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.
Should I stop taking hormone replacement therapy
(HRT)?
Even though my breast tumor does not have hormone receptors,
should I take tamoxifen to reduce the risk of a new tumor?
I have a ductal carcinoma in situ (DCIS), a type of localized
cancer. Why have I been advised to have a mastectomy when other women with invasive cancer have
lumpectomies?
Should I stop taking hormone replacement therapy
(HRT)?
Breast cells are programmed to respond to certain hormones as
signals for growth and multiplication. The most prominent examples
of
these hormones are estrogens and progesterone.
Many breast-cancer cells retain hormone receptors (molecular configurations on
the cell surface to which the hormones bind). The hormone receptors therefore
make the cancer cells responsive to these particular
hormones.
In general, taking hormones is not recommended if a diagnosis of breast
cancer is under consideration. This does not necessarily mean that you can never
resume hormone replacement
therapy. This issue is generally reconsidered after the
completion of your evaluation and treatment. You should consult with your physician before you stop or start any new medications.
Even though my breast tumor does not have hormone receptors,
should I take tamoxifen to reduce the risk of a new tumor?
Following completion of your treatment for breast cancer, whether
or not tamoxifen (Nolvadex) is prescribed should at least be addressed. In many
cases, the primary
breast cancer for which the patient is being treated may not be
hormone-receptor positive. In these cases, tamoxifen (which binds to
the estrogen receptor in place of estrogen) is not generally part of
the treatment protocol.
However, the Breast Cancer Prevention Trial (a study of the use of
tamoxifen) demonstrated a significant reduction in the development of
new cancers in the opposite breast in patients who were treated with
tamoxifen. So, the possible use and benefits of tamoxifen should not
be ignored. A thoughtful evaluation of all the factors in a
particular case will lead to a recommendation which balances the
benefits of tamoxifen against the potential risks. Your treatment team should address this issue with you.
I have a ductal carcinoma in situ (DCIS), a type of localized
cancer. Why have I been advised to have a mastectomy when other women with invasive cancer have lumpectomies?
Ductal carcinoma in situ (DCIS) sometimes presents a difficult
dilemma. Most patients with DCIS can undergo successful breast-conservation therapy but not all. The diagnosis implies that this is
an "early" form of cancer in the sense that the cancer cells have not
acquired the ability to penetrate normal tissue barriers or
spread through the vascular or lymphatic channels to other sites of
the
body. It is important to realize that breast cancer is a wide spectrum of diseases and no comparisons should be made just on the basis that someone you know has "breast cancer" and shares a different treatment approach with you.
However, the millions of cells forming the DCIS have accumulated a
series of errors in their DNA programs which allow them to grow out
of
control. There are varying degrees of disturbance, called "grades,"
of the normal
cellular patterns. Low grades are more favorable, and
high grades are less favorable.
The DCIS cells originate from the inside of the breast gland
ducts (microscopic tubes). As they multiply, the cells fill and
spread
through the normal ducts of the breast glandular tissue. With many
DNA errors already in place and millions of these cells exposed to
the
usual risks of
additional DNA damage, a few cells will ultimately become invasive.
This invasive change is the real risk of DCIS.
Treatment which does not physically remove all of the DCIS seems
to
leave a substantial risk of recurrence and, therefore, invasive
disease.
This risk of recurrence is particularly increased in the high-grade
form
of DCIS. In cases where the DCIS has spread extensively through the
breast ducts, even though the disease is in a sense "early" because
it
is not yet invasive, it may still require a large surgical resection,
at times even a mastectomy (removal of all or part of the breast).
Your treatment team should be able to discuss the pros and cons of the different approaches and actively include you in the decision process.
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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