The Importance of Self-Advocacy for Breast Cancer Patients

Intro: This is Weekly Dose of Wellness, brought to you by Memorial Care Health System. Here's Deborah Howell.

Deborah Howell: For some breast cancer survivors, fear and anxiety about the potential recurrence of cancer can take a significant toll on their emotional and physical wellbeing. I'm Deborah Howell. And today, we'll be talking about the importance of self-advocacy for breast cancer patients. Our guest is Dr. Richard Reitherman, Medical Director, Breast Imaging at Memorial Care Breast Center at Orange Coast Medical Center. Welcome, Dr. Reitherman.

Dr. Richard Reitherman: Thank you. I look forward to this opportunity.

Host: A true pleasure to have you. First off, how common is breast cancer recurrent in breast cancer survivors? And should women be fearful of breast cancer recurrence?

Guest: In general, the answer is no. Overall, most women treated with breast cancer these days will not have a recurrence. However, the risk of recurrence for a specific woman is actually determined by her age, stage and the treatment she had, and it varies widely. The concern level for a specific survivor is based on these factors, and this information usually is available from either her surgeon or the medical oncologists, who generally monitors her care.

In this discussion, I will break it into two components of recurrence. One is called local regional, which refers to the treated breast, the opposite breast and the axillary lymph nodes. Second category is called systemic, and it involves the detection of breast cancer metastasis elsewhere in the body, such as bone or liver.

Deborah Howell: All right. This all sounds good. Now, why is it important for breast cancer survivors to be self-advocates?

Dr. Richard Reitherman: Well, first, let's start with a definition. One definition is an individual's ability to effectively communicate, convey, negotiate, or assert her own interests, desires, and needs and rights. This does involve informed decisions and taking responsibility for those decisions. Now, as in all aspects of life, being well informed optimizes the confidence with people to make decisions and also strengthens the effectiveness of advocating for oneself. The result is that we can improve the woman's physical and emotional well-being.

Deborah Howell: That's excellent news. Now, how often should breast cancer survivors have mammograms? Is that a different cadence than those who've never been diagnosed?

Dr. Richard Reitherman: It's really not a different cadence. Mammograms should be performed in the survivor at least annually, sometimes more frequently based on the recommendations of their treating physicians due to other factors.

Deborah Howell: Okay. And what different types of screening are available to breast cancer survivors?

Dr. Richard Reitherman: There are generally three different types of imaging studies that we use to monitor survivors. One is mammography, which is well known. Ultrasound and breast MRI are very important in certain categories. Now, the frequency or intervals between mammograms and the use of what we call supplementary imaging modalities, such as ultrasound and MRI are again based on the patient's age, stage at diagnosis and the treatment. Other studies that we do in terms of scanning are nuclear medicine bone scans, CT scans and PET scans. Those are used when an appropriate and more often only with metastatic disease.

Deborah Howell: All right. Now, how can women learn what their personal risk is for breast cancer or breast cancer recurrences?

Dr. Richard Reitherman: Well a woman needs to consult, be an advocate to her treatment team, including the surgeons, radiation oncologist and medical oncologist for recommendations. The breast radiologist who's also monitoring her surveillance imaging is also an excellent source.

Deborah Howell: Okay. Make sure and get those business cards before you leave. How does a woman's risk level influence when they should have mammograms or other types of testing?

Dr. Richard Reitherman: In terms of the different modalities that I talked about, mammography, ultrasound and MRI, breast ultrasound is indicated for women with dense breast issues, being a terminology which is related to the composition of the breast tissue determined mammographically not related to the physical breast exam.

Breast MRI is the most sensitive test we have for breast cancer, and it's indicated in a variety of situations which may be related to risk of local recurrence, as well as the types of treatments including chemotherapy, surgery, and radiation. The American College of Radiology has recently recommended consideration of adding breast MRI to the yearly mammograms for survivors in situations where women have dense breast tissues, particularly those that are diagnosed premenopausally.

Deborah Howell: And how would a woman know if she has dense breasts?

Dr. Richard Reitherman: It's in the mammography report. It'll say you have dense breast tissues or you do not have dense breast tissues. And that letter, which goes to every patient and is mandated by the federal government, has to have that information in it. In addition, women as self-advocates should always, either with a MyChart situation or request a copy of the medical records, the reports that actually go to their doctors.

Deborah Howell: That is excellent advice. You're very much entitled to your own information, right?

Dr. Richard Reitherman: Exactly. And nobody should be paternalistic about this.

Deborah Howell: Okay. Now, what can women do to ensure their emotional and mental toll is not at stake after a breast cancer diagnosis?

Dr. Richard Reitherman: I would say the best thing to do is get back to normal to try and regroup your social structure to try and eat right, weight reduction, all those things are very important, particularly normal activities and getting back to your normal network. If you need extra support, be sure to use your nurse navigator or physicians so that the appropriate referrals can be initiated and don't feel that you have to do this on your own. It's actually better to be in self-advocate if you have a partner, a spouse, friend, or relative to be with you at all these interactions and to even practice your advocacy interactions with your doctors.

Deborah Howell: I love that. Don't go it alone.

Dr. Richard Reitherman: That's right. It's very important.

Deborah Howell: Now, where can women go to learn how to be better self-advocates for their breast health?

Dr. Richard Reitherman: I would say the best place to go is your treatment team, number one. Number two, this podcast will have numerous addenda to appropriate websites for survivors. And use your friends and neighbors to do everything you can to feel good and to be healthy.

Deborah Howell: Yeah, it takes a village. Is there anything else you'd like to add to our conversation, Dr. Reitherman?

Dr. Richard Reitherman: I would include in terms of going back to one of the initial questions of looking at recurrence rates, I'm going to use three examples. Most women diagnosed with breast cancer will be early stage. estrogen-positive. And since this group has a very low risk of local regional recurrence, the appropriate imaging would simply include a yearly mammogram.

Now, second group, for those women who are diagnosed at later stages, diagnosed premenopausally, have particularly aggressive type tumors and those treated with chemotherapy or have a family history of breast cancer, particularly bilateral, or a proven genetic mutation should have more intense imaging, including an MRI and a mammogram every year. For those women with metastatic disease, imaging as well as other surveillance testing is through your treating physicians, and they use established guidelines to recommend these tests. Don't be reticent about asking why and if you need them and why you need them.

The other last thing I would like to leave you with is the definition of self-advocacy. Women with breast cancer should be self-advocates. You should use the other supports we've talked about previously in terms of spouses, friends, neighbors. Remember, this is your ability to assert your own interests, desires, needs and rights. These involve physical and emotional by making informed decision and taking responsibility for those. Don't do it alone. It's important to be able to enlist your nurse navigator, spouse, friends, relatives in this process. And you do not have to go this alone, and it's better not to go it alone.

Deborah Howell: Right. Well, that's excellent advice.

Guest: You deserve the best.

Deborah Howell: Yes, you do. Every single woman and man going through this. Thank you so much, Dr. Reitherman, for your time and your expertise today. We really enjoyed having you on the show.

Dr. Richard Reitherman: Thanks for your help. It was an honor.

Deborah Howell: For more information or to listen to a podcast of this show, please visit memorialcare.org/cure. That's memorialcare.org/cure. That's all for this time. I'm Deborah Howell. Have yourself a terrific day.