Q&A: Breast Surgeon Says Early Detection Of Cancer Is Important Enough To Get Screened Even During A Pandemic

Dr. Edna Kapenhas, a staff breast surgeon at Stony Brook Southampton Hospital, was awarded a fellowship in the American College of Surgeons (ACS) on Sunday, October 4.

Dr. Edna Kapenhas, a staff breast surgeon at Stony Brook Southampton Hospital, was awarded a fellowship in the American College of Surgeons earlier in October — a month marking Breast Cancer Awareness Month.
Dr. Kapenhas, who leads the hospital’s Breast Surgical Oncology Program and has been the medical director of The Ellen Hermanson Breast Center at Stony Brook Southampton Hospital since its inception in 2009, attended Queens College and earned her medical degree from State University at Buffalo. She completed her surgical residency training at New York Hospital of Queens, followed by a yearlong clinical fellowship in breast surgery at St. Luke’s-Roosevelt Hospital Center and Beth Israel Medical Center. She is actively involved in clinical research.
She recently spoke about her career milestone, and key points to remember this October.

Q: So, first off, congratulations.
Thank you.

Q: What is the real-world impact of the fellowship?
I finished my residency in 2003, and then I did a fellowship in breast surgery to become a breast surgeon. So I finished everything in 2004, but I really never went through this whole thing, this whole process — it’s sort of, life got in the way and work got in the way. And I just never did it.
So I finally got my act together and did everything I needed to do, and I became a fellow of the American College of Surgeons. I can read something from their side, because I don’t want to paraphrase what they say: It means that the “surgeon’s education and training, professional qualifications, surgical competence and ethical conduct have passed a rigorous evaluation and have been found to be consistent with the high standards established and demanded by the college,” by the American College of Surgeons.

Q: What originally got you interested in becoming a breast surgeon, specifically?
So, the actual surgical residency, general surgical residency, is five years. So when I was a fourth-year, that’s when I decided I was interested in becoming a breast surgeon.
The reason for that is that I saw the special relationship that a breast surgeon develops with their patients, and that great rapport that they developed with their patients, basically, for breast cancer patients and their surgeon, this is a lifelong relationship, right? Because the cancer patient, the survivor, they continue to follow up with their breast surgeon. So it’s a very special relationship or that special bond between the surgeon and their patients.
That’s was one of the reasons that got me interested. The other thing was that so much progress was developing even then in the breast cancer world, progress in therapeutics, in surgical techniques — and the survivors benefit. The survival rate was becoming higher and higher in breast cancer patients.
And detection stages, the stages where these cancers were being detected, were coming earlier and earlier. And we all know that the earlier that you diagnose the breast cancer, the higher the survival rate and a chance of cure.
… It’s amazing how the whole breast cancer world is rapidly advancing and evolving.

Q: So that’s still occurring?
Yeah. Yeah, absolutely. Yeah. I mean, compared to … we can’t even really fairly compare to five years ago, since five years ago — there’s even, since last year, there are new things that on the horizon.
… We know so much more about different kinds of breast cancer that we didn’t know before. It’s due to research. And it continues to be there’s tremendous research in breast cancer.

Q: The press release from the hospital had a really wonderful quote from you: “Breast cancer is no longer the death sentence it once was.” I feel like that’s a really important message to get out into the world.
It’s absolutely true. I mean, I’m not going to say that we have a 100 percent cure, because that’s not true. There are some sad stories also — but the happy stories are much more than the sad stories.
And the fact is that if can get the word out there … especially in this time, in the pandemic time, people are scared. They don’t want to come for their screening. We were told to stop screening people for however amount of time. … So I constantly had to think about, I wonder how many cancers we’re not picking up because people are not coming for the screening.
… Even now, there are some people who are afraid to come because of COVID-19. So I think it’s very important to get the word out there that it is safe to come for your screening. We are taking every precaution; every effort has been made to make things safe for all the patients. So I think that’s very important.
Of course, yes, breast cancer is no longer the death sentence it used to be — but we need to pick it up early. So the earlier we pick it up, the higher rate of survival, the higher rate of cure.
… The other thing I want to make a comment on is that, let’s talk about prevention and early detection, right? The early detection we talked about through screening prevention. Now, we know that the certain people, for example, we do genetic testing on people who we think they need to get tested. And if they’re gene-positive, now there are ways to prevent the cancer, right? … Some of the breast cancers can be preventable, by changing the lifestyle. Or if someone has the genetic mutation, talk about the risk reduction surgery.

Q: So to a patient who might say, “I’m going to wait six months for my screening, because of COVID-19,” you’re suggesting that’s maybe not a smart idea?
No, because six months is a long time. Six months is enough time to have cancer picked up at a very small size, where it can be either stage zero or stage 1, and it can progress to the next stage. And in certain cancers, which the biology’s very, very aggressive, six months is a tremendous time. So I would say that I would not recommend that at all. And I strongly advise against that.

