Runowicz: Fosamax 10 mg dose in AM. May have some intestinal irritation. Given for up to 3 years. Citrical 800 mg daily; Calcitron- nasal spray or subcutaneous injection. None of these medications affect the heart, but all have an impact on bone density.

Bobroff: Stereotactic breast surgery extends the diagnostic capabilities of mammograms. It would be used in a workup if abnormalities were found on a mammogram. We do see many benign nodules using this method. It is a very accurate test that has moved the management of mammogram abnormalities from the "wait and see" approach to a more active one.

Kobre: Women can and should get mammography. Federal government and NY State Dept of Health provide funds for the Breast Health Partnership. American Cancer Society oversees the program with its cosponsors, Nyack and Good Samaritan Hospitals, Planned Parenthood, the Nyack Hospital Health Center, Rockland County Department of Health , and with doctors and nurses throughout the county who provide free care. The program has served more than 1000 women over its five years in existence. They have gotten free breast health checkups, mammogram , and followup diagnosis and treatment. Added just last year, pelvic exams and pap tests are now included. Any woman in Rockland County who is 40 -50 years of age can get a mammogram every 2 years and annual pap test. Women over 50 can get mammograms and pap tests annually. Women can arrange for an appointment by calling the American Cancer Society office in Rockland.

Shreedhar: There are several mastectomy types: lumpectomy (also called segmental, partial, or quadrectomy) in which a small wedge of normal breast tissue is taken in addition to the tumor) with lymph node dissection on the same side and followup radiation; simple or total mastectomy (in which there is no axillary node dissection); modified radical (in which the breast and sample axillary nodes are removed, but not the underlying chest wall muscles); radical mastectomy in which the breast and axillary nodes, as well as tissue from the chest wall muscles are removed.

Kaul: Radiation therapy is not harmless, but it is helpful in a malignant situation. There are both good and bad effects of any kind of radiation, but it is definitely useful in killing cancer cells. For breast cancer patients, the side effects over the lifetime are 2% of patients risk injury to the lung tissue; 5-6% report rib inflammation; and after more than 10 years there may be shrinkage of the breast.

Lonberg: Chemotherapy or Tamoxifen may decrease the risk of recurrence in conjunction with hormonal therapy or chemotherapy. Research data and medical analysis done estimated that postmenopausal women with breast cancer on Tamoxifen show 25% reduction in risk of recurrence of breast cancer, with limited side effects. The data on women who have had lymph node dissection suggest that Tamoxifen can be stopped after 5 years, and the benefits will persist. Data are not yet "in" for those breast cancer survivors who had lymph node involvement.

Stanton: Diagnosis & treatment are shocking experiences. Patients need to talk about it. People often have stereotypic responses to diagnosis related to images and stereotypes of cancer as a death sentence. These need to be erased. Furthermore, the experience of treatment requires that people express their fears. The fear of dying is often not discussed with spouses in an attempt to protect the spouse, but this too needs to be addressed. Sometimes a short course of antidepressive medication is necessary.

Longberg: Overall I would stress the importance of good healthy eating habits including increase in fresh fruits and vegetables, increased fiber, as well as limited use of smoked, cured, and pickled meats. None of these however, show a direct correlation with breast cancer. Protein requirements are based on weight, age, and amount of exercise- but should always maintain focus on low fat protein choices. Most important is to limit alcohol use and to cut out smoking.

Thalenberg: County is protecting us against pesticides and building materials. In fact, we still have little information about the actual causes of cancer. Studies have shown, however, that DDT , other insecticides, and drugs such as DES were found to act like estrogen. These "echoestrogens" in combinations were shown in Long Island to be work synergistically in the breast to have 160-1600x potency of naturally occurring estrogens, and may be related to the high incidence of breast cancer there. Rockland County is not a highly agricultural area and we do require registration before certain pesticides are used. There has been no evidence of a pesticide effect on the cancer rate in Rockland. There is some increase in breast cancer rates in Monsey, but many women of ashkenazi descent live there and BRCA-1 gene is more common among Ashkenazi Jews.

Edge: The risk of dying from breast cancer appears to be the same with or without risk factors. While having second degree relatives iwth breast cancer heightens awareness and gives you a psychological sense of risk, you are not actually at greatly increased risk. You, like all women should continue regular screening mammography. On another note, it is critical that we assure that Medicare covers mammography.

Lonberg : Inflammatory breast cancer is a rare type. Its first sign is often diffuse redness of skin on the breast. Disease spreads into lymphatic. It used to be considered uniformly fatal and surgery was contraindicated. Today it is treated aggressively with chemotherapy. If there is a good response then surgery followed by radiation is done. Bone marrow (or stem cell) transplants are considered experimental but have shown encouraging results.

Runowicz 1) HRT individual therapy- must look at cardiac risk, eating, bone density, etc. 2) Use moderation and no binge drinking of alcohol and cut out daily alcohol.

Bobroff: Sonograms can provide information that separates cysts from solid masses, which can reassure the patient about the status of tissue seen on the mammogram. Mammography, while not perfect, can see small breast cancer tumors and microcalicification clusters which cannot be seen on sonogram. Breast self-exam and professional breast exam are as important as a regular mammogram, but while sonograms can observe an occasional breast cancer not visible on a mammogram, it is not a reliable tool for diagnosis of most early breast cancers.

Edge: Fibrocycstic disease is less a disease and more a change in breast tissue which most women have. Changes in tissue are evident but not a risk factor except in certain circumstances. Biopsies which show fibrocystic changes and hyperplasia with atypia may be a risk factor for breast cancer. All new masses seen on mammogram are cancer unless proven otherwise. Mammogram can pick up pre-cancerous lesions. We commonly find some which, when biopsied, show atypical changes that may be precancerous. Thus, biopsies are necessary to provide information, although most reveal benign tissue.

Bobroff: Mammogram after surgery usually done at 6 months, one year, and then annually. This varies with the individual.

Kobre: Specific support groups are run by ACS & meet on regular basis, free of charge. These include monthly breast cancer support groups, lumpectomy support group, and a group for women with cancer of any type. Free individual counseling is also available. I’d like to use this opportunity to reiterate that annual breast health check-up important. Please tell a friend who does not have insurance about the breast health partnership. Cost should not be the factor which decides whether a woman has a regular mammogram. Another point is that "Medicare Plus" pays for mammograms every other year. Breast Health Partnership can be used in the "off" year for a free mammogram.

Lonberg: We do have many major medical centers in the New York metropolitan area, but most standard treatments are offered locally and are done well. Many of us are on staff at major medical centers and have access to the latest protocols and treatments. For more experimental therapies, we have access by bringing our patients to major medical centers. As a matter of fact, Columbia Presbyterian is setting up a satellite center at Nyack Hospital for stem cell (bone marrow) transplants. Thus, even more complex, experimental treatments are available in the county.

 Thalenberg: I would like to note that I am a cancer survivor- treated here in Rockland County ten years ago by local physicians and I am "clearly not wasting away"!

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First Created: September 18,1997
Last Updated: September 18,1997