I'm a breast cancer surgeon. AMAZING

[Gincision]

What the thread title says. I've been a consultant for nearly 2 years. Open for questions...

@KarinVogel I'm always happy to discuss removing these 'dogears' as they're called, many patients are bothered by then for a variety of reasons. As to how successful it is depends. Most ladies have an amount of fat like this under their arms which is normally hidden by a breast. Surgery is less likely to be successful if you are overweight and it's just fat that's extending from the back, because it's hard to know when to stop, and you often just move the dogear further back. Some ladies who have a very defined extra fold though and surgery to remove this is usually both easy and successful under local anaesthetic. It's certainly worth seeing your surgeon to discuss this.

@TroubleInSnowland I'm personally in favour of breast screening. You're right thought that it's not totally clear. The figures are that fit every life saved, 3 cancers will be overdiagnosed (which basically means that the cancer picked up wouls not have altered the patient's life expectancy if it wasn't identified, but it's diagnosis results in treatment that is therefore unnecessary - overtreatment). Of course, you only know a cancer has been overdiagnosed with retrospect! The loris trial I linked to above is being done to try and get to the bottom of this a bit more.

If you are young and otherwise fit, it's likely that a cancer identified would affect your life expectancy however. This is why I'd accept the invitation to be in the trial (which if it's what I think it is means you're called for mammo about 47 years, so one extra). But it's a personal decision

@SonggBird check out my post above to TallulahMazda about breast cancer risk. One second degree relative with breast cancer in their 60s would not increase your risk over the general population as this is most likely to have occurred purely by chance. So try not to worry. 95% of breast cancer occurs by chance and most people overestimate their risk because family history is so well publicised as a rush factor

@Shillieshallie feel free to interrupt! Lots of very knowledgeable people on this thread who have been extremely informative, this isn't the gincision show . And I totally agree with you

usernamesarerubbish Sat 21-Jul-18 18:35:33
How do you feel about the Optima trial?

Sorry for butting in and I'm in no way any expert but the Optima trial is looking at the tumour and deciding on this whether chemo would be beneficial to the patient - a fantastic step forward IMO - why put yourself gruelling chemo if the tumour you have wouldn't respond anyway? x

@Aurea it is normal not to give radiotherapy after breast conserving surgery for dcis if it's not high grade. Some people would use it for intermediate grade but not low or low/intermediate. Basically because there is insufficient evidence that the benefit outweighs the risk. When your prognosis is so very good which yours is, it's pretty hard to improve it further, which is all any other treatment would do.

@Gincision thank you so much. X

@NicoAndTheNiners most hospitals won't agree to just do a mammogram without also assessing the patient because to fully assess sometime you also need a clinical examination. This might be the reason you were recalled, not necessarily because there was any concern. Even if they saw something which was the reason they recalled you it obviously wasn't anything to serious if 10 years later you have no symptoms.

Regarding your family history though, an aunt with breast cancer at a young age plus ovarian cancer and a mum with ovarian cancer would be suggestive of a because gene mutation in your family so it would be worth asking to be referred to genetics for an assessment. Even if you decide not to be treated you would most likely be eligible for early screening (depending on your age) and for screening with MRI scan as well as mammography

Typo - not treated, TESTED

@HungryHippo101 I love my job. It's phenomenally rewarding, I'm inspired every day by the courage my patients show, and being able to be part of the team that cures someone's cancer is about as good a reason to get up and go to work as you can get! I'm a fixer, which is why I like surgery, because it's a practical tangible thing I can do to 'fix' someone. I also like the creativity associated with breast reconstruction. All in all I wouldn't do anything else.

As to would I do it all again. I would, because I can't think of anything else is rather do instead. I do think the way junior doctors are treated now is pretty shit though, especially with regards to the central application for training posts making it more difficult to stay in a geographic area where you might have ties. I also hate shift working with a passion, especially night shifts, which when I started weren't common. I was so so relieved when I finished my training not to have to do on calls anymore!

If you do it then ask the very best of luck. I doubt you'll regret it. So look at what the bosses job is like when deciding what to do though. F1 jobs in surgery are notoriously crap, you never get to theatre and there isn't often much support because all your seniors are in theatre / clinic. It gets better!

@user546425732 sounds like either small abscesses or sebaceous cysts. If they've been there all your life probably nothing serious but if you're concerned get your GP to have a look

@freddiemercury that's a new one on me - I've never heard of that before! If you had radiotherapy to your armpit too that might affect your sweat glands but I'd guess that would more likely make it less smelly! I don't know, you've got me stumped.

Sorry your first consultant was a twat but glad you've found someone you trust.