Q: What’s the biggest public misconception about the disease?
Well, I don’t know if there’s a misconception about the disease. I know there’s some misconception around screening for the disease.
For example, some patients are afraid of the radiation from the mammogram itself, and I have had patients — thankfully, not too many patients — who are worried about the radiation that they’re exposed to from the mammography itself.
And what I try to tell them is that, first of all, with the new mammographies that we have now, the radiation, it’s, yes, there’s absolutely radiation, but you also have to compare the pros and cons, right? The chance of, okay, you get a little bit of radiation once a year. If you’re getting your screening mammography versus not picking up a cancer that can threaten your life. So that’s one of them, I would say, a misconception.

Q: I wonder if there’s anything that, as a breast surgeon, there’s an opportunity to sort of clear up, basically to bust a myth.
Well, I can tell you that sometimes patients tell me, “Well, I’m 80 years old — I didn’t think I would develop breast cancer.” And, well, that’s not true, because as we get older, our risk goes up.
However, having said that, I don’t want the younger patients to think that they’re not at risk either, because I have plenty of young patients who have breast cancer, and some of them don’t even have any family history or any prior history of anything.

Q: Is there anything regarding men and breast cancer that’s worth discussing?
Men and breast cancer? Interesting that you said that. Actually, of course, breast cancer in men is less than 1 percent of the breast cancer, of all the breast cancers — but it happens in men. And I do have a few male patients with breast cancer
… So, it’s interesting that men who are diagnosed with breast cancer tend to be, I don’t want to say advanced, but maybe it doesn’t get picked up right away. Why? Because men don’t do self breast exams, or men don’t think that they develop breast cancer. That’s absolutely a misconception, yes. It’s less than 1 percent of all the breast cancers, but they do, they can develop breast cancer, especially if a man has a genetic mutation, that [puts them at] high risk for developing breast cancer.
And then you just mentioned that there’s another misconception that I hear that all the time. Unfortunately, I hear that from some medical people as well, which is completely false. They say, “Well, yeah, I have a family history of breast cancer, but it’s on my father’s side. It’s not on my mother’s side, so it doesn’t matter.”
Which is absolutely false. Because you get 50 percent of your genes from your mother and you get 50 percent of your genes from your father. So, if it is a genetic predisposition, you can get it from your father. And if it’s not a genetic, and you have tons of family history on your father’s side, you’re still high risk because I believe that there are probably other genes out there that we have not discovered.

Q: Mammographies are so advanced now that when women go for exams, the mammography often returns “artifacts.” Correct? I think a lot of women are frightened when they get that message: We found something and we want to talk. But so many of the times, it ends up being nothing. Early detection is so good now that you can pick up on abnormalities that may or may not be malignant, correct?
That’s true. … The mammography has gotten so sensitive that you can pick up the slightest abnormality. But among all of those abnormalities that get called back, there are also those cancers, tiny little cancers that maybe wouldn’t have been picked up years ago on previous mammography. Now they’re getting picked up because of the better technique and better mammography technique.
But you’re absolutely right: There are biopsies that are done that come back as benign. But the only way to know they’re benign is by doing the biopsy.

Q: What is the basic information that women need to have for Breast Cancer Awareness Month, as far as: When should you be tested? When should you do the screenings? How often, and at what age do you start? Can you give me some basics?
Sure. So, for an average woman who has no family history and they have no symptoms, and this is just a screening, they start at age 40. And then after that it’s annual — every year, once a year, they get a mammogram.
Obviously, if someone has family history and they’re high risk, then depending on what their situation is, the surgeon decides, there are things that we consider and we decide what age they should start their mammogram.
For example, if they have a first-degree relative — that means a mother or sister who was diagnosed with breast cancer — then the recommendation would be [to begin mammograms] 10 years younger than the age that family member was diagnosed. For example, if their mother was diagnosed at age 40, then we start screening the daughter at age 30.

Q: And what are the symptoms to watch out for?
So, I do recommend self breast exams. So the symptoms to watch out for could be any change in the way the breast looks, whether there is any dimpling in the skin or any retraction. Is there any change in the nipple? Is there any nipple retraction, nipple discharge? Do they feel any masses in the breast?
So those are things that … any change to the breast, they should bring it to their doctor’s attention.

Q: October being Breast Cancer Awareness Month really has raised the awareness level in recent years, hasn’t it?

Q: I mean, you see that the NFL …
Absolutely. Yeah. They wear the pink. Yes, yes.

Q: As a surgeon, I imagine this really is a case where an ounce of prevention is worth a pound of cure. Correct?
That is correct. I like the way you put it. Yes, absolutely. Yeah. Yeah. That’s the most important. If I can get the point across that the key is to pick it up early.