Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
How urgent is it that I make decisions and begin
treatment?
It is extremely rare that a patient must be rushed into
treatment. The biology of breast tumors is established fairly early
in their development, and by the time the tumors are detectable, most
have been growing undetected for considerably more than a year. This
means that if you take a few weeks to complete a thorough evaluation,
obtain appropriate consultations, understand the situation, discuss
the alternatives and initiate a treatment plan, it is not likely to
add any
significant risk. This time frame, however, should allow the facts
of your
case to be carefully sorted out and errors to be minimized. Your treatment team should be able to help you in this process and specifically advise you on the urgency to start certain treatments.
Are there controversies in the recommended treatments among
reputable experts?
Doctors may differ in their recommendations
if
they weigh the risks differently. There will always be
uncertainties in any given case. These issues are rarely "right
versus
wrong." They can be compared with decisions such as "how do I
balance my desire to have the largest and safest care with the need to
have convenience and economy?" There are tradeoffs. For example,
certain breast-cancer treatment options may favor cosmetic appearance
but slightly increase the risk of recurrence in the affected breast. If you have concerns, a second opinion by a different treatment team can often be helpful.
How might my treatment affect future risks and follow-up
treatment?
There are often indirect consequences of treatment decisions. For
example, breast-conservation therapy achieves, as its goal, treatment
of the breast cancer along with preservation of the breast. This is
clearly a highly desirable objective. However, in doing so, it
leaves
the possibility that cancer may recur in that breast. The risk is
small but is definitely there. Most of the time, the recurrence
will be
recognized and the new tumor treated early but not always.
These risks mean that a patient choosing breast-conservation
therapy must have the treated side (and the other breast
as well) carefully monitored with regular examinations and imaging
tests. Occasionally,
tissue
abnormalities develop which may suggest a new or recurrent cancer,
thereby
necessitating further evaluation with more tests or even another
biopsy.
The majority of these abnormalities turn out to be benign, perhaps
caused by benign breast disease or changes from the surgery and
radiation therapy. But the psychological impact of having to repeat
such an
evaluation may be very upsetting to some patients. Breast conservation is not appropriate for every breast-cancer patient or breast-cancer type.
There are similar considerations in each treatment plan which have
to be understood and carefully evaluated before committing to a
particular method of therapy. You should discuss these issues
thoroughly with your doctor.
Should genetic testing be part of the treatment decision
process?
The majority of breast cancers occur as unconnected (sporadic)
cases and
are not caused by an inherited genetic abnormality (mutation) passed
from parent to child. However, if you have close family members,
such
as
a mother or sister, who have had the disease, especially if it
occurred at a young age, then the possibility of a genetic
predisposition to develop cancer cells should be investigated. In these situations, genetic
testing may provide valuable information. The test results may
affect not only recommendations for your therapy but may also have
major
implications for other family members as well. Gene testing should
only be done after careful genetic counseling so that everyone has a
thorough understanding of the potential value and also the
limitations
of these tests.
Lymph nodes help the body's immune system fight infections. Causes of swollen lymph nodes (glands) may include infection (viral, bacterial, fungal, parasites). Symptoms of swollen lymph nodes vary greatly. They can sometimes be tender, painful or disfiguring. The treatment of swollen lymph nodes depends upon the cause.
Systemic lupus erythematosus is a condition characterized by chronic inflammation of body tissues caused by autoimmune disease. Lupus can cause disease of the skin, heart, lungs, kidneys, joints, and nervous
system. When only the skin is involved, the condition is called discoid lupus.
When internal organs are involved, the condition is called systemic lupus
erythematosus (SLE).
Fibrocystic breast condition (sometimes called fibrocystic breast disease) is characterized by lumpiness and usually discomfort in one or both breasts. The condition is very common and benign (not malignant). Fibrocystic breast condition is the most common cause of "lumpy breasts" in women. A common symptom of fibrocystic breast condition is breast pain or discomfort. There are two types of fibrocystic breast condition, cysts and fibrosis, and Hyperplasia and atypical hyperplasia of breast cells.
Pleurisy, an inflammation of the lining around the lungs, is associated with sharp chest pain upon breathing in. Cough, chest tenderness, and shortness of breath are other symptoms associated with pleurisy. Pleurisy pain can be managed with pain medication and by external splinting of the chest wall.
