What is Radioactive Seed Localization?

Starting in 2016, Touro Infirmary has offered our breast cancer patients Radioactive Seed Localization (RSL) surgery to target lesions in the breast. The program, supported by Dr. John Colfry and Dr. Danial Rupley, established Touro as the first hospital in the Gulf South region to offer this treatment. Dr. Colfry, a Breast Surgical Oncologist, and Dr. Rupley, a Radiologist, trained at MD Anderson Cancer Center to bring these advanced treatment to our patients.

What is a radioactive seed localization?

RSL is a new way for radiologists and surgeons to identify the tumor or lump. A RSL implant is the size of a grain of rice and is placed at the area of the cancer using a mammography or ultrasound. The seed is placed one to five days before the surgery and found by the surgeon using specialized tools that detect the seed. Traditionally, wire localization has been used as the guide for surgeons to find the cancerous area.

If the seed is radioactive does it mean that there will be radioactive exposure?

The seed is a very low level of radioactive energy. In fact, the seed poses no risk to your family members, caregivers, or anyone who comes into contact with you during the time that you have the seed. Additionally, are the seed is taken out it leaves no trace radioactive material.

So, why would I want radioactive seed localization?

Compared to wire localization, there are many benefits of RSL. Wire localization typically requires patients to have the procedure done immediately before surgery, while RSL can be done up to five days in advance. With wire localization, part of the wire remains outside of the breast, which may be uncomfortable for patients and, if accidentally touched or moved, may decrease the surgeon’s ability to identify the lump. During the surgery, less tissue needs to be removed from the breast if using a seed because the surgeon is able to easily identify where the lesion is.

Are you considering your options before breast cancer surgery or do you have more questions about RSL? Contact our team at the Women’s Imaging Center at (504)-897-8600 to learn more or visit our online website. Our team is dedicated to our patients and to continuing our values of respect and family.

Preparing for your First Mammogram

Going in for your first mammography can be a stressful and scary time. However, mammography is an important detection tool and can help find problems earlier than with a self-exam. Health experts have different opinions regarding screening frequency. The American Cancer Society suggests an annual screening for women between 45 and 54. Women age 55 and older can have a screening every one to two years. Women should talk with their physicians to determine the appropriate time to begin getting mammograms, based off of individual risk factors.

What to know beforehand:

  • Schedule your mammogram for when your breasts are not tender or swollen. This will reduce discomfort and allow for better pictures.
  • On exam day, do not wear deodorant or antiperspirant which may show up on the x-ray as white spots.

What to expect during the screening:

  • You will be undressed from the waist up.
  • During your exam, your breasts will be flattened by the machine.
  • The whole test will take approximately 20 minutes.
  • It is normal to feel discomfort, but if you feel pain tell the radiologists.

Touro offers comprehensive women’s imaging care at the Women’s Imaging Center on Napoleon Avenue. Our team members excel at offering a positive and comfortable experience for first time and experienced patients. Need to schedule your mammogram? Please give us a call at (504) 897-8600 or visit Touro Imaging online.

Breast Self-Exam vs. Breast Self-Awareness

It is normal for breasts to change during the stages of your life. Therefore, knowing what is normal for your breasts to look and feel like is vital towards breast health. There are two main ways of evaluating your own breast health: a breast self-exam and breast self-awareness.

Breast Self-Exam

Self-exams are encouraged at least once per month. John’s Hopkins Medicine states that 40% of breast cancers are detected by women performing regular breast self-exams. It is important that with a self-exam, to perform them regularly.

The steps of an exam are as follows:

  1. Raise arm opposite to the breast being checked, and using pads of your fingers, move along your entire breast and armpit in a circular motion.
  2. Check both breasts for any lump, thickening or hardened knot.
  3. Visually inspect your breasts with your arms at your side and again with your arms high overhead.
  4. Press your palms on your hips firmly and check for dimpling, puckering or one-sided changes.

Breast Self-Awareness

Compared to a self-exam, self-awareness does not rely on a certain method or schedule but looking for changes in your breasts. Any noticeable changes should be reported to your healthcare provider.

Changes to look for include the following:

  • Nipple discharge other than milk
  • Swelling
  • Change in size or shape
  • Redness, thickening, or dimpling of the skin
  • Swollen lymph nodes in the armpit
  • Pain or redness of the nipples

What is the Paxman Cooling Cap?

