you coming up next on being well dr. ruben boyajian from Effingham will be my guest this week dr. boyajian is a surgeon who specializes in the treatment of breast cancer we'll be learning more about how breast cancer is diagnosed and how the treatment has evolved over the years we'll also learn more about how the treatment is customized based upon several factors we've got a lot of information to cover so let's get started you production of being well is made possible in part by Sarah Bush Lincoln Health System supporting healthy lifestyles eating a heart healthy diet staying active managing stress and regular check-ups are ways of reducing your health risks proper health is important to all at Sarah Bush Lincoln Health System information available at sarahbush.org alphacare specializing in adult care services that range from those recovering from recent hospitalizations to someone attempting to remain independent while coping with a disability chronic illness or age-related infirmity alphacare compassionate professional home care additional funding by Jazzercise of Charleston well I am so pleased that dr. ruben boyajian from Effingham has come to visit being well for the first time thank you thank you so much for for coming this way tell us a little bit about your practice and the types of cases that you deal with well we do general surgery which it's the run-of-the-mill you know gall bladders and hernias and endoscopy but my main interest always has been breast care mm-hmm particularly with breast cancer issues and tell us about your role as a director of the Women's Wellness Center at st. Anthony that has been a very rewarding program we started out a few years ago to emphasize the issues of prevention you know early diagnosis in breast cancer other breast illnesses and motivating women to get their mammograms on time and regularly it's amazing how many women do not get their mammograms as a routine you know diagnostic and screening method to detect breast cancer early stage well I don't want to say you've been around for a while but you we were talking earlier before we started taping about there has been a lot of changes in breast cancer and breast cancer treatment and care and surgery you want to talk about some of the big things that have happened that you've seen in your time in the field I think being older gives you the advantage of looking in the past and learning from experiences and also witness in a tremendous amount of progress in the field in the eye trained in new haven in Connecticut late 70s was an eight-time word the changes were so impressive such as introduction of chemotherapy for the first time that didn't happen until the 70s late 70s great that this was a trial by bonadonna from italy that introduced this EMF type of chemotherapy that made major difference on patients with advanced breast cancer and at the same time the mammography came along became more sophisticated as a diagnostic method but in for a screening of breast cancers and then through dr. Fischer's research the transformation from radical mastectomy into lumpectomies with breast preservation so all this happened in a relatively short period of time from there on with witness all the advances in genetics you know more sophisticated targeted chemotherapy design exclusively for particular situations because the breast cancer is different at every age different racial groups and the extent of disease the type of cancer so it's been definitely tailored to the needs of the person the women and sometimes men because we do get breast cancer as well can you give us right now what are our current breasts right breast cancer statistics here in the United States they are frightening as I say we still in the year 2015 we expect to diagnose over 230,000 cases of breast cancer in an additional 60,000 cases of pre-cancer situations called DC is okay you know this group about unfortunately 40,000 women will die from the disease still is that number going up the number of women dying from it or are we doing better that has improved okay since denied the mid-90s the death rate has decreased to over thirty four percent in the diagnosis has increased and now he's kind of plateau we talked earlier about that there are some risk factors that you can control and some that you can't like genetics can you talk about the risk factors for breast cancer there's some risk actors that is out to our control for example being a woman it's a risk factor first one the racial the the Caucasian and the Western civilization has a higher incidence incidence of breast cancer the age of the first menstruation period called menarche they the younger the age the higher the risk late menopause meaning past age 55 okay lack of pregnancies no nulliparous meaning no pregnancies have occurred is a high-risk first pregnancy after the age of 30 is also a higher risk obesity smoking alcohol all the fun stuff then we want to take away it seems like some of those factors when we had dr. Philip Dion who's a colleague of years a while ago some of the same risk factors for breast cancer are similar for ovarian cancer that is very true and what is the connection between the period and ovulation and getting cancer later in life what does I don't understand kind of how that those work hand in hand is that I call it the fertilizing atmosphere okay you know because this is a time of life were fertilizing hormones such as estrogen progesterone will will actually be consumed by rapid growing cells they love that and the majority of cancers are hormone sensitive particularly in the years of you know normal administration or otherwise and therefore it becomes an issue tremendous importance that realizing that the breast cancer and the ovaries are two areas of this naso the system in a woman that is constantly undergoing changes all right the ovaries are producing ovulation and then they had to retreat you know then they had to I call it the expected pregnancy most of the time doesn't occur the breast has to gear up to you know producing milk and that may or may not happen so the changes are just they rapid and constant month after month it's that hormones up and down and I'm going down that cancer likes is that kind of a way to put it correct okay that's interesting another thing that we hear a lot about is the genetic testing and the bracha gene it talked a little bit about that clarify that for our viewers well so far as far as we know the current knowledge and that is well established is the brca1 and 2 these are genetic tests that are readily available with a high degree of accuracy however it's very important to know that the majority of breast cancers are not hereditary okay and only five to ten percent maximum will be you know affected by heredity and be transmissible and of course you know as the general public you know has a lot of we all have fear with