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Frequently Asked Questions

Breast Disease

How can I prevent breast cancer?
We don't know how to prevent breast cancer, because we don't know what "causes" breast cancer. Breast cancer is the most commonly diagnosed cancer in women, and it is the second most lethal cancer behind lung cancer. The most important risk factor is being female. Other important risk factors are your age, your family history, any prior history of breast cancer or proliferative breast diseases, and your personal endocrine factors (estrogen exposure). Endocrine factors are related to your lifetime exposure to estrogen - risk includes starting your menstrual cycle periods early, late menopause, late first pregnancy or not having children. As you can see, there are not a lot of things that you can change.

Diet may play a small role, but studies vary. Green vegetables and monosaturated fats decrease your risk. Soy is a phytoestrogen and has weak estrogenic properties. Data regarding soy is minimal. It may decrease the risk of breast cancer in a premenopausal woman, but may increase the risk of breast cancer in a postmenopausal woman.

Alcohol has been linked to an increased risk of developing breast cancer. This should be weighed against the possible beneficial effects that alcohol may have for cardiac disease.

The most important thing that you can do is be proactive - do your monthly self-breast exams, have your yearly physical exams by your physician, and have your mammograms. Do not ignore a lump or an abnormal mammogram. Please call your physician for an evaluation.

When and how should I do self-breast exams?
Self-breast exams are an easy, healthy and inexpensive way to be proactive in your own health care. Current recommendations by the American Cancer Society are that women should start performing self-breast exams (SBEs) when they are 20 years old. This allows a woman to "learn" her breasts and to become comfortable with the lumps that are normal. When a woman starts this habit in her 20's, it is easier to keep the habit into middle age and beyond when breast cancer becomes more of a risk.

SBEs should be performed monthly. The best time of the month is the week following your menstrual cycle. This is when the hormone levels are down and the breast tissue is least stimulated. It is important that you palpate the breast tissue as well as visually inspect the skin and contour of your breasts.

Many people find that performing a breast exam in the shower is easiest because the fingers glide over the skin better. Start by raising your same side arm above your head. This pulls the breast tissue against the chest wall and makes it easier to feel all of the tissue. Use the finger pads of the left fingers to feel the right breast and the right finger pads to feel the left breast tissue. Use circular motions and vary the pressure (light, medium, and firm) to feel different depths of the breast tissue. Move around the breast either in a circular pattern or in a grid like pattern. Make sure you examine the entire breast - from the armpit to the sternum (breastbone) and from the clavicle (collarbone) to the inframammary fold (lower edge of the breast).

After examining your breasts, stand in front of a mirror. Place your hands on your hips and press down firmly. Look for any change in size, shape, contour or dimpling. Also examine your nipples for any change (new inversion) or redness.

Lastly, examine each armpit with your arm raised only slightly. Raising the arm too high causes the area to tighten and makes examination more difficult. If you have any concerns or notice any abnormalities, please call your physician for further evaluation.

When should I get a mammogram?
Breast cancer can occur at any time in your life. It is more likely as you get older. The risk when you are 40 years old is 1:25. By the time that you are 80 years old, the risk is elevated to 1:7. The American Cancer Society recommends that you have your first mammogram when you are between 35-40 years old. There is no upper age limit or a certain time that a woman should stop having mammograms.

Women who have a higher risk of developing breast cancer, should consult with their physician regarding when they should start having mammograms and if they require more frequent mammograms.

Almost 10% of women who have screening mammograms are asked to return for additional imaging. This is to clarify a possible abnormality such as cysts, microcalcifications or solid nodules. From this point, follow-up or additional testing (biopsy) may be recommended.

Mammograms can detect extremely small cancers - ones that cannot be felt as a lump or a change for several years. This means earlier diagnosis and treatment and the best chance for successful treatment. Mammograms do have a 10-15% false negative rate; that means that 10-15% of the time, mammography is not able to detect a cancer that is present. If you feel a lump or are concerned about a change in your breast, please call your physician for further evaluation.

Breast cancers that are found early are the most successfully treated. Your best defense against breast cancer is early detection and treatment.

What can I do about my breast pain?
Mastalgia, or breast pain, is a common problem and is a common reason for referral to a breast center. Most breast pain is benign in nature. Breast cancer is an unusual cause of pain. In a study of over 200 patients, only one patient (0.5%) had breast cancer related to her pain. This pain is generally on one side, is persistent and stable in its position.

The most common type of breast pain is cyclical. The pain tends to be related to the menstrual cycle. The pain is typically described as a "heaviness" or a "tenderness". Nodularity is common, especially in the upper outer quadrants of the breasts. The pain may be on both sides and it may radiate down your arm.