Touro is proud to be the first hospital in Louisiana to offer the Paxman Scalp Cooling System. The Paxman Scalp Cooling System is globally recognized as the leading product for hair loss prevention during chemotherapy treatment. Paxman allows more control, precision, and coverage than traditional scalp cooling treatments like ice packs and cold caps. The lightweight design provides a close fit around the patient’s head. Research shows that these systems give you a much greater chance of keeping your hair. The use of scalp cooling has been proven to be effective in preventing chemotherapy induced alopecia or hair loss and can result in women retaining much of the hair.

How does scalp cooling work?

It works by reducing the temperature of the scalp by a few degrees immediately before, during and after administration of chemotherapy. This in turn reduces the blood flow to hair follicles, which may prevent or minimize hair loss.

Who is scalp cooling for?

Scalp cooling can be used with all solid tumor cancers that are treated with chemotherapy drugs that target rapidly dividing cells and the matrix keratinocytes, which results in hair loss.

Scalp cooling cannot be used with the following conditions:

  • Hematological malignancies (leukemia, non Hodgkins and other generalized lymphomas)
  • Cold allergy
  • Cold agglutinins
  • Manifest scalp metastases
  • Imminent bone marrow ablation chemotherapy
  • Imminent skull irradiation

Will you be able to keep all your hair?

Patients will lose some of their hair, and some patients will lose more than others. Every patient is different. Moderate hair loss is expected. If you do not have to wear a wig or head cover, it is considered a success.

How long does the cap have to be worn?

The cap is worn for 30 minutes before the start of chemotherapy, during the infusion of the drugs and for up to 90 minutes after drug infusion. You may be moved to a different area for 90 minutes cooling.

How cold will it get?

Cold at first but not unbearable. It is much less noticeable after 10 – 15 minutes. Deep breathing can help at the initial stages of scalp cooling. The benefits can include immediate relaxation as well as an improved ability to handle stress or calm down.

Are there any side effects of scalp cooling?

Scalp cooling can cause discomfort if you’re sensitive to cold. Applying cold temperatures to the scalp can lower your overall body temperature, so we recommend that patients bring warm clothes or blankets to chemo treatments to prevent symptoms of hypothermia.

Short to medium-term side effects include:

  • Cold discomfort (during scalp cooling)
  • Headache (during and after scalp cooling)
  • Forehead pain (during scalp cooling) caused by pressure and tightness of the cooling cap
  • Dizziness or light-headedness (during scalp cooling)

Most of the symptoms are temporary and the benefits outweigh the side effects.

How much does Paxman Scalp Cooling cost?

Through a generous donor, Touro Infirmary Foundation has established Locks Everlasting, which raises funds to assist patients in participating in scalp cooling treatment. The opportunity to keep one’s hair while undergoing cancer treatment can be empowering in someone’s battle against cancer. You can support Locks Everlasting by donating to the Touro Infirmary Foundation at www.touro.com/donate

Click here to read Amanda’s story and testimonial about the Paxman cooling cap.

Should You Start Getting Mammograms Early?

Screening mammograms are breast X-rays that can detect breast cancer before it causes symptoms. Experts agree that mammograms save lives. But there’s a difference of opinion about the best age to start getting them. In guidelines from different studies, the starting age varies from 40 to 50. So, when should you get a mammogram?

Balancing Benefits and Risks

Mammograms reduce deaths from breast cancer. That’s a huge benefit. Yet women ages 50 and older have the most to gain. For those ages 40 to 49, the number of deaths prevented is smaller. Mammograms have risks as well. They sometimes produce false positives—results that appear abnormal when no cancer is present. False positives can cause anxiety and lead to more testing. Another risk is overdiagnosis—finding and treating noninvasive breast cancer that never would have caused problems. This isn’t harmless because unnecessary treatment has risks of its own.

What Does the Experts Recommend?

The American Cancer Society says that screening mammograms should be an option starting at age 40, and all women should be getting them by age 45. The U.S. Preventive Services Task Force, on the other hand, says that all women should start mammograms by age 50.

