Today I had a consultation with a lovely couple. The wife and patient is a 31-year-old mother of two young children. During a breast self-exam (which I hope all women do but know they don’t so do it) she noticed something very slightly different in one of her breasts. She saw her doctor, who sent her for an ultrasound evaluation of the breast.
Just to clarify, young women typically have very dense breast tissue. This is why mammograms aren’t done in younger women; it’s very difficult to see any pathology or disease through the dense tissue. If there are any concerns, an ultrasound is the first test performed.
The ultrasound was performed and read by a radiologist as normal. Fortunately, this radiology group uses two radiologists as a sort of checks and balances system. The second radiologist, either due to experience or intuition, suggested that the patient get a mammogram for clarification. The mammogram confirmed the doctor’s suspicions, something irregular, was there. Our patient was then referred to a breast surgeon, Dr. Virginia Chiantella. Dr. Chiantella (can-tell-a) is well-trained and performs outstanding breast surgery.
Now just take a minute. Think about the whirl-wind that this woman was undergoing. She was living a normal, happy, suburban life one day and in a very short period of time she’s going to see a surgeon for a potential cancer.
Just take a moment and put yourself in that position.
There aren’t enough adjectives to describe the feelings that would go through your mind and body. But our patient is tough. Tough, like so many other women in this situation, because she has to be-children don’t understand when mom is sick. And the thought of your own children having to grow up without you will drive any parent to do what is necessary.
Dr. Virginia Chiantella MD FACS, is incredibly talented, smart and caring. She performed a needle biopsy on our patient. This involves using a needle to take an actual piece of breast tissue. The pathologist determined that the this tissue contained cancer, DCIS (Ductal Carcinoma In-Situ). Now when I was a resident physician DCIS wasn’t considered “cancer” but over the course of time and multiple studies we know that this is the first stage of invasive breast cancer. In addition, because of her young age and an extensive family history of breast cancer, gene testing was suggested.
Gene testing looks for damaged BRCA 1 and BRCA 2 genes. These genes are in the class of tumor suppressor genes. What they do is produce proteins that go out and repair DNA that has been damaged. Like a power company fixing a power line-they either repair it or replace it. Damaged DNA, if not fixed or removed, will proliferate as the cell it is contained in multiplies. There are lots of these gene in our DNA that protect us from cancer and other diseases. The problem is that these genes, like any gene, can become damaged and not able to perform their duties. When this happens cancer occurs. When these damaged genes are present they can increase the possibility of breast cancer as well as other cancers AND be passed onto offspring in their damaged state. Our patient got tested and her results indicated….