(Georgetown University Medical Center)

Online Chat with Robert Warren

Wednesday, Oct. 14, 1998

October is breast cancer awareness month. We invited Dr. Robert Warren, a specialist from Georgetown University Medical Center, to answer your questions.

Warren has completed a three-year fellowship in medical oncology at the National Institutes of Health and has served on the medical staffs of several hospitals. He is currently the director of clinical affairs at Georgetown's Lombardi Cancer Center.

Dr. Warren was online and has answered your questions below.

Washingtonpost.com: We would like to remind the audience that Dr. Warren's responses to your questions are not medical diagnoses. You should talk to your doctor about any specific concerns you may have.

silver spring, maryland: I'm a 27 year old woman and I've never had a mammogram. Lately my right nipple has been itching, does this have anything to do with breast cancer?

Robert Warren: In general itching of the nipple itself does not mean that you have breast cancer or anything serious, but you should see your doctor.

GLASGOW, MONTANA: WHAT IS THE LATEST RESEARCH FOR TREATING INFLAMMATORY BREAST CANCER?

Robert Warren: In general the approach includes Chemotherapy, surgery and Radiotherapy. But it requires consultation with a cancer specialist.

Richmond, VA: My fiance, who has had small silicone breast implants for a number of years now, has this frightening ability to squeeze liquid from the ducts. This wouldn't alarm me if it weren't for the fact that the liquid is dark in color (blue - probably cloudy). It doesn't flow out or even squirt. But it can show up after she squeezes the nipple area in a way so as to demonstrate the seepage. Could this be a big problem?

Robert Warren: I would tell your fiance to see a breast specialist as soon as possible.

Washington, DC: Should women take Tamoxifen who were diagnosed with early stage breast cancer (introductal)?

Robert Warren: The answer is perhaps. Women who have had a diagnose of intraductal breast cancer are at somewhat greater risk of developing another breast cancer, either intraductal or possible invasive. Tamoxifen may be of benefit in reducing that risk but should be discussed with a breast specialist or medical oncologist.

Potomac, Md.: Are women as vulnerable to breast cancer that runs in their father's side of the family? Most talk seems to focus on the maternal side, and the literature I've read hasn't made this clear.

Robert Warren: The greatest concern is with a family history of first degree relatives (mother or sister), who develop breast cancer pre-menopause. Especially if they have cancer of both breast; however, any family history (grandmother or aunt) on either side of the family may be important and should be discussed with your doctor.

Fairfax, VA: I'm 22 years old and I have three female relatives (an aunt and 2 older cousins) who have all had breast cancer. All are fine, but I'm concerned that I'm in a high-risk category. Am I too young to be worried or should I take steps now?

Robert Warren: That family history may not indicate a genetic risk, but to be sure you should discuss these issues with your doctor. Even with the family history not including first degree relatives it may be a good idea to begin breast screening at a somewhat earlier age with your doctor. The National Cancer Institute and the American Cancer Society both have guidelines, as do breast cancer centers that you can check.

San Jose, CA: Some people argue that we should devote less attention to cures and more to prevention, particularly when it comes to government spending. I think this is (at least partially) baloney, but what do you think?

Robert Warren: I think what we need is a balance between the two, the National Cancer Institute and other funding sources have been doing quite well. The recent Tamoxifen prevention trial is an excellent example of a drug that is useful in breast cancer prevention, that was initially used in breast cancer treatment. Additional agents which might reduce the risk of developing breast cancer are also under investigation.

Washingtonpost.com: We are at the halfway point of our forum with Dr. Warren. We will end at 2 p.m. EDT.

Crownsville MD: Do I have to have a doctor write up a prescription to have a mammogram or can I schedule one with the local facility on my own?

Robert Warren: You need to have a Doctor write the prescription. It is preferable to have a clinical breast examination done first. In that way, any areas of concern to you or to your MD, would receive focused attention during the procedure. If you do not have a doctor then by all means take advantage of any mammogram screening opportunities offered by your local health facilities.

Crystal City, VA: What advice would you recommend for a cancer patient to deal with their doctor? For example, being a cancer survivor (6 years now), I read everything I could and tried to be as knowledgeable about it as possible, however, the doctor(s) still wanted to be the expert. Since it was my body, I wanted more of a say in treatment than I got. How could I have dealt with it better? Should I have shopped around for different doc's (I was feeling an extraordinary time pressure when I was diagnosed, though).

Robert Warren: Most doctors appreciate well informed patients and welcome the opportunity to discuss all the patients questions. It is important that you are satisfied that those issues were discussed completely. It may be necessary to schedule another visit with the doctor to be sure enough time is given to your needs, without keeping the doctors other patients waiting. It is crucial that a cancer patient feel an excellent rapport with her physician. If you do not have that rapport then consulting another physician may be the answer.

Arlington, VA: What type of preventative measures can you take against breast cancer ? I realize that genetics may play a role, however there is no history of breast cancer in my family. Does the birth control pill reduce the chance of getting breast cancer ?

Robert Warren: There are contradictory studies regarding the effect of oral contraceptive agents and their effect on breast cancer incidence. The accepted breast cancer preventive agent, Tamoxifen, has an anti-estrogen effect within breast tissue that may be responsible for reducing the risk of breast cancer. The other preventive measures are a healthy diet with minimal animal fats and plenty of fresh fruits and vegetables coupled with regular exercise, these measures has been associated with a decreased risk of breast cancer.

Annapolis, MD: Are there any tools that doctors have that they can use to show patients what a lump would feel like when they perform their monthly exam?
My physician said I have "lumpy" breasts to start with - so how would I tell what is normal lumpiness and what is a potential problem?

Robert Warren: At the Ourisman breast health center here at Georgetown, we combine hands on teaching with a breast specialist and the patient, a video tape demonstration and breast models complete with lumps to be certain that you are comfortable with breast self examination technique, there are also numerous print materials as well. The instructional video tapes are also available through most hospitals and your local American Cancer Society.

Oil City, PA: Can an injury to your breast later be a cause for cancer

Robert Warren: Although I have seen several patients that recalled an injury to the breast, and were later found to have cancer in that same breast, Breast trauma is not usually considers as a predisposing factor in breast cancer.

University Park, MD.: Does abortion have any links to breast cancer?

Robert Warren: The data is controversial, I suggest discussing this with your physician.

Washington DC: Does radiation therapy need to be conducted straight through or can the number of weeks be interrupted without loss of effectiveness?

Robert Warren: It needs to be continued as prescribed by the radiation oncologist. While occasionally breaks may be necessary due to medical considerations, the treatment is highly effective when continued on the prescribed schedule.

Washingtonpost.com: That's all the questions we can answer today. Dr. Robert Warren of Georgetwon University Medical Center has been our guest expert. Thank you for participating.