Both groups agree on a key point: You should discuss this issue with your doctor. If you have risk factors for breast cancer, such as a family history of the disease, earlier mammograms may be particularly important. Your doctor can help you choose the right starting age for you.

Click here to request a mammography appointment at Touro online or call 504-897-8600.

Not All Breast Cancers Need Chemotherapy

Melanie Sheen, MD

Breast cancer is the most common cancer diagnosis among women. Many times when a woman hears the words “breast cancer,” they often think that it will be a long road of surgery, radiation, and chemotherapy. However, with small tumors and no cancer in the lymph nodes, this is not always the case.

Approximately 80% of breast cancers are driven by estrogen (called estrogen receptor positive). This means that individual breast cancer cells receive a signal from estrogen that allows each of those cells to multiply. After surgery and radiation, women who have small estrogen receptor positive breast cancers may be able to skip chemotherapy and only need to take an estrogen blocking pill. In 2003, a new test was developed, called Oncotype DX, to help determine who will need chemotherapy in addition to the pill and who can skip chemo. The patients who need chemotherapy have a higher risk of the cancer coming back somewhere else in the body, and they can reduce that risk with chemotherapy. An update to this test, published in June 2018, identified even more women who can skip chemotherapy and only need to take the anti-estrogen pill. In fact, with the use of this test and other tests like it, such as Mammaprint and Endopredict, women with estrogen receptor positive breast cancer have the chance for a more personalized approach to treating their cancer without chemotherapy.

When breast cancer is diagnosed, doctors not only test for estrogen. But, they also test for a cancer protein called HER2. If this cancer protein is found, the breast cancer, certain medications are used to target just those cancer cells. Unlike estrogen, these medications are given through an IV and aren’t in pill form. Breast cancer that has this cancer protein is more aggressive and more likely to spread to other parts of the body. Unfortunately, two or three chemotherapies are often recommended in addition to the medications that target the cancer protein. However, new research in breast cancer shows that almost all small HER2 cancers do not come back when only one chemotherapy and one HER2 target medication is used. Currently, there is ongoing breast cancer research to find out if these small tumors can be cured with targeted medications alone.

However, in triple negative breast cancer, it is not driven by estrogen and does not have the HER2 protein. Chemotherapy is the only recommended treatment. This is because triple negative is the most aggressive type of breast cancer, the most likely to spread to other parts of the body, and there are no targets that can be used to treat the cancer.

Whether the breast cancer is small or large, it can be treated by chemotherapy or a pill. Also, breast cancer that is not metastatic remains very curable. As more breast cancer research occurs, there may be treatments that allows all kinds of breast cancer to avoid chemotherapy.

Dr. Melanie Anne Sheen, MD, is a Hematology/Oncology specialist fpor Crescent City Physicians, Inc. She attended and graduated from Tulane University School Of Medicine in 2010. She has more than 8 years of diverse experience in Hematology and Oncology.

“You Have Cancer” Were Words I Never Thought I Would Hear

Kristin Fletcher

Valerie Leclercq was born and raised in France. She moved to California in the early 90s where she met her partner of 17 years, who is from New Orleans. They relocated to Las Vegas in 2003 where Valerie opened her private practice as a Licensed Professional Counselor. They returned to New Orleans in December of 2016 to be closer to family and friends.  Valerie loves her work and life in New Orleans, and she never thought that she would experience cancer. That changed last fall.

“I was sleeping in the middle of the night, and I felt a higher power telling me to feel my right breast,” Valerie says. “I felt a huge lump. It was hard at the touch and felt like cement.” The following morning, Valerie called Dr. Donna Waters, her Gynecologist at Touro for assistance. Dr. Waters immediately scheduled a mammogram and ultrasound. Valerie never once thought it would be cancer.  “I thought it might have been a cyst,” recalls Valerie. Following her mammogram, a biopsy was ordered immediately.

On November 14, 2017, Valerie’s life changed completely. Valerie was in between client appointments as she waited for the phone call to learn the results of her biopsy.  When the phone rang, she asked the physician directly if she had cancer and she replied yes. Valerie was diagnosed with HER2-positive breast cancer, which is a more aggressive form of breast cancer. HER2-positive is a cancer that contains a certain protein that promotes cancer cell growth. Normal HER2 proteins regulate proper breast cell growth but become HER2-positive when there is an overproduction of HER2 cells.

