent lifetime risk, So that's
a whole different situation. Most familyhistory aren't even going to be the bracas
(11:11):
though, and there's just a lotof people who have the genetic testing and
they don't have BRAKA, but there'ssome minor ones out there. We can't
tell those families what is their lifetimerisk as well as we know the bracut.
But we are learning in medicine withall of the advances in genetics that
there are more and more genes beingidentified. So what are some other things?
(11:35):
For example, race, ethnicity,does that have anything to do with
it? Yes, so Caucasian womenare at higher risk than African American who
are at higher risk than Asian forHispanic or Hispanic Native American at the lowest
risk. What about dense breast tissuedoes that increase your risk? Doesn't increase
(11:56):
your risk. It makes it moredifficult to find the breast cancers, and
so sometimes the modalities that we useto screen for breast cancer are going to
be a little bit different. Andthe women that have very dense breasts,
and what about maybe starting your mensiesearly or having menopause late. So the
longer that your body is being exposedto estrogen. If we say that these
(12:20):
cancers are oftentimes hormonally stimulated, it'show long you were. So if you
were one of those people that startedtheir periods very young, I mean,
the average age is twelve and ahalf, but it can be as young
as nine and as old as fifteenand still be considered normal. So if
you were that young child that startedat ten and then you didn't go through
(12:41):
menopause until year or later, there'sa lot longer time period your body was
exposed to estrogen. There's also aprotective event of pregnancies and breastfeeding. So
women who've never had any children areactually at higher risk for breast cancer.
Women who didn't have their first childtill after the age of thirty or at
(13:01):
slightly higher risk. And those womenthough that did have several children and who
did breastfeed are at lower risk.Okay, so what about you know,
some people have early cancers or havethe other things that get radiation. So
radiation to the chests, things likethat can predispose you, right, and
that's one of the biggest other thanthe family history with the brackagenes. Radiation
(13:24):
exposure to the chest between the agesof ten and thirty significantly increase your risk.
And so that's oftentimes children who hadchildhood cancers or malignancies are now going
to be at higher risk for secondarycancers, including breast cancer. And there's
nothing we can do about any ofthese things that we've talked about. So
let's talk about some lifestyle changes thatcan be related to your risk actors how
(13:48):
you can reduce your risk. Forexample, alcohol, alcohol is going to
increase, so particularly excessive use forwomen we don't metabolo as well as men.
Really more than one glass a day, we can increase our risk of
breast cancer. Wow. Overweight,overweight obesity because obesient in itself. People
(14:11):
don't realize that fat cells can actuallymake estrogen, and so that increases a
hyper estrogen in the state when you'resignificantly overweight. So managing our weight and
trying to keep a healthy body massindex of under twenty five can make a
huge difference in what our risks are. And that goes along with not being
physically active. So the more physicallyactive you are, the less you're going
away, You're going to take offsome of the fat, you're gonna have
(14:33):
less estrogen in your body. Andthen you already mentioned a couple of them
not having children. There is one. Nothing I'm encouraging everybody to go out
and get pregnant. But you know, it's great for you know the obstetrician
great and breastfeeding. Breastfeeding is veryimportant, so it really produces your risk
of breast cancer. So that's amazing. Now, what about hormones, So
(14:56):
there's a lot of I know you'regoing to you know, this is a
tough one. This is a toughone. Where hormones are not taking hormones
in younger ages, the risks associatedwith it are not as significant, but
we still can worry about long termexposure to hormones and does that increase your
risk over time for breast cancer.Really where we worried about it is in
(15:16):
the postmenopausal women, So particularly estrogenreplacement or people women over age of forty
who are still still menstruating but aregetting to that time peri where they're higher
risk. Being on estrogen after theage of forty may give you a little
bit more of a risk factor associatedwith it. So there were some studies
(15:39):
very early on when we were firststarting out our practices that you know,
encouraged us to stop using hormones inthe postmenopausal women. So we went through
that whole phase, you know,twenty years ago, and so we're starting
to show our age a little bitor even thirty years ago, and then
it's kind of faded away and we'reusing them again. We're finding well,
it's not as bad as well whatthey thought in these studies, and so
(16:00):
we're using them again. But Ithink that the women are smarter now because
they know, they do their exams, they get their mammograms, they let
us know if there's an issue,and we always discussed the risks and benefits
whenever we start any of these medications, so everybody knows going into it how
important it is. I think alsothe products that we have available to prescribe
patients now have a lot lower estrogencontent in them when they first came out
(16:23):
with the burst control in the sixties, and that's way before we were practicing.
We were born, I was born, but about it, but those
were that amount of estrogen was amuch higher risk. I mean, the
products that we're able to prescribe forpeople have much lesson so the risk goes
down associated with that too. Okay, so let's move on. Then let's
talk about some symptoms of breast cancer. How do we know what is it?