Non-cycle breast pain is not related to the menstrual cycle. This pain is typically described as "burning" or "pulling". Nodularity is not as pronounced as in cyclical pain. Musculoskeletal pain is often on one side and is reproducible.

Keep a pain journal. This will help your physician in deciding what type of pain you have. Record when you have the pain, the degree of pain, on a scale of 1 to 10, where you are in your menstrual cycle, and any aggravating or alleviating factors.

Some simple steps you can try at home include limiting your caffeine intake, decreasing your fatty food intake, and exercising (make sure you wear a good sports bra). If your pain is persistent, please contact your physician for further evaluation.

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What causes diverticular disease?
This condition which affects about 10% of Americans over the age of 40 and almost half of all people over the age of 60 has been traced to a low fiber diet. The disease was first noticed in the United States in the early 1900s. At the same time, processed foods were introduced into the American diet. Many of the processed foods contain low-fiber flour. Unlike whole-wheat flour, refined flour has no wheat bran. Fiber is the part of fruits, vegetables, and grains that the body cannot digest. Some fiber dissolves easily in water (soluble fiber). Both kinds of fiber help make stools soft and easy to pass. Fiber also prevents constipation. Constipation makes the muscles strain to move stool that is too hard, which is the main cause of increased pressure in the colon. This excess pressure over time might cause weak spots in the colon to bulge out and become diverticula.

What are the symptoms?
Most people with diverticulosis do not have any discomfort or symptoms. However, some people may experience mild cramps, bloating, and constipation. Other diseases such as irritable bowel syndrome (IBS) and stomach ulcers cause similar problems, so these symptoms do not always mean a person has diverticulosis. You should visit your doctor if you experience these symptoms. The most common symptom of diverticulitis is abdominal pain with tenderness around the left side of the lower abdomen. If infection is the cause, fever, nausea, vomiting, chills, cramping, and constipation may also occur. The severity of the symptoms depends on the extent of the infection and complications.

Does colon cancer occur primarily in people with a family history of cancer?
Approximately 75% of all new cases of colon cancer occur in people with no known risk factors for the disease.

What types of colon polyps cause colon cancer?
Adenomatous polyps account for between 30-50% of all colon polyps. If these polyps are not removed, they can develop into cancer. Another 10-30% of polyps known as hyperplastic polyps and mucosal tags do not increase the risk of cancer.

If rectal bleeding resolves, does this mean you do not have to worry about colorectal cancer?
Rectal bleeding can be caused by many factors, including cancer. Patients often make the mistake of attributing rectal bleeding only to hemorrhoids. When the bleeding stops, patients often do not seek proper medical care. Polyps and cancers bleed intermittantly, so an episode of rectal bleeding may be the first sign of colorectal cancer. Rectal bleeding should always be evaluated to rule out colon cancer.

In colorectal cancer, is the size of the tumor the most important factor in predicting the long range outcome for the patient?
Unlike other cancers, such as lung and breast cancer, the size of the tumor has little to do with the long range prognosis (predicted outcome) in colorectal cancer. What really matters is how deeply the tumor has invaded the wall of the bowel. A small tumor that has penetrated through the bowel wall is more serious than a larger tumor that has not penetrated the bowel wall.

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What causes gallstones?
The gallbladder is about 3 inches long and stores and releases bile into the intestine to help digestion. Bile is a liquid made by the liver. It contains water, cholesterol, bile salts, fats, proteins, and bilirubin, a bile pigment. During digestion, the gallbladder contracts to release bile into the intestine where the bile salts help break down fat. Bile also dissolves excess cholesterol. Gallstones may form in one of three ways: when bile contains more cholesterol than it can dissolve, when there is too much of certain proteins or other substances in the bile that causes cholesterol to harden, or when the gallbladder does not contract and empty its bile regularly. Gallstones are clusters of solid material that form in the gallbladder. They are made mostly of cholesterol. Gallstones may occur as one large stone or as many small ones. They vary in size and may be as large as a golf ball or as small as a grain of sand. Experts have estimated that between 16 to 22 million people in the United States have gallstones - as many as one in every 12 Americans.

Will I be able to live a normal lifestyle without my gallbladder?
Fortunately, the gallbladder is an organ that people can live without. Losing it won't even require a change in diet. Once the gallbladder is removed, bile flows out of the liver through the hepatic ducts into the common bile duct and goes directly into the small intestine, instead of being stored in the gallbladder. However, because the bile isn't stored in the gallbladder, it flows into the small intestine more frequently, causing diarrhea in approximately 1 percent of people.

