Thompson featured speaker at October meeting of MHHS A Meal & More
Morristown surgeon Dr. Tom Thompson was the featured speaker Wednesday afternoon during the October A Meal & More luncheon series sponsored by Morristown-Hamblen Healthcare System.
Thompson, with the University of Tennessee Surgical Associates, addressed the “Facts About the Diagnosis and Treatment of Breast Cancer.”
The doctor explained that because of advances in medication and surgical intervention, breast cancer is no longer treated the same as it was even five years ago.
He explained that while the breast appears to be a single organ, an fact it is a “housing” surrounding multiple glands and ducts. Cancer can arise in any of the microscopic structures inside the breast.
He explained that breast cancer tends to spread to lymph nodes located around the breast and under the arm. Three-quarters of the lymph nodes that are most likely to be affected by breast cancer are under the arm. Those are the ones that are excised for diagnosis and staging of the disease.
Thompson said there is no “silver bullet” whereby a doctor can say that any specific person will develop cancer. Instead there are a combination of risk factors.
According to statistics, one in eight American women will develop breast cancer in her lifetime. Thompson said these statistics are not the same for less developed nations.
“It’s (breast cancer) a disease of the affluent,” he said.
For example, he said, in China, breast cancer was almost non-existent 25 years ago. Now, he said, it’s exploding as the country is embracing the lifestyle of other rich nations.
He gave an example of a typical African women versus one in the United States.
In Africa, puberty typically begins between 12 and 14. Women marry shortly thereafter and begin having children, which are breast fed. Menopause for these women typically begins in the 40s.
In the United States, on the other hand, puberty is beginning as early as 10. Pregnancies typically happen in the late 20s or early 30s. There are fewer pregnancies and they are spread further apart. Breastfeeding is rare.
Some women have genetic risk factors for the development of breast cancer.
“Family history is significant,” the doctor said.
While all American women have a one in eight risk, women with several first-degree relatives (a mother, sister or daughter) with breast cancer have a one in six risk for the development of the disease.
Despite that, “only 10 to 15 percent of cancer is linked to genetics,” Thompson said.
Breast cancer can be detected in several ways: during a routine monthly self-exam, during a clinical breast check by a physician or during a screening mammogram.
“If you do a monthly breast exam, if something happens, you’re going to know,” Thompson said.
Physicians, on the other hand, prefer to discover a breast cancer on a mammogram while it is still too small to feel.
Thompson said he encourages all women to have a baseline mammogram done in their mid-30s. The results of that mammogram will determine the timing of the next mammogram.
“I think it needs to be based on a case by case basis,” the doctor said.
When a suspicious sighting is found on a screening mammogram, it can be followed by a diagnostic mammogram.
“That’s not always a bad thing,” Thompson said. “Most of the time that will solve the question.”
If not, the next step can include ultrasound, a MRI or biopsy.
Thompson said 25 years ago, breast biopsy involved a surgical removal of the suspected area. Today, that is not likely to happen. Physicians are able to do more targeted procedures so the patient only has to go to the operating room once.
Thompson said he understands that a cancer diagnosis is “a traumatic, emotional moment.”
But long-term survival rates have drastically improved as more and more cancers are being discovered at early stages.
“The long-term survival for women with Stage I breast cancer is the same as someone without breast cancer,” Thompson said, adding that the earlier the cancer is found, the more options are available.
Ten year survival rates for Stage II cancer are in the upper 80 percent and 70 percent for Stage III cancers.
“Rarely does someone present with Stage IV cancer if she’s been having annual mammograms and regular self-exams,” Thompson said.
Treatment of breast cancer is tailored to each patient dependent on the characteristics of the disease, the patient’s age, risk factors and desires.
Some women have to have a mastectomy. Others want it.
“It’s patient specific,” he said, adding that he encourages his patients to slow down and understand what their options are before making a decision.
He said while some women want to save their breast, “we’ll never sacrifice survival for cosmetics.”
Many women are candidates for breast conservation surgical techniques. He said if the tumor doesn’t involve the skin, there’s no reason why surgeons can’t make a cut in the breast in an area where it won’t be visible.
He said that his office has recently begin using a retractor typically used during laparoscopic surgery during breast cancer surgery. It allows the surgeons to make a cut around the nipple, move the skin to expose the area, and remove as much tissue as is needed.
Whether used in a partial mastectomy (lumpectomy) or radical mastectomy, Thompson said his goal is to make the breast look like it’s always been that way, without radical scars.
But, he again stressed the need for early detection.
“The later a person waits to have a baseline mammogram, the more likely an abnormal mammogram will lead to a test,” he cautioned.
- By Denise Williams, Tribune Staff Writer