Breast Cancer Awareness Month Q&A: Dr. Melanie Friedlander

Dr. Melanie Friedlander answers FAQs about Breast Cancer.

How soon can breast cancer be diagnosed?

Breast cancer can be diagnosed as early as Stage 0, otherwise known as Ductal Carcinoma in Situ (DCIS), which is microscopic cancer cells contained within the ducts. Invasive ductal carcinoma or lobular carcinoma can be discovered when it is as small as 3 or 4 mm – too small to feel but visible on a mammogram or other breast imaging studies, such as ultrasound or MRI.

If my breast cancer has spread, can I still survive?

Two thirds of all breast cancers are diagnosed early, when they are still localized or limited to the breast and have not spread anywhere else. Based on data collected from 2014 to 2020, patients with breast cancers that were contained in the breast had an incredible 98.9% survival rate at 5 years after diagnosis. Patients with regional spread (to lymph nodes or nearby organs) still had an 86.3% 5-year survival rate. And even 5.9% of patients with distant spread (to other organs in the body) had a 32.4% survival rate at 5 years. I would guess that with all the new treatments available, data from the last few years will show even better results. When treating patients with metastatic cancer, we know we cannot cure it but for many patients we can manage it with medications.

Is there a difference in breast cancer incidence depending on race?

White women have a slightly higher incidence of breast cancer than Black, Hispanic or Asian women but Black women are more likely to develop more aggressive breast cancers. Black women also have a higher incidence of breast cancer at a young age.  Black women with breast cancer also have a lower survival rate. In some parts of the country, this may be due to difficulty in access to screening mammography and medical care. Triple negative breast cancers are more common in Black women as well.  Fortunately, new treatments for triple negative breast cancers are proving to be effective. Resources need to be focused on improving routine screening and better access to new therapies.

Is breast cancer becoming more common?

The incidence of breast cancer is increasing, but not at a dramatic rate. It may seem like that sometimes because many women are more open about sharing their diagnosis and cancer journey. In recent years, incidence rates have increased by 0.6% per year. The rise in incidence rates is a little steeper in women younger than 50 (1.0%).

From the American Cancer Society:

Breast cancer is the most common cancer in women in the United States, except for skin cancers. It accounts for about 30% (or 1 in 3) of all new female cancers each year.

The American Cancer Society's estimates for breast cancer in the United States for 2024 are: 

• About 310,720 new cases of invasive breast cancer will be diagnosed in women. 
• About 56,500 new cases of ductal carcinoma in situ (DCIS) will be diagnosed.  
• About 42,250 women will die from breast cancer.

Breast cancer mainly occurs in middle-aged and older women. The median age at the time of breast cancer diagnosis is 62. This means half of the women who developed breast cancer are 62 years of age or younger when they are diagnosed. A very small number of women diagnosed with breast cancer are younger than 45.

If my mom had breast cancer, should I get checked early?

Anyone with a first degree relative (mother, father, sister, brother, or child) who has been diagnosed with breast cancer should get a yearly mammogram starting no later than age 40. You should also consult with your primary care physician or local breast center regarding any additional screening tests to consider. As always, any change in the breast such as a lump, pain, or change in skin contour should be checked by a physician as soon as possible.

Do breast cancer survivors need to have extra yearly tests/labs to check reoccurrences?

Depending on the specific type of breast cancer and the treatment plan, some breast cancer patients may be advised to have a mammogram sooner than their normal annual screening tests. In addition, most breast cancer survivors will undergo diagnostic rather than screening mammograms, which includes compressing the breast tissue for additional views.

How do you know when you have breast cancer? What are some of the first signs?

From the Centers for Disease Control (CDC):

• New lump in the breast or underarm (armpit)
• Thickening or swelling of part of the breast
• Irritation or dimpling of breast skin
• Redness or flaky skin in the nipple area or the breast
• Pulling in of the nipple or pain in the nipple area
• Nipple discharge other than breast milk, including blood
• Any change in the size or the shape of the breast
• Pain in any area of the breast

What advice would you give someone who was recently diagnosed with breast cancer?

The early days after a breast cancer diagnosis can be overwhelming. From a clinical standpoint, it is important to find a medical oncologist and a breast cancer surgeon with specific expertise in treating breast cancer. At the Hunt Cancer Center, our nurse navigators can guide our patients through their breast cancer journey.

I always advise my patients to take things one step at a time and try not to worry about outcomes that may never come to pass. While seemingly simplistic, it is one of the biggest challenges for patients in the first few days after receiving a breast cancer diagnosis. I also think it is important for patients to develop a support network of family and friends.

Are there any lifestyle changes I can make to prevent breast cancer?

While it may seem obvious, maintaining a healthy weight and fitness level is important. Avoiding processed sugar and flour is also a simple change that can make a difference.

What do you love most about your job?

My interactions with my patients are always the best part of my day. Being able to develop a connection, get my patients through a scary time in their lives, and see them thrive as they move past their cancer treatment is very satisfying.

How often should I have a mammogram and at what age should I begin?

From the American College of Radiology (ACR):

“The ACR and Society of Breast Imaging recommend annual mammography screening beginning at age 40, which provides the greatest mortality reduction, diagnosis at earlier stage, better surgical options, and more effective chemotherapy. Annual screening results in more screening-detected tumors, tumors of smaller sizes, and fewer interval cancers than longer screening intervals. Screened women in their 40s are more likely to have early-stage disease, negative lymph nodes, and smaller tumors than unscreened women. Delaying screening until age 45 or 50 will result in an unnecessary loss of life to breast cancer and adversely affects minority women in particular. Screening should continue past age 74 years, without an upper age limit unless severe comorbidities limit life expectancy. Benefits of screening should be considered along with the possibilities of recall for additional imaging and benign biopsy and the less tangible risks of anxiety and overdiagnosis.”

What can I expect during a mammogram?

A mammogram is a simple and straightforward test, but most patients will agree that it is a bit uncomfortable. The breast is compressed to flatten the tissue and allow for a better X-ray of the tissue, and that can cause some discomfort. It is, however, a very safe test as far as radiation is concerned.

If I have no family history of breast cancer, am I still at risk?

As noted by the American Cancer Society, only about 5 to 10% of breast cancer cases are thought to be hereditary, meaning they result directly from gene changes (mutations) passed on from a parent.

BRCA1 and BRCA2: The most common cause of hereditary breast cancer is an inherited mutation in the BRCA1 or BRCA2 gene. In normal cells, these genes help make proteins that repair damaged DNA. Mutated versions of these genes can lead to abnormal cell growth, which can lead to cancer.

It is, however, important to consider that having a first-degree relative with breast cancer nearly doubles a woman’s risk of contraction. Having two first-degree relatives increases one’s risk about 3-fold. Women with a father or brother who has had breast cancer also have a higher risk of breast cancer.

The best news for breast cancer patients and their families today is that the cure rate for breast cancer is incredibly high and with all the funding donated for research, new treatments are constantly being developed. While a diagnosis of breast cancer can be scary and overwhelming, most patients become survivors and return to their normal lives.

Melanie Friedlander, MD, is a breast surgeon at Torrance Memorial Medical Center and specializes in general surgery, advanced laparoscopic surgery, breast surgery, and thyroid and parathyroid surgery. She is located at 23451 Madison Street, Ste. 340. She can be reached at 310-373-6864.

This article was updated on September 25, 2024.