am I gonna get it or not or if you have a relative at close relative that have the cancer is it going to increase my risk so all these issues are clarified through consultations and if they you if we follow the guidelines and and the candidate is qualified for the Baraka test then we make sure we schedule it is an expensive test so do you recommend that to patients we we try to educate them there are qualifiers and they're not for example if the cancer occurred a woman that younger than 45 the testing is recommended okay if the person has the cancer at an age younger than 50 but there is a close relative let's say sister mother had breast cancer we recommend the testing and then there's also the male sector or the malefactor if there are some families that don't have many many females in the family and the old boys and then you assume that there is no breast cancer here but if there is a history of pancreatic cancer or aggressive prostatic cancer that means that the BRCA gene could be in the family so we as you say your local stations as well men can get breast cancer not it's not very common correct well for yes for every hundred women that will have breast cancer only one men will have it yeah talk about breast cancers not just breast cancer there are different types right different places can you clarify that for viewers out there the most common cancer is the invasive ductal carcinoma okay that's about seventy to eighty percent then there's a smaller percentage the one that follows is called lobular invasive cancer and then there's a number of other names like tubular medullary mucinous there's a lot less frequent so the majority of cancers are called invasive ductal are those different types is one more aggressive than the other or harder to treat than the other the invasive doctor takes the lead it's usually the more aggressive there is also another variety that is not very common called metaplastic and that could be very aggressive so you had talked about that one of the biggest changes is in the treatment plant that it's not just you don't go through a checklist and go okay you have this this is how we're going to do you have the treatment has really become customized to the patient so once you talk a little bit about how you as doctors determine the treatment played for a woman who has breast cancer we we don't just go from the consultation room to the operating room you know that used to be on the old days it's still done in some areas but it we do them we follow the multidisciplinary approach so the patients are seen by the on colors following the diagnosis through core biopsies usually and then depending on the pathology report and looking at all these issues that we are talked about is a tumor hormone-sensitive we know is her to New which is a protein that stimulates growth is a positive or not is it a triple negative cancer the age of the woman the size of the breast the size of the tumor is a person a candidate for breast conservation can we just do a lumpectomy and keep all the profile and the normal feminine Anatomy as intact as possible that it does the patient need lymph node sampling and to what extent so these are all a large number of variables that and that's that is when you come into play your surgeon and so you consult with the patient over their option so it's not just radical mastectomy correct yeah the in fact the majority of the cancers are not treated by mastectomy anymore is that something that has you said has changed BS okay Laurie it has changed mostly because due to the fact that the discovery of cancer at the time we find the tumor has evolved from large cancers to very small ones is the ideal is to find the cancer when is less than two centimeters or less than one inch in diameter the smaller the cancer they higher the probability of cure and and also you know when the cancer is a small one we have to remove less breast tissue obviously when does reconstruction come into play because that's an you know having this part of a woman's identity right when I'm guessing that's a common question that it is again when how do you decide when someone can have the reconstruction it all depends we here we follow the lead of the patient the woman and the family in all so we had to match the the implications of the treatment and what is it going to do to the system and what potential deformities will occur and then the reconstructions are also Taylor you know the woman is very large-breasted let's say and she also wants a breast reduction of the opposite breast then we have to consider that and some some of the reconstructions in ball placement of tissue expanders the letter change into the prosthetic and then the nipple is recreated some of the reconstructions are based on free traps transplants of tissue into the area is also affected whether the patient will have chemotherapy and/or radiation or not because those treatments can affect the healing all day and the timetable of the reconstruction as well so how where does the chemo part in the radiation part come into play and how do you determine if a patient needs one or the other both after surgery thank you for asking a question well see the the results of the lumpectomy or partial mastectomy these are equal terms to the traditional mastectomy are equal as long as the patient has radiation treatment after the partial mastectomy so this is that's the main role of the radiation okay in in some cases where the lymph node involvement is significantly say axillary when the neck then radiation treatment to those areas are also is also providing what about when does chemo come in it air is one used more than the other is what you must I'm sorry yeah chemotherapy is also a very customized treatment you know if the tumor is estrogen sensitive we have easy made I mean medications that are easily taken like tamoxifen that blocks the hormones and as simple as that if the tumor is a is a triple negative so call is non hormone-sensitive then more aggressive chemotherapy is indicated it also makes a difference if the tumor is reoccur these metastasis or spread to other areas as well I was going to ask about cancer spreading does breast cancer have like other cancers kind of a typical path if it's going to spread it's generally going to go here here and here or is it don't you know actually he does actually does did they might the breast likes bone and he doesn't like to go to the gastrointestinal system you may go to the liver sometimes brain but bone is a very frequent site for metastasis how about the what about the lymph nodes you often hear of women who have maybe the surgery and then they also have a few lymph nodes taken out why does why do you do that it's really for staging I'm trying to see if the horses out of the barn or not you know because they the lymph nodes are a barrier it defends so the network oh the