Cancer is a disease caused by an abnormal growth of cells, also called malignancy. It is a group of 100 different diseases, and is not contagious. Cancer can be treated through chemotherapy, a treatment of drugs that destroy cancer cells.
Pleural effusion is an excess fluid between the two membranes that envelop the lungs. There are two classifications of causes of pleural effusion; transudate and exudate. The treatment of pleural effusion depends on the cause.
Breast lumps in women can have a variety of causes such as breast inflammation, infection, injuries, cancer, and non-cancerous growths. Breast lumps in women are diagnosed with physical exam, mammogram, ultrasound, MRI, and biopsy. Treatment of breast lumps in women depend on the cause.
The breast generally refers to the chest, however, more specifically, to the mammary gland. The mammary gland is a milk producing gland comprised largely of fat. Within the mammary gland is a complex network of branching ducts. The ducts exit from sac-like structures called lobules, which can produce milk in females. The darkened area around the nipple is called the areola. Common medical concerns in regard to the breast include breast lumps, breast cysts, breast cancer, and breast infections.
Male breast cancer accounts for 1% of all breast cancers, and most cases are found in men between the ages of 60 and 70. A man's risk of developing breast cancer is one in 1,000. Signs and symptoms include a firm mass located below the nipple and skin changes around the nipple, including puckering, redness or scaling, retraction and ulceration of the nipple. Treatment depends upon staging and the health of the patient.
Phlebitis is the inflammation of a vein. Thrombophlebitis is when a blood clot causes the inflammation. Phlebitis can be superficial or deeper in the veins. A blood clot deep in a vein is deep vein thrombosis (DVT). Some of the common causes of phlebitis include prolonged inactivity, varicose veins, trauma to a vein, underlying cancers, clotting disorders, etc. Symptoms of phlebitis may be mild (pain, tenderness, redness, or bulging of a vein. Treatment of phlebitis depends on the cause.
Hypercalcemia is a condition in which calcium levels in the blood are elevated. Hypercalcemia is associated with other conditions such as hyperparathyroidism, lung cancer, breast cancer, kidney failure, and elevated levels of vitamin D. Symptoms of hypercalcemia include constipation, nausea, abdominal pain, kidney stones, to name a few. Treatment depends on the cause of hypercalcemia.
Lymphedema is a condition in which one or more extremities become swollen as the result of an impaired flow of the lymphatic system. There are two types of lymphedema; primary, secondary. Filariasis is the most common cause of lymphedema worldwide; however, in the U.S. breast cancer surgery is the most common cause. Symptoms include swelling of one or more limbs, thickening, cracked, and secondary bacterial or fungal infections of the skin. There is no cure for lymphedema.
Enjoying a satisfying sex life as we age is important to both physical and mental health. As we age, diseases and conditions may pose challenges in our sexual health, and sexual experiences. Learn how to manage your conditions and still have a gratifying sex life as you age.
Inflammatory breast cancer is an accelerated form of breast cancer that is not usually detected by mammogram or ultrasound. Symptoms of inflammatory breast cancer include pain in the breast, skin change in the breast area, bruise on the breast,sudden swelling of the breast, nipple retraction or discharge, and swelling of the lymph nodes.
Lymphedema is a common chronic, debilitating condition in which excess fluid called lymph collects in tissues and causes swelling in them. It is common after a mastectomy, lumpectomy or breast cancer surgery and radiation therapy.
Women's health is an important topic area to guide a woman through the stages of her life, as well as knowing the conditions and diseases that may occur. Educating yourself so that the transitions into different phases of life is key to a healthy, happy, and productive life.
Lifestyle changes, a healthy antioxidant-rich diet, exercise, and weight reduction can help reduce a woman's risk of developing breast cancer. It's important to be aware of how risk factors such as family history, lifestyle factors, breast conditions, radiation therapy, and hormonal factors may influence your chances of developing breast cancer. Mammography and breast self-examinations are crucial steps in breast cancer prevention.
Disease prevention in women includes screening tests that are a basic part of prevention medicine. All screening tests
are commonly available through your general doctor. Some specialized tests may be available elsewhere.
As breast cancer is the most diagnosed non-skin cancer in American women, it is important to know your breast cancer risk. Risk factors include age, age at menarche, age at first live birth, history of breast abnormalities, breast biopsies, race, and history or breast cancer among first-degree relatives.
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