Constant Reassurance

Valerie was referred to Touro Breast Surgical Oncologist, Dr. John Colfry. “Some of my friends in the medical field told me that Dr. Colfry was one of the best surgeons in the city,” says Valerie. This provided Valerie with a sense of reassurance before her first appointment. “Dr. Colfry and the staff were truly amazing. I felt right away that it was a good fit,” says Valerie. “He was kind, genuine, sincere and very knowledgeable.”

During her visit, Valerie was informed that she had invasive breast cancer, which means the cancer had spread to outside the duct and into the normal tissue inside the breast. “I was told that everything was going to be okay,” says Valerie. “Dr. Colfry told me that I would have to start chemotherapy immediately. The treatment plan was to reduce and eradicate the size of the tumor through neoadjuvant chemotherapy and then to consider my surgery options.”

Valerie began chemotherapy on December 1. She had six rounds of chemotherapy every three weeks.  “I was devastated to lose my hair, but I knew the chemotherapy had to be done,” says Valerie.  Through regular appointments with Dr. Colfry, Valerie reviewed her options of having a lumpectomy or a bilateral mastectomy.  Dr. Colfry recommended a double mastectomy as the best option for her cancer. “No radiation would be needed with a double mastectomy,” says Valerie.

On May 9, Valerie underwent a bilateral nipple sparing mastectomy and breast reconstruction. “I do not regret anything,” says Valerie. “However, the decision was hard to make.” Valerie’s cancer is currently in remission, and she visits Dr. Colfry every month for follow-up care. “He is a fantastic doctor and an amazing human being. His nurse Terri is awesome as well. She will talk to you at any time of the day if you have a question,” she says. “I am glad to have listened and trusted my surgeon.”

Click here to learn more about Touro’s Breast Cancer Surgery Program.

What Does it Mean to Have Dense Breasts?

Did your last mammogram report say you have dense breasts? It’s more common than you think. Almost half of all women who get mammograms are found to have dense breasts, and many don’t know what it means.

Understanding dense breast tissue

Breast density describes the different kinds of tissue that show on your mammogram. Your breasts are made of fat, connective tissue, and milk ducts and lobules that together are called glandular tissue. Dense breasts have higher amounts of glandular and connective tissue and lower amounts of fatty tissue. Breast density matters because women with dense breasts have a higher risk for breast cancer than women with fatty breasts.

The radiologist who reviews your mammogram classifies your breasts according to these 4 groups:

  • Almost entirely fat (about 1 in 10 women)
  • Some dense areas: scattered areas of dense glandular and connective tissue (about 2 in 5 women)
  • Many dense areas: numerous areas of glandular and connective tissue (about 2 in 5 women)
  • Extremely dense: almost all glandular and connective tissue and little fat (about 1 in 10 women)

Dense breasts fall into groups C and D. Dense areas look white in a mammogram, the same color as cancer, making it tricky for doctors to read the images and find breast cancer.

Factors affecting breast density

Experts aren’t sure why having dense breasts increases your risk for cancer. Typically, breast density is inherited, but other factors can influence it. You may have higher breast density if you’ve used postmenopausal hormone replacement therapy or are underweight for your height. You are more likely to have lower breast density as you age, if you have had children, or if you have taken a breast cancer prevention medicine called tamoxifen.

Should you have additional tests?

If you have dense breasts, speak with your doctor about your personal risk factors for breast cancer and whether you should have more screening tests, such as 3-D mammography, a breast ultrasound, or an MRI exam. No screening recommendations beyond mammography have been established for dense breasts, although research is underway. Some states require healthcare providers to notify you if your mammogram shows you have dense breasts. Many states also require insurance providers to cover additional imaging tests. Learn more about the legislation in your area.

Regular screening is key to catching breast cancer early. You can also reduce your cancer risk by maintaining a healthy body weight, getting enough exercise, and limiting alcoholic drinks.

Click here to learn more about the comprehensive imaging services offered at Touro’s Women’s Imaging Center.