lymphatic drainage of the breast is so rich and most of it goes to the axillary area so that has evolved into doing a very limited sample called sentinel node so we only need to take one two or three nodes to really figure out if spread to the lymphatic system has occurred or not and there could be a modifier as far as the treatment whether the patient will need chemotherapy or not in or radiation therapy as well I wanted to ask you what are the most common concerns or questions that patients ask of you when they when they find out that they have this diagnosis it's very scary and maybe not to have surgery what are some things that you hear it's a very difficult time obviously we try to place ourselves in the position of the patient and try to understand their environment their support system they want to know they're going to be cure or not second common question is the fear rejection losing their job the sources of income you know losing the insurance is a huge one then the cosmetic implications so those are the sack very common questions and if we try to we try to analyze the patient's social situation as well there's also fear rejection by the spouse or significant other so all these things do appear but the leading question is always you know the probability of cure is the cancer ever going to come back and is it going to be transmitted to my family and should I get genetic testing so there's a very common questions how do you determine is breast Richard SS vs breast cancer staged like lung cancer and ovarian cancer does it have stages that you give it yeah we have a precise staging system based on the size of the tumor the spreading to the lymph nodes and or other organs ok so can you talk about cure rates or survival rates based on the stages great question I'm gonna put you up but great questions and here comes to the concept of DCIS ductal carcinoma inside to inside to means that the cancer has not broken through the membranes of the tubing or the tubes that form the breast so when those have discovered the cure rate is almost hundred percent the second is the cancer less than two centimeters or less or half an inch or less then with lymph node-negative the cure rate is ninety-three ninety-five percent when you know what lymph node involvement it goes down to seventy percent used as metastasis now we are dropping to twenty percent so is it has a lot of importance in predicting the potential outcome and also prepared they and customize the weaponry knowing those probabilities and it sounds like you have a lot of things in your arsenal to help right surgery chemotherapy radiation that sort of stuff I want to get back to mammograms a little bit it seems that sometimes in popular media there's this debate and then maybe the medical community mammograms every year and then it came out now it's every couple of years or they're not great at detecting breast cancer and younger women sometimes as a woman early years like I don't know what to do Lori I sigh I have a large number of patients that had a normal mammogram the year prior on the next year they have a tumor that is discovered knowing and having experienced that I refuse to to step back and say that the mammography it can be done at increasing intervals so mammogram after age 40 yearly is the standard this has been challenged by the sum of the government agencies task force and you know to the our societies the american cancer society we are very strong and we have fundamental issues with it that mammography should continue after age 40 on an early basis in fact i have have a letter sitting at home telling me it's you know with my ears up and i need to go in so after taping this i think i'm going to pick my appointment in connecticut yeah sure and modifications i introduced let's say the person is BRCA positive or a strong family history even if the BRCA is negative then we start mammography at an earlier age 25 30 sometimes does the mammogram show can it show everything even those tiny no it doesn't okay I'm glad you asked that question because the density is another buzzword right now I've heard that anytime yeah started in the state of Connecticut history behind that but the density of the breast isn't is a increase it will increase the risk for breast cancer and he makes the diagnosis more difficult you have a very thick breast tissue that looks all white on the mammogram and you can't tell so those persons qualify for ultrasound of the breast as a screening method and sometimes the MRI and I'd imagine the technology in mammography just like the technology and what you're doing treatment wise is always getting better it's getting better we're going to 3d mammography now he's got its drawbacks to example 3d mammography a lot of patients are asking for it we are getting it in effingham but you know what when it comes to calcifications or microcalcifications it's not as accurate so you know we have to use all this technology wisely and there's not one recipe for all I wanted to ask you as we wrap up here what advice can you give to a woman who's just newly diagnosed what would you say to them I would say first of all reassure and we have a lot of transparency and clarity on what we're doing we issue copies of the pathology report to all the patients share all the findings with them we given instructions in the form of printed material and you know access accessibility to websites and I think education is very fundamental and you know that that knowledge gives power to realize that is not the end of the other life and and transform the fear into an energizing factor and we have many situations where the patient becomes an advocate helps other patients and he faces the treatment with more optimism and ready to go on so well doctor boy is gonna thank you for coming to the show you've provided some great information for our viewers that I know they'll appreciate and we hope to have you back again sometimes thank you I do appreciate the opportunity on the interest that you have expressed so thank you very much being well is also available online at our youtube channel youtube.com / w EIU TV just look for the being well playlist here you can view current as well as past episodes production of being well is made possible in part by Sarah Bush Lincoln Health System supporting healthy lifestyles eating a heart healthy diet staying active managing stress and regular check-ups are ways of reducing your health risks proper health is important to all at Sarah Bush Lincoln health system information available at sarahbush.org alphacare specializing in adult care services that range from those recovering from recent hospitalizations to someone attempting to remain independent while coping with a disability chronic illness or age-related infirmity alphacare compassionate professional home care additional funding by Jazzercise of Charleston you