Ask The Doctor

Why should I get an annual mammogram?
Early detection and treatment are the keys to defeating cancer.  Annual mammograms are the first line of defense for detecting and treating breast cancer.  A mammogram can detect abnormalities in breast tissue like masses and microcalcifications in the earliest stages.  When these abnormalities are found, diagnosed and treated early, cancer remission rates are in the upper 90th percentile.  Annual mammograms starting at age 40 are recommended for women.  Some studies suggest that mammograms for women after age 70 are not necessary, but, since cancer can appear at any time, I recommend getting regular mammograms and breast exams for your lifetime.

Why would I be called back for an ultrasound after my mammogram?
All mammograms are graded according to the density of breast tissue.  Breasts are comprised of fat and tissue.  Fat is easy to see through.  Tissue can be different degrees of dense – the denser the tissue, the more difficult it is to see into it.  If your breast tissue is denser than 50%, you should consider talking with your physician about having a screening ultrasound performed at the time of your mammogram.  A 2009 Connecticut law requires that women be informed of the density of their breasts determined by mammogram.  In some cases, cancers not detected by mammogram can be detected by ultrasound.  Talk with your physician about your options for complete breast health care.

I have no family history for breast cancer.  Am I still at risk?
All women are at risk for breast cancer.  More than 85% of women diagnosed with breast cancer have no family history. The average lifetime risk for women to get breast cancer is 1 in 8!  This risk almost doubles when there is breast cancer in a first degree relative – mother, sister or daughter.  Only 5 – 10% of people with breast cancer test positive for the BRCA gene – the gene that gained notoriety with Angelina Jolie’s recent disclosure.  The BRCA gene is not common but drastically increases the risk of breast and ovarian cancer.  Other risk factors include age (over 50), obesity, alcohol consumption, smoking, hormone replacement therapy and never having children.

What causes breast pain?
A spike in estrogen is the most common cause of breast pain.  Occasionally breast pain is caused by a cyst.  A cyst is a benign, fluid-filled pocket in the breast.  Some cysts can become large and can be felt.  Painful cysts can be aspirated (drained) by a simple, in-office procedure that provides almost immediate relief.  Fibrocystic, or dense tissue breasts, tend to be more painful because they are more susceptible to hormonal changes.  There can be modest successful pain relief with the use of the natural supplement Evening Primrose Oil.  Before trying an over-the-counter aid, it is best to have a breast exam done by a medical professional to confirm that the pain is benign. Breast cancer infrequently causes pain, but it is best to be safe.

What is laparoscopic surgery?
Laparoscopic surgery is performed with the aid of a video camera inserted into the abdomen through a small incision in the belly button.  The camera allows the surgeon to view body structures clearly which reduces the instance of injury.  Smaller incisions also mean less healing time and less post-operative pain.  Some surgeries that can be performed laparoscopically are gallbladder removal, appendix removal and hernia repair.  Most patients are candidates for laparoscopic surgery.

What is robotic (computer assisted) surgery?
Computer-assisted or robotic surgery is an advancement of laparoscopic surgery and requires extensive training by the surgeon.  Similar to laparoscopic surgery, a camera is inserted through a small incision in the belly button which provides the surgeon a three dimensional view inside the body.  Organs and structures are more clearly defined which significantly reduces the incidence of injury.  The surgeon manipulates instruments that move just like human hands and fingers while viewing a 3D image to perform the surgery.  Computer-assisted surgeries take less time to perform than conventional surgeries which means less anesthesia in addition to the benefits of reduced recovery time and reduced post-operative pain.  Most patients are candidates for computer-assisted surgery.  Be sure to talk with your surgeon about this option.

What is my risk for skin cancer?
Skin cancer is the most common form of cancer in the United States.  1 in 5 people will develop skin cancer in their lifetime.   Most skin cancers can be cured by removing the cancerous area during a simple in-office procedure.  There are 3 major types of skin cancers: Basal Cell Carcinoma (most superficial), Squamous Cell Carcinoma and Melanoma (most invasive).  Melanoma is the most aggressive cancer and accounts for less than 5% of skin cancers.  Even one blistering childhood or adolescent sunburn can double the risk for melanoma.  Indoor tanning booths significantly increase the risk of skin cancer to 69%.  Using daily sunscreen with at least an SPF of 15 can reduce your risk for melanoma by 50% and for Squamous Cell by 40%.

What does skin cancer look like?
Superficial skin cancer, like Basal Cell, can look like non-healing scabs or chronic, dry, pink patches.  Squamous Cell Carcinoma can look like a raised lesion with continual scabbing.  Moles that change are often associated with melanoma.  You can monitor mole changes by paying attention to your ABC’s:
A – asymmetry; one side of the mole should look like the other
B – borders; the edge of the mole should not look irregular or scalloped
C – color; mottled color involving shades of brown, black, pink or white are concerning
D – diameter; moles larger than 6 millimeters, about the size of a pencil eraser, are more concerning
E – elevation or enlargement; a mole increasing in size or elevation should be checked
Your primary care physician should regularly check your body for suspicious moles.  If you notice changes to a mole, it would be appropriate to see your physician.

What is a hernia?
A hernia, simply stated, is a hole in the thick connective tissue that layers the abdomen and protects the bowel.  A hernia is not in the muscle but in the layer beneath muscle and can only be treated with surgery.  Hernias frequently occur in area of weakness like the belly button or at the site of a prior surgery.  Sometimes hernias occur relative to a specific injury like heavy lifting or they occur due to regular wear and tear as we age.  Some hernias are associated with pain and a bulge caused by fat and sometimes bowel protruding through the hole.  Hernias require surgical repair.

What causes varicose veins?
Several factors can contribute the development of varicose veins.  Pregnancy is a significant risk factor – the weight of the baby low in the pelvis causes damage to the veins in the upper leg, which is why varicose veins are more common in women than men.  But, men are not exempt!  Obesity can cause the same damage to veins in the upper leg.  A healthy diet and exercise can help prevent varicose veins.  Heredity is also a major factor for the development of varicose veins.  Injuries to the legs from contact sports or accident can also weaken the veins causing varicose veins.  Sitting or standing for long periods of time can also contribute.  Staying active, watching your weight, wearing compression stockings or knee-highs can help slow or prevent varicose veins.

Are varicose veins a cosmetic problem?
Varicose veins can be unsightly, but, they can cause very real medical problems as well.  Usual symptoms are aching, a heavy feeling in legs and feet, swelling and night cramps in your legs.  Most symptoms worsen in the evening after being on your feet during the day.  Untreated varicose veins can cause skin color changes, thickening of the skin and skin ulcers.  Ulcers are very painful and difficult to heal.  Sometimes varicose veins can bleed.  Because of the medical problems varicose veins can cause, most insurance companies will pay for evaluation and treatment.

What are symptoms of gallbladder disease?
The most common symptom of gallbladder disease is pain in the mid to right upper abdomen under the ribcage. Pain can also occur in the right back or the chest or in the right shoulder blade area.  Pain can also wrap from the right abdomen to the right back.  Because the gallbladder assists with the digestion of foods, especially fats, pain will often follow a heavy fatty meal.  Gallbladder disease symptoms can also include nausea and vomiting. Most patients complain of pain in the evening or the middle of the night when digestion takes place.