[Music playing] [Text on screen: Ohio State Health & Discovery Health Talks] Gail Hogan: Thank you for joining us for Health Talks. I'm Gail Hogan, [Text on screen: The James The Ohio State University Wexner Medical Center] and breast cancer expert Dr. Amy Kerger is here to tell us about some symptoms you may not know about that can indicate certain kinds of breast cancer. Welcome, Dr. Kerger. Amy Kerger, DO: Thank you for having me. [Text on screen: Gail Hogan Host Health Talks] [Music fades] Gail Hogan: I think this is interesting because I think many women think they know the signs and symptoms of breast cancer, so let's talk about the ones that are most well-known, and then maybe some of the lesser known signs. [Text on screen: Amy Kerger, DO Diagnostic Radiologist OSUCCC - James] Amy Kerger, DO: So I think some of the most well-known, first of all, are things like I have a lump in my breast. A lot of women will talk about maybe their nipple's inverted or they have pain. Probably some of the more less well-known signs and symptoms of breast cancer are a red, swollen breast or your breast changes sizes pretty dramatically, whether that's bigger or smaller. Swelling under the armpit or a nipple discharge that would be spontaneous, clear or bloody, and also the last one that's a little lesser well-known is maybe a scab or rash or irritated nipple. Gail Hogan: It's interesting because the lump is what we've all been told to watch for and we don't know about some of these other signs. But when some of these signs show up, how critical is it that someone see a doctor? [Text on screen: Amy Kerger, DO Diagnostic Radiologist OSUCCC - James] Amy Kerger, DO: Well, they should definitely get in and see their healthcare provider because even though a lot of these are signs and symptoms of breast cancer, which is the thing we're most concerned about, they can also be signs and symptoms of other things that we can treat such as infection, some other inflammation, dermatitis, things like that. Seeing a health expert to be able to decipher whether it's something that's a little less concerning or is it something concerning like breast cancer and then having them be able to send you for appropriate imaging with a mammogram and possibly an ultrasound to get that further evaluated is really important. Gail Hogan: There are different types of breast cancer, and one I never heard of was inflammatory breast cancer. First, what is it, and then how do you treat that compared to other types of breast cancer? [Text on screen: Amy Kerger, DO Diagnostic Radiologist OSUCCC - James] Amy Kerger, DO: Inflammatory breast cancer is a more rare form of breast cancer. It only affects about 4% of women. It's one we don't think of a lot because a lot of times it doesn't appear with a lump. It does come on very quickly, so we tell women if they start to notice signs and symptoms such as a red, swollen breast, pain can be sometimes associated with this. Pain's a very rare sign and symptom of any kind of breast cancer. Swelling under the armpits. If their breast, the skin of their breast starts to look like an orange peel, like the outside of an orange where you have those kind of little dots, that can be a sign of inflammatory breast cancer. It's caused by the same underlying pathology that causes most other types of breast cancer, but this type of breast cancer gets into the lymphatics of the skin. As we all know, we have lymph nodes under our arm, but we have lymph nodes all over our body, and so this type of breast cancer tends to get into the skin and then spreads quickly. So it's really important that if a woman starts noticing this, that they get in to see their healthcare provider. 95% of the time this is going to be caused by something called mastitis, which is an infection of the breast. Most of the time your doctor's going to put you on a course of antibiotics and see if that gets rid of the problem. But if it does not fully resolve, then you want to start thinking along the lines, is this an inflammatory breast cancer? And that's when your doctor should send you to see somebody, or if they don't, you should seek out the care from a breast expert in breast health. Gail Hogan: I thought that mastitis, and I know, am I saying that right? Amy Kerger, DO: You are. [Text on screen: Gail Hogan Host Health Talks] Gail Hogan: It was only a problem for women who have just had a baby and may be breastfeeding. [Text on screen: Amy Kerger, DO Diagnostic Radiologist OSUCCC - James] Amy Kerger, DO: It is the most common time to have mastitis. But mastitis can occur at any time during your life, but it is less common later in life when you're not breastfeeding or you haven't just had a baby. That's