Ask Anna Maria
Breast cancer diagnoses bring about all kinds of questions. With so many changes and challenges, navigating a new normal can be overwhelming. Nothing calms anxiety quite like hearing answers directly from an oncologist. Luckily, we know a great one!
Anna Maria Storniolo, MD, a specialist in breast care and cancer treatment, now serves on the Vera Bradley Foundation for Breast Cancer Board of Directors. An oncologist and clinical researcher for over 40 years, she was an active participant in bringing science to the bedside and clinical observations back to the laboratory. With over 140 publications, Dr. Storniolo’s work has impacted women – and the research world – forever!
Q: Are there any downsides to having reconstruction surgery?
A: Reconstruction is a personal choice. There are different kinds of reconstruction, and some are better than others depending on the situation. I strongly advise that you ask a plastic surgeon to be involved in your initial care plan, so you know what options are best for you. Ask all kinds of questions – recovery time, number of surgeries, symmetry, etc. – and ask to see examples of their work. Finally, bear in mind any surgical procedure has inherent risks of bleeding and infection, among others, and you need to be prepared for these.
Q: How important is it to get a second opinion?
A: The breast cancer journey is as much a battle of medicine vs. cancer, as one of doubt vs. peace of mind. Your relationship with your oncologist is unlike most other patient/physician relationships. For most people, this is the toughest battle they’ve had to face. It’s critical you TRUST the medical professionals on your team and feel comfortable talking to them. Though getting a second opinion isn’t always necessary, it’s never wrong. You need to feel like you’re on the right path. A different set of eyes will either confirm the original recommendations or teach you – and your physicians – something new. And don’t worry about your doctor’s feelings…we’re big girls and boys, we can take it!
Q: How important are breast self-exams? I’ve been told to do them but am not sure what to feel for! Do annual mammograms suffice?
A: Breast self-exams by themselves are poor screening tools. Women should adhere to mammogram guidelines, especially women with a strong family history of breast cancer or other risk factors. BUT, examining your breasts is FREE!! I counsel every woman, starting at about age 25, to know her breasts. While you’re in childbearing years, examine yourself at different times in your cycle, because the breast changes with normal hormonal fluxes. After menopause, examine yourself once a month. Though breast cancer usually forms a lump, this isn’t always the case – there may be a thickness, a puckering, a change in color, or a new asymmetry. If you’re worried about “how”, just ask your primary care provider. Remember, it’s never wrong to talk to your doctor about a change in how your breasts feel.
Q: Will I lose my libido or desire for sex?
A: Some of the anti-estrogens used to treat breast cancer can cause lessening of your libido, or sex drive. The degree varies from person to person. It’s important to remember that breast cancer most commonly affects women during their menopausal or perimenopausal years, times when libido is naturally waning. My advice is to talk with your partner about approaches to arousal and foreplay. This can be seen as an excuse to have some fun during a very trying time!
Q: Why do my ribs hurt a year and a half after chemo and radiation?
A: This is a very common complaint. The removal of breast tissue, especially in a mastectomy, involves the cutting of many tiny nerve endings. Most of these heal or reconnect, however, occasionally the discomfort persists for a long time. Radiation further irritates these nerve endings. If bothersome enough, taking an NSAID – ibuprofen or naproxen – can help. With pain often being localized, avoiding underwires or seams that overlie the area may help. If the pain is severe or new, please consult your surgeon or oncologist.
Q: Can I continue taking vitamins, collagen, and using beauty products during treatment? Also, is there anything I can take to help prevent or manage hair loss?
A: I recommend checking with your oncologist or the specialty pharmacist in their practice before using or taking any supplement/unusual beauty product. Even common vitamin supplements taken at unusual doses may have unexpected or even harmful consequences. Bring the bottle or label of the specific product with you to your appointment. Also, beware of accepting the recommendations of well-meaning friends, relatives, or even other breast cancer survivors. There are several different kinds of breast cancer. Make sure that a product is safe for you!
Hair loss is certainly one of the most distressing side effects of some breast cancer therapies. This is because it’s a sign to you and everyone else that you’re “sick”, even though you’re likely to have many good days throughout your treatment. There is nothing that will guarantee your hair will not fall out. However, scalp hypothermia during chemotherapy, or “cooling caps”, works to some degree in most patients. There are several approaches, including literally changing out a tight-fitting frozen cap several times during treatment or having ice-cold liquid flow through a tight cap. These can be costly, aren’t always covered by insurance, and may include side effects. Your oncologist should have information regarding options available to you.
Q: I’ve tried three different long-term medications, experiencing horrible side effects with each. Someone suggested I start drinking tart cherry juice to help with the side effects – and it’s working! Why does tart cherry juice help and is there anything else I can do to reduce negative side effects?
A: Tart cherry juice hasn’t been carefully studied as a means of decreasing side effects from any form of cancer therapy. There is some evidence in nutrition literature that it has anti-inflammatory and melatonin-like properties. I advise checking with your oncologist, and if you do decide to try it, avoid products with a high sugar content.
Q: How can I best support my wife during treatments or after surgery?
A: My most sincere advice is twofold: BE THERE and LISTEN. No two people’s cancer journeys are the same. It’s important to not avoid the topic or pretend nothing’s wrong. Often, a patient’s loved ones are afraid themselves and don’t know what to say. The answer is to listen! Ask your wife what she needs or wants from you. Cancer patients often feel an overwhelming loss of control over their lives, so allowing them to express their needs gives them some control back.
Q: I’m having a hard time finding myself attractive with scar tissue and loss of feeling in my breasts. How can I become more confident in the new me?
A: My heart goes out to you. You’re still the same amazing person you were before this happened! Talk to your plastic surgeon about ways to minimize the scar, and if necessary, consult a wound specialist. The numbness may resolve or lessen over time. It’s important to discuss your feelings with your partner and close friends. You will get affirmation and love in return.
Q: Is there any way to know whether breast cancer is genetic or not besides genetic testing? I have no family history but want to know for my girls’ sake!
A: You’ll be surprised to learn that only approximately 30% of breast cancer is familial and less than 10% are associated with a known genetic defect. It’s important to know which diseases occur in your family, especially any types of cancer. It’s also important to know the cancer history of the father’s side of the family. Mutations are often inherited in an “autosomal dominant” fashion, meaning you only need one copy of the faulty gene to develop the problem. Since we have two copies of all our genes and inherit one copy from each parent, the “faulty” one may be inherited from the dad’s side, even if he didn’t have breast cancer.
Having said that, we are far from understanding all the genetic details of breast cancer, and new genes of clinical significance are being identified all the time. It’s worth nothing that having had breast cancer, your daughters’ lifetime risk increases by about 60% – from approximately 12% to 18-20%. Personal risk also increases with the number of family members that have had breast cancer.
Q: Do exercise and nutrition reduce your chances of getting breast cancer? If not, what does?
A: As noted above, we have no clear cause for 70% of breast cancers. Women who learn they are at high or moderate risk may consider taking tamoxifen, which lowers lifetime risk by at least 50%. I encourage all women to adopt a healthy balanced diet, nothing fancy, and moderate exercise. Getting your heart rate up for 30 minutes at least five times a week is ideal. These lifestyle changes have been shown to reduce breast cancer risk in several excellent, well-done studies.
Have a question? Email foundation@verabradley.com