What happens if a gallstone can't be removed during surgery and remains in my common bile duct?
You will normally be required to have blood tests and may even need an ultrasound or CAT scan to monitor your condition. If you do not pass the stone, a separate procedure called an Endoscopic Retrograde Cholangiopancreatography (ERCP) may be required to remove the stone.

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What does a hernia feel like?
A hernia can be both seen and felt. You may notice a lump in your abdomen or groin that may or may not disappear when you lie down. You also may be aware of a dull aching sensation that becomes more pronounced when you are active.

Why does a hernia hurt?
The discomfort you feel, especially when you cough, lift something heavy, or stand for a long time, comes from the constant pressure of tissue pushing its way through the weakened spot in your body. As more tissue pushes through the weakened area, the feeling of pressure increases. A hernia that develops or worsens quickly can produce a sudden intense pain as it expands.

Who gets a hernia?
According to the National Center for Health Statistics, approximately five million Americans have hernias. Hernias in the groin area (inguinal hernias) are most common in men, primarily because of unsupported space left in the groin area after the testicles descend into the scrotum. Hernias in the femoral area, at the top of the thigh, occur most often in women. They commonly result from pregnancy and childbirth.

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Weight Loss (Bariatrics)

How much weight will I lose after bariatric surgery?
Most patients will lose approximately 70% of their excess weight.

Can I gain weight after the surgery?
Yes, the operation is a tool to help with weight loss and weight maintenance to prevent regaining weight after surgery and requires a combination of a balanced diet and regular exercise.

Will I need to take medicine after surgery?
Yes, because part of the intestine is bypassed certain vitamins and minerals are not well absorbed from the diet. You will need to take vitamin supplements forever.

Are there any problems with the band that is created during surgery?
In 1-2% of the cases, patients may develop problems with the band. Most of these problems can be corrected without surgery.

Can this operation operation be performed with laparoscopy?
Yes, many patients will be a good candidate to have surgery using a laparoscopic approach.

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Gastroesophageal Reflux Disease

What are the primary symptoms of reflux?
Most patients suffering from reflux disease have a combination of heartburn and regurgitation. The regurgitation can actually come up into the month and this has been described as sour brash reflux. Patients often will have nausea and will have frequent belching. They may experience some bloating and very rarely will have any abdominal pain. Occasionally and less common, reflux patients can have symptoms that irritate the upper airways. These would include coughing, hoarseness, sore throat, aspiration, asthma, and laryngitis.

Will my reflux get better on its own?
Usually not. Once, the patients begin suffering from reflux, the natural history of the disease is one in which the reflux will continue throughout life. This may stay the same but often symptoms can worsen in severity and frequency over time.

Does medical therapy really work?
Yes. Medical therapy is adequate treatment for most patients with reflux disease. Life style modifications along with simple antiacids will relieve reflux symptoms in most patients. Medicines include simple over-the-counter antiacids to more potent acid blocking medications. The majority of patients have to stay on their antiacids for the rest of their lives otherwise reflux symptoms will return.

Are there any complications of reflux disease if left untreated?
Yes. Some patients can experience a phenomenon known as Barrett's esophagus. This is where the lining of the esophagus changes and has been associated with increased incidence of esophageal cancer. Other complications include bleeding, stricturing, or narrowing of the esophagus, and occasionally, the progression of symptoms higher up in the esophagus.

Is surgery ever an option to treat reflux disease?
Yes. Surgery is a very good option to treat reflux disease. Patients on antiacids who have worsening symptoms, or who are relatively young with a long life expectancy are good candidates for surgery. The surgery consists of wrapping the stomach around the esophagus to create a new valve around the esophagus and thus prevent the regurgitation and reflux of gastric contents. This can be done in the vast majority of patients with a laparoscopic approach so as to avoid a larger incision and thus eliminate many of the complications of open surgery. Individuals who are overweight are not good candidates for surgery as their increased abdominal weight often causes failure of the surgical wrap over time.

What is the overall effectiveness of surgery?
Most patients who have antireflux surgery will stop taking their antiacid medication altogether. Their heartburn will completely resolve as will their regurgitation. The results after antireflux surgery show that 80-90% of patients undergoing surgery are still symptom free between 7 and 10 years after the operation. In a small number of cases the initial surgery is unsuccessful in resolving the reflux symptoms because of wrap failure. A second surgery for failure of the wrap over time is certainly an option although fraught with more risks and difficulties. Those patients who do have reoperations are likewise goods responders to their symptoms and control of their reflux over long periods of time after the second operation.

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