also why it's really important to see a healthcare provider because if you're really not at risk for something like that, they may send you more directly to get breast imaging and talk to a breast health expert such as someone in breast surgical oncology or breast medical oncology to get further evaluation to make sure it's not this inflammatory breast cancer. Gail Hogan: So who is at risk? Amy Kerger, DO: All women are at risk for inflammatory breast cancer. The literature states that most commonly, we see this between the ages of 40 and 60, but we see it at all age groups from 20 on up. It's not as common in those age groups as it is in the 40 to 60 year olds, but it still can be very common in any age group. Gail Hogan: Can you discover or find inflammatory breast cancer with a mammogram? Amy Kerger, DO: Sometimes you can, but it's actually much more common that you find it because someone comes in with a sign and symptoms of inflammatory breast cancer. Gail Hogan: It will show up on the patient almost before they can get a mammogram to... [Text on screen: Amy Kerger, DO Diagnostic Radiologist OSUCCC - James] Amy Kerger, DO: Correct, and sometimes on the mammogram, all we end up seeing is just that skin thickening and we don't actually see anything else. Sometimes that will lead you then to an MRI, and sometimes on the MRI, we do find underlying things that we can biopsy that show us that it's that breast cancer. But sometimes the only sign and symptom is really in that skin, and so it's important that a healthcare provider actually evaluates you because it's more commonly diagnosed by physical exam. Gail Hogan: Should you start with your family physician? Amy Kerger, DO: Yes, or your Ob/Gyn is also another good person to go see. And if they are not comfortable or if they treat you and it does not resolve, then you should seek the care of a breast health specialist such as we have here at The James. Gail Hogan: We've talked about a lot of things. What would be the most important thing that you'd like women to know, to take away from this? [Text on screen: Amy Kerger, DO Diagnostic Radiologist OSUCCC - James] Amy Kerger, DO: To know their breasts, to be self-aware of what their breasts look like and if things are changing. Also, so that they make sure starting at the age of 40 that they start getting an annual mammogram. Even though with inflammatory breast cancer, it's not usually caught on the annual mammogram, there's so many other types of breast cancer out there that are much more common to get that we will and be able to diagnose on an annual mammogram at a much smaller size at a time when we can end up having to do less surgery, less chemotherapy, less radiation in order to treat you and get you back to your normal life. Gail Hogan: I want to clarify something, but you said a mammogram every year? Amy Kerger, DO: Yes. Gail Hogan: It used to be every two years or at a certain age it was different, so across the board, you're saying after 40 every year? [Text on screen: Amy Kerger, DO Diagnostic Radiologist OSUCCC - James] Amy Kerger, DO: Every year, after 40. The American College of Radiology and the American College of Breast Surgeons have never wavered from that. We have always said that every woman at the age of 40 annually, every year, should get a mammogram. It's the best way to find breast cancer, and it's the best way to keep ourselves healthy and be able to treat this and fight this in the future. Gail Hogan: What about research at The James? Amy Kerger, DO: There's a lot of research going on right now at The James around all types of breast cancer and including the inflammatory breast cancer piece I just talked about. We have many clinical trials going on and then other research also within all kinds of aspects of breast health. Gail Hogan: You do have clinical trials. Who's eligible for those? [Text on screen: Amy Kerger, DO Diagnostic Radiologist OSUCCC - James] [Music playing] Amy Kerger, DO: Depends on what the clinical trial is for. Some clinical trials, people are eligible because they fall into a certain category of age. Sometimes it's because of the type of breast cancer that you have. It really just depends on what it is that's going on with you. But if you would be eligible for one of those clinical trials and you're seeing one of our breast health specialists, they will let you know that, "Hey, we have this trial going on, you could be eligible. Are you interested?" Gail Hogan: Dr. Kerger, thank you. So much great information. Appreciate it. Amy Kerger, DO: Thank you very much, Gail. Gail Hogan: And thank you for joining us for Health Talks. [Text on screen: Ohio State Health & Discovery Health Talks health.osu.edu] [Music ends]