(16:45):
Like? What are some of thesymptoms that you would think I have
breast cancer that you would distinguish betweenfibercystic change and a cancer, so meaning
like the lump, the shape.Well, first of all, the one
we already mentioned was the tenderness.Typically cancers until they get very large or
(17:07):
there's certain subtypes are not going tobe tender. They're just going to be
a lump that you found. FiberCystic tends to be more tender if they
are firm and fixed, so youfeel it and there's it doesn't wiggle at
all, it doesn't have any jiggleto it. You know, a cyst
is going to be a little fluctuin. It's going to feel like a
(17:29):
water balloon, a little blottable sensationto it that the cancer is going to
be a hard consistency. Oftentimes,when that cancer is sitting a little bit
below the surface, it's what's goingto pull on the skin. And so
we're did we talk about dimpling ortinting in the skin where there's this regularity
where the skin goes down, you'regoing to look for something like that.
(17:52):
There are subtypes of cancers that canactually have changes to the nipples too and
have a very irregular look to it. We use a term called poe to
orange, but basically means the peelof an orange. It has that kind
of bumpy irregularity. If you seethat on the surface of the skin,
that's another concerning love. You wouldsee a discoloration of the skin. And
then she also mentioned about the retractionof the nipple. Though it can be
(18:14):
normal, if it changes, that'ssomething that we want to look into.
And a nipple discharge, but thatis not always going to be cancer.
Women with fiber cistic breast disease canhave colored nipple discharges like a blue green,
like a bluish green, and thatis from the cyst. It's not
cancerous. So you know, don'tbe alarmed, but it's something that we
do have to be part of thesymptom to a bloody discharge is going to
(18:38):
be more concerning, or all ofa sudden you see a change in the
shape of the breast, you haveone breath, all of a sudden it's
grown, or you find a largermass, there's something not right. You're
looking in a mirror that wasn't likethat before. You know, that's why
it's important and you want to beseen. Okay, So we've talked about
you know what you do. We'vetalked about what you're looking for. So
you do this, you go tothe doctor, and then what does a
(19:00):
doctor want to do. Well,they're going to do and exam themselves and
get a better feel and then takeyou into overall consideration. They're not only
going to feel the breast. They'regoing to feel in for the lymph nodes,
so in the area above your collarboneand into your armpit, and if
they're going to feel any little lumpsor bumps there that may make them more
(19:21):
concerning. They're also going to takeinto consideration though your age. Like I
said, if it's a twenty fouryear old comes into me and tells me,
she just got off a period andI feel it was a lumpy bumpy.
I may tell her to stay awayfrom the caffeine, take some vitamin
E, and come back and seeme in three weeks so that we're in
a different part of your cycle andjust re examine it if it's concerning.
(19:44):
And it almost always if you're goingto be older, anybody over the age
of forty, we're going to sendyou straight for a mammogram. And typically
the diagnostic mammogram that's when we're actuallylooking for something that we can feel is
going to be associated with an ultrasoundat the same time. So that's why
a lot of the time, whenthe women come in for their annual examinations,
they usually will call the office sometimes, well, I want to get
my mamogram ahead of time, butif we find something on an examination,
(20:07):
it's a different mammogram, So that'swhy we'd like to wait until we see
you instead of riding ahead of timebecause it's different. Makes sense. Yeah,
With the diagnostic mammogram, they're goingto use sometimes an extra visualization,
a different size or shape, andoftentimes, if we were to find something
ahead of time, the diagnostic mammogramis always going to be done at the
(20:32):
hospital where we know that they're goingto have easy access to the radiologists,
so the radiologists can actually come intothe room while you're still there and say,
oh, there is something here,let's get an extra visualization, whereas
a screening mammogram can be done inyou know, the traveling vans, right,
Yeah, yeah, Dina has allkinds of sites that you can do.
You're all over the place, youknow, in Columbus they have them
(20:52):
at the mall so people can goshopping and all buy on the way,
go have my mammogram with those arefor those screening mammograms, and that's going
to be a little bit different.But I think you know, with Kathy
coming in here today, it's justsomething we wanted to share and we wanted
to let the people know, andthe women in particular to know, don't
be scared. Get out there,do it for your families, Do it
for yourself, get your mammograms,do your breast exams and be checked,
(21:17):
and you know and love your families. Just do it for them. And
of course, doctor Villarela, ifwomen are hearing this and they're scared,
you know, they maybe there's somethingirregular. Maybe they're like, I'm long
past two, I need to getchecked. So I'm sure they can call
Adeena and get an appointment set upif they don't have a doctor. You
guys still accepting new patients. We'reall accepting new patients, all the gecologists,
(21:38):
all the family practitioners, you know, the internists. The law gets
you in now. And the onething that's changed as far as screening goes
to is that you actually don't youcan sell for refer yourself. If you
call Adina and self refer, they'rejust going to ask you who do you
want the results sent to. Soif they have an abnormality, they've got
(21:59):
to reach out and find somebody that'sgoing to get you follow up. But
even if you don't have a primarycare and you make your appointment, those
breast care specialists that we have,if they find something, they're gonna find
you a doctor for follow up.So that's important. So you don't have
to wait. If somebody can't getyou into somebody who you want to see,
just call, get your mammogram andthey'll take care of you. All
right, great, thank you somuch again, Kathy. Thank you doctor
Richard Villarreal. This has been ladyparts with doctor Villarreal.
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