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Medical director answers common cancer questions
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With the arrival of October in North Georgia comes cooler weather, changing leaves and pumpkins. But October also marks the start of another season, more important than fall seasonal trends. It is Breast Cancer Awareness Month.

According to a study by the National Breast Cancer Foundation, 1 in every 8 women will be diagnosed with breast cancer at some point in her life. They estimate every year more than 246,660 women will receive a breast cancer diagnosis. More than 40,000 women will die of it.

These statistics may seem daunting if you or a loved one are starting the process of dealing with a cancer diagnosis, but a number of different resources can help reassure patients and set them on the right path.    

Dr. Charles Nash, the Cancer Center medical director at Northeast Georgia Medical Center, said even though the process of diagnosis and treatment can be a scary one, knowing what to be prepared for is the best tool to help reduce stress and navigate the process.

To find out more about what women can expect when going through the difficult first steps of cancer treatment, The Times spoke with Nash about some of the different elements surrounding breast cancer.


Question: Who should be screened for breast cancer?

Answer: We generally say all adult females in their mid-30s should begin getting screened. Or if they have a family history of breast cancer at a younger age, they should begin being screened at that age. We don’t usually screen men for breast cancer, but men can have it.

Q: Why are regular screenings for breast cancer important?

A: To ensure that noticed abnormalities are found at the earliest possible time. The results of treatment and expected prognosis is better when a cancer is discovered earlier in its course.

Q: Are doctors or scientists currently aware of any ways to prevent breast cancer?

A: There is some clinical data that the use of Tamoxifen antiestrogen medication taken for five years in patients less than 65 years of age who have a first-degree relative with breast cancer may result in a lower incidence of that patient developing breast cancer.

Q: What are the types of breast cancer?

A: Most are infiltrating ductal carcinomas. Less common cell types are lobular carcinomas, mucinous carcinomas and metaplastic carcinomas.

Some cancers are hormonally driven to grow while others are found to be hormonally insensitive. And some may contain a genetic mutational driver. The oncologist takes into consideration all of these factors when designing a treatment plan.

Q: What are the different stages of cancer?

A: To an oncologist, stage is strictly defined depending on the size of the primary tumor and whether there is involvement of regional axillary nodes or distant organs. Stages 0-4 are defined in this way.

Q: How does cancer stage affect a patient’s long-term chances for survival?

A: Generally cancers presenting at an earlier stage have a better prognosis in terms of recurrence rate and survival duration. However, cancers that present at more advanced stages can still be treated with beneficial effect.

Q: What are the kinds of treatments available?

A: Surgery, chemotherapy, hormonal therapy, genetic therapies and radiation therapy. (They are) sometimes given alone or in combinations can be used quite successfully.

Q: What treatment do you recommend and why?

A: I can recommend all of these therapies depending on the particular situation presented by a given patient. Most ladies need some sort of surgery, usually a lumpectomy or a mastectomy. A lumpectomy is usually followed by a round of radiation therapy.

Q: How do treatments affect different people?

A: The effects of surgery are as expected with necessary healing times.

Lumpectomy (removal of a breast lump without removal of the entire breast) is well tolerated with short recovery times.

Chemotherapy is now tolerated much better than before due the use of modern antiemetics, shorter treatment duration and newer treatment regimens. Some patients have few if any side effects from chemotherapy, but others have some nausea, fatigue and hair loss. Healthy patients generally tolerate chemotherapy well.

Radiation therapy can result in skin redness that resolves after treatment is completed, sometimes with mild skin tanning as a result.

Q: How do you know which treatment is right for you?

A: Consultation with an oncologist is necessary to discuss the treatment options for a given patient as there are many options to address the multiplicity of breast cancer types, hormonal status and genetic mutations that may present in a given cancer.

Q: What is the goal of treatment?

A: The goal is always cure if possible. However, in cancers that present to the physician with metastasis, the goal will be response of the cancer to treatment, relief of symptoms and improved response duration that can lead to improved survival times.

Q: When should you get a second opinion? How do you ask for a second opinion?

A: Consider a second opinion if you desire confirmation of a treatment plan or diagnosis, are in doubt of the accuracy of information presented to you or if you have unanswered questions.

Q: What happens after treatment?

A: After completion of treatment, the patient is typically followed to assure success of the given treatment, to screen for side effects and for surveillance for cancer recurrence.

Q: How does reconstruction work?

A: Surgical reconstruction is used for cosmetic recovery after or during cancer treatment. Generally it is performed by a plastic surgeon skilled in breast cancer procedures. Either patient tissues or prosthetic implants can be used as indicated.

Q: Is reconstruction work normally covered by insurance?

A: For patients with a breast cancer diagnosis, reconstruction is generally a covered procedure by most insurers.