@Fattygettingthin good luck

@tiddliewinkiewoo that is the obvious plus of the trial, and if it concludes that then it will be a fantastic step forward. Of course, it might show that the group who avoid chemo end up with a higher rate of recurrence/ deaths due to breast cancer. If we knew the outcomes would be positive then there would be no need for the trial in the first place, but without trials like this there is no way of moving forwards with cancer treatment and finding ways to individualise treatment is really important

Haven't RTFT. My dad had bilateral breast 5 yeara ago. He had a mastectomy. His brother and a male cousin also had it too. He didn't need chemotherapy or radiotherapy, only surgery. His cancer was early stages (encapsulated) but mu uncle's was only found out when it was very advanced. They are both alive.

Due to this very significant medical history on my family i've tested for BRCA1 AND BRCA2 privately (so expensive) and the results came all negative, which was a relief.

My dad doesn't like to speak about the cancer and hasn't been doing an apropriate follow-up with his doctors and i worry a lot. Is there a significant chance of him having cancer again? I apreciate this may not be possible to answer but any information would be helpful.

*bilateral breast cancer

My mum was diagnosed with hormone receptive breast cancer (that's all I know) in 2004. She had a double mastectomy in early 2005. She had had a cyst a year earlier an they told her it was just a cyst after tests. It went away but kept coming back and got big so a year later she went back to the GP and it was a massive cancer tumour this time (It stuck out;) and was about as big as a gobstopper (you know those things bigger than golf balls??)

Anyway, she had the mastectomy and radio to her ovaries etc. Her lymph nodes were affected and then she has tamoxifen. It was fine for 3 years and she then found out it had spread and was incurable.

What I want to ask is that if she had had chemo would that have stopped it spreading? Would she be more like to have lived? She died just before the 5 years since diagnosis was up.

Thanks for this thread OP. I had a mastectomy 2 years ago. I’m just nervous about the fact that having had breast cancer puts me at an increased risk for ovarian cancer, yet that doesn’t seem to be recognised or acknowledged by NHS? No one ever tells you about it and scans or Ca125 tests are not recommended (according to my surgeon). So I’m thinking (as I’m 50) that perhaps I should have my ovaries removed, is that an over reaction? Do other women choose to do that?
My cancer was strongly oestrogen positive, lymph nodes clear, and oncotype score was low so no chemo.

Thank you Gin x

I’ve read, for example here: www.theguardian.com/society/2017/jul/18/uk-cancer-survival-rates-lag-behind-those-of-other-european-countries-study
that cancer survival rates in the UK are not as high as comparable European countries and that this was down to later diagnosis.

Do you have a view on what goes wrong with diagnosis in this country? Do people not go to the GP early enough, or are their fears dismissed, or do they not get the full suite of tests early enough?

I’m fortunate not to have experienced cancer care at all, either for myself or a close friend or relative. But I do work with a lot of people from other countries who are frequently taken aback by the ‘wait and see if it goes away’ type approach of GPs here compared to other countries they have lived in and I wondered if that had something to do with it?

@gincision
Thank you very much for taking the time to reply and your kind words!
X

@Inthetropics check out my post to sharpandshiny teeth which tells about recurrence. In your case it's harder because you can't force your dad to talk about details regarding his cancer. In general the longer you go cancer free the more likely it is that it won't come back but some types of breast cancer can come back many years after successful treatment so it's important he remains vigilant.

Thanks so much for this thread. What you said about taking your cue from the patients' emotions really rang true for me - I'm very very pragmatic and my oncologist and surgeon echoed this and I found it very helpful.

@Timpani so sorry to hear about your mum. As to your question, it's impossible to know for sure. At the time of initial diagnosis surgery is done to get rid of the cancer, other treatments are given to reduce the likelihood of it ever coming back - called adjuvant treatments (or neoadjuvant if given before surgery). The decisions regarding what adjuvant treatments are offered are based on balance of risks versus benefits, as well as the patient's wishes and their general health. Sadly no treatments can totally remove the risk of the cancer coming back. It's possible chemo might have made a difference, but it's also possible your mum would have had a miserable time on this treatment and it would still have recurred.

@missyB1 having a previous breast cancer doesn't hugely increase your risk of ovarian cancer - the link is at least partly explained by the risk of both of these cancers being associated with brca gene abnormalities, but also because they are both often hormonal related and associated with other similar lifestyle factors.

Removing your ovaries however is not an unreasonable thing to request for discussion, not least because this is excellent treatment for a hormone receptor positive breast cancer and reduces your risk of another breast cancer by 50%. Important to emphasise 50% is relative risk not absolute risk and the absolute benefit to you would depend on what your risk is in the first place. It would also allow you to have letrozole instead of tamoxifen which is better but only effective in postmenopausal women.