Breast Health & Preventive Care

Finding breast cancer early is the main goal of routine breast care. That’s why it’s so important to follow a plan for preventive care. Finding problems early gives you the best chance of successful treatment. Routine care can also help find other noncancerous (benign) conditions, too. Experts don’t all agree on the best breast cancer screening plan for women at average risk. Talk with a healthcare provider about your breast cancer risk to decide on the best preventive care plan for you.

The American Cancer Society (ACS) says that all women should get to know how their breasts normally look and feel. Doing this can help you notice any changes more easily. Changes to your breasts may include:

  • Lump
  • Leaky fluid (discharge) other than breastmilk
  • Swelling
  • Skin irritation or dimpling
  • Nipple problems. This might be nipple pain, redness, or flaking. Or the nipple may turn inward.

See your healthcare provider right away if you notice any of these changes.

The U.S. Preventive Services Task Force (USPSTF) and the ACS don’t recommend doing breast self-exams (BSEs). This is because they may not lower the risk of dying from breast cancer. Talk with your healthcare provider about if you should do them.

Clinical breast exam (CBE)

Your routine physical exam might include a clinical breast exam (CBE) by a healthcare provider or nurse trained to check breast problems. The American College of Obstetricians and Gynecologists recommends:

  • Between ages 25 and 39, women should be offered a CBE by a healthcare provider every 1 to 3 years.
  • After age 40, women should be offered a breast exam by a healthcare provider every year.

But the USPSTF and ACS believe there isn’t enough evidence to know if CBEs are helpful for women ages 40 and older. Talk with your healthcare provider to decide if you should have a CBE.

Mammogram

A mammogram is a low-dose X-ray of your breasts. A mammogram can find cancer or other problems early, before a lump can be felt. It can also help diagnose other breast problems. But a biopsy is needed to know for sure if you have cancer.

Health experts have different advice for breast cancer screening with mammograms:

  • The USPSTF recommends screening every 2 years for women ages 50 to 74.
  • The ACS recommends yearly screening for all women ages 45 to 54. Women ages 55 and older should change to mammograms every 2 years. Or they may choose to still have a yearly screening.

Talk with your healthcare provider about when to start getting mammograms and how often to have them. Click here to learn more about mammography at Touro’s Women’s Imaging Center.

Click here to take our online risk assessment for breast cancer.

31 Days of Pink

Welcome to 31 Days of Pink, Touro Infirmary’s movement to raise breast health awareness every day during October, National Breast Cancer Awareness Month. Throughout the month, Touro will share daily education on our blog and social media sites designed to inform, educate, inspire and provide helpful resources.

Today, breast cancer affects 1 in 8 women in the United States during her lifetime. In Louisiana, the rate of breast cancer is 123.4 per 100,000 women, which is on average for the nation. However, Louisiana has one of the highest rates of mortality in the nation. We can change this by educating our community and encouraging to life saving screenings. When detected early, breast cancer is most treatable.

Together we are fighting to beat this disease. We hope that you will join the conversation.

Visit www.31DaysofPink.com to read our blog daily, and share your story with us on Facebook, Twitter or Instagram using the hashtags #31DaysofPink #StrongerTogether.

Race for the Cure

Join Team Touro on October 20th for the Susan G. Komen Race for the Cure®. Click here to register as a member of Team Touro.

Date: Saturday, October 20, 2018

Location: City Park, Practice Track Facility

1 Palm Drive, 70124

Times:          

8:00am – Survivor Program
8:30am – Kids Dash
8:45am – 1mile walk or run
9:30am – 5k walk or run

Be Social

Find Touro on our social media platforms and tell us why you pink on social media! Use the hashtags #31DaysofPink and #Stronger Together to connect with us.

Pampered and Pink: A Women’s Health Celebration

Join Touro for a fun and informative evening where we celebrate all things women!

Thursday, October 18
6pm to 8pm
Audubon Zoo Tea Room

Enjoy festive fare at our gourmet food and beverage stations, meet our panel of experts and ask questions during our women’s health round table, visit with Susan G Komen and the American Cancer Society, pamper yourself with mini manicures, chair massage, hair styling, makeup and more! You’ll also be able to Shop for a Cause with Kendra Scott and take photos to share with friends and family in our pink photo booth.

Tickets are $20 each or 6 for $100.

This event is made possible with support from The Heebe Family Fund at the Touro Infirmary Foundation.
>> Click here to register