for skin cancer, abdominal wall and pelvic reconstruction and limb salvage. What should women do in terms of preventative care to stay ahead of a breast cancer diagnosis? (at home, with doctors, etc.) SP: Clinical breast exams are very important, especially in your 30s before you start getting regular mammograms. Young women should learn the correct way to do a clinical exam, perform them regularly, and most importantly, if they find anything that they even think might be abnormal (a lump, skin changes, nipple discharge), they need to have it looked at by a physician. Thinking that something will go away if you ignore it is an all too common mistake. This is especially important in pregnancy where breast cancer is often misdiagnosed at first as a clogged duct or mastitis. Most women should get mammograms annually starting at age 40, and women in their 20s and 30s should undergo a risk assessment (the Tyrer-Cuzick score is commonly used), which is based on their medical and family history, and which will let them know if they need to start screening earlier than 40. In terms of lifestyle changes to reduce the risk of breast cancer, maintaining a healthy weight, staying active, minimizing alcohol, not smoking, and eating a whole- food focused, plant-heavy diet are all things we can do to improve our overall health and minimize the risk of breast cancer. What role does community and sisterhood play in supporting someone through breast cancer? SP: Given that the breast cancer patient demographic is usually women in their 40s-60s, their
community (friends, family, coworkers) has the opportunity to play an important role in supporting them through their treatment, especially because these women are usually used to being the support for everyone else! Breast cancer patients benefit from having a non-medical support system to help navigate multiple doctors appointments, deal with side effects of chemotherapy and radiation, assist physically during recovery after surgery, provide emotional and psychological support as they adjust to their new body and to help deal with the transition into the survivorship phase after active treatment. What are the best ways someone can help or support a friend or loved one who is enduring breast cancer treatment and even on the other side of remission? SP: How much support a patient wants is really very personal. I’ve had patients say they felt extremely alone, and others who say they felt smothered. If you have a friend or loved one going through breast cancer, your best bet is probably to ask them what you can do to help. This may be concrete tasks like helping with childcare or cooking/cleaning while they’re physically not able to do everything they normally would, or just being there as someone they can talk to without judgement. What advice would you offer young women who may not be thinking of preventative health care? SP: Preventative care is extremely important and should never be ignored. In your twenties and thirties, women should get a breast cancer risk assessment to determine at what age they should start mammographic screening and should perform clinical breast exams monthly.
Maintaining a stable healthy weight, exercising, sleeping
well, managing stress, minimizing alcohol, not
smoking and eating a whole food, plant-heavy diet also play a role in minimizing your risk of breast cancer. Most patients who develop breast cancer have no family history of the disease and no genetic mutation, so as we’re seeing breast cancer in younger and younger patients (more in their 30s), the assumption is that there are multiple environmental factors that are increasing our risk. How does someone’s mental health affect their physical health when battling breast cancer or even after reconstruction? SP: Patients with pre-existing mental health issues (especially anxiety, depression and body dysmorphia) may find them exacerbated during breast cancer treatment. Having breasts is so closely associated with intrinsically feeling female to many patients, that the adjustment after surgery (especially if you need delayed or staged reconstruction) can be very difficult. Many patients will permanently lose breast sensation after a mastectomy, which can impact intimacy with partners and overall sexual health. Additionally, the anti-estrogen therapies that the majority of patients will need for five to 10 years will throw them suddenly into menopause, which has dramatic effects on mood, weight and libido — all of which impact mental health even well after active treatment.
What do you view as your greatest responsibility to your patients? I have a very collaborative working style, both with my fellow physicians and my patients. My job is to assess their clinical situation, elucidate their goals and present them with all the potential options that are available (detailing the pros and cons of each option). They need to make the ultimate decision about what procedure is best for them; I’m here to educate and guide them, but I can’t make the decision for them. I also always err on the side of over-educating my patients, as most people handle it better if expectations are set accurately in advance, rather than having surprises pop up later. What other surgeries do you do for your patients in addition to breast reconstruction? SP: I also perform breast, body and facial cosmetic surgery, excision and reconstruction
29
Made with FlippingBook Digital Publishing Software