Episode 2 – Breast Disease with Dr Nicole Yap and Wendy Squires

Wendy Squires (00:10):

Welcome. My name is Wendy Squires. I’ve been a journalist for more than 30 years, specializing in women’s health issues. Which is why I have the great honor of introducing highly respected breast doctor and surgeon, Dr. Nicole Yap. She’s an expert in oncoplasty which involves removing cancers with pleasing aesthetic results for patients. Training in both plastic and general surgery, Dr. Yap’s breast techniques were refined whilst working at the European Institute of Oncology in Milan at the Royal College of Surgeons in London and working with world renowned experts in Paris and Lyon. Amongst her many accolades, Dr. Yap is the former deputy chair of the Royal Australasian college of surgeons. And it’s representative on the cancer council, Victoria medical and scientific committee. She’s also pink coat expert advisor and vice president of the medical legal society of Victoria.

Dr Yap. Obviously you’re a very well respected cancer surgeon. I’d like to talk to you now about some of the things that affect women’s breasts and men’s breasts that aren’t actually cancerous and there’s quite a lot. Aren’t there?

Dr Nicole Yap (01:18):

There are, and in fact, in certain age groups, there’s probably lots of lumps diagnosed, which are benign. So women in their twenties to 40, so twenties and thirties, for example, the lumps that they commonly get are called fibro adenomas and once Bob seed and confirmed, I can safely say, this will remain a benign lump and not turn into a cancer.

Wendy Squires (01:45):

So their hard lumps that you feel when you feel your breasts. And they actually quite sore to the touch, would that’d be right?

Dr Nicole Yap (01:51):

They can be sore because they can increase or decrease in size according to hormone or influences, specifically estrogen. So they’re sorts of lumps you can remove, or you can keep them, but if you go to keep them, I often advise to keep a surveillance ultrasound at least every year, because I’ve had a number of patients who’ve had fiber adenomas chosen to keep them and then become complacent. And they co incidentally develop an early breast cancer, very close to the fiber adenoma. And it just gets ignored because they think it’s their fiber adenoma until it’s advanced disease. So I always say be careful because if it’s a, once we get in, get onto that subject of palpable palpable. It means you can feel it. If you can feel the lump, then you need, it could mask an early breast cancer.

Wendy Squires (02:48):

Oh, that’s a really interesting thing too. Because most women at some stage will suffer lumpy breast won’t they? They’ll feel a lump in their breast.

Dr Nicole Yap (02:56):

Yes. It’s relatively common. There’s also a subset family called phyllodes, which act locally aggressive and do need to be removed, phyllodes is spelt whit a PHY not an FI. So if people want to look that up on the internet. And then of course we have papillomas, which are gross within the duct, which up to 18% can become cancer. So they really do need to be removed.

Wendy Squires (03:23):

So that’s when they say that you’ve got like, it’s in your ducts. That’s.

Dr Nicole Yap (03:26):

So within the duct, the lining of the duct, you can develop an outgrowth and that’s called a papilloma in the breast. And they often present as nipple discharge, but can present as a lump. So it depends how close to the surface they are and how big they get prior to presenting as a lump. And then there’s other benign causes that occur during pregnancy and breastfeeding, which is a blocked milk duct, which creates what we call a galactocele. And that’s old blood sitting in a certain area because it can’t drain and it presents as a lump, but don’t be complacent. If you do get a lump, when you’re pregnant, one in 3000 pregnancies are diagnosed with breast cancer. These are the most recent statistics. So please get it checked. Don’t just think it’s just a blocked duct, milk duct. So that’s something to be aware of.

Wendy Squires (04:27):

A lot of women feel awful about not being able to breastfeed as well, and probably would put that aside and think, well, once I stopped breastfeeding, I’ll look at that. But [crosstalk 00:04:38] yeah.

Dr Nicole Yap (04:38):

Never, never put anything aside, always be proactive.

Wendy Squires (04:43):

So what other issues can happen around the breast? I know a lot of people suffer from very dense breasts. Can you explain to us what’s happening there?

Dr Nicole Yap (04:50):

So dense breast tissue means that the proportion of your breast that’s made up of both glandular breast tissue plus fatty tissue. So the proportion is you have a greater amount of glandular, normal breast tissue. That’s often seen. You don’t really feel that so much. You might feel it if you get a bit of breast pain, because that’s the breast glandular tissue is what is painful when you have painful breasts, but essentially you will see it on a mammogram and or ultrasound. And it’s become very important to know whether you have dense breast tissue, because we have noted in most recent years that women who have that for their age group. Okay? So you’re going to have dense breast tissue when you’re very young and as you get older, it should become this dense. But if it doesn’t, then we get concerned because you have your risk of developing a breast cancer.

At that point is 1.6 times than the general population. So it’s a little bit more so not a lot, but something to be very aware of. And for those women, I often tell them to get checked annually. And what checking means is a clinical examination because lobular cancer can present without anything shown on the mammogram or ultrasound or very little, but you can feel it. They need to have a mammogram, and they also need to have an ultrasound because a mammogram is good for looking for precancer change, which you can’t actually feel a lot for. And of course an ultrasound is very good for looking at solid and cystic lesions.

Wendy Squires (06:27):

Dr. Yap, I understand breast pain is a big issue for a lot of women. I personally have suffered it. Acutely so can you tell us what’s going on with that? And should we be alarmed?

Dr Nicole Yap (06:39):

Well, breast pain is, as you say, very common, but very little has been looked into it. And what we believe is the cause of that problem is that the glandular tissue, the true breast tissue is being affected by an imbalance of estrogen within the breast. Okay. So it doesn’t mean that you’ve got an imbalance throughout your whole body it’s within your breast. And therefore a lot of people find that it can be cyclic in nature. That is to have more pain just before their periods and when the estrogen level is high. And then it settles down when the period starts or their cycle starts. So, and that’s because the estrogen level has dropped. So there’s that problem there, but there’s also a problem where it’s non cyclic and it’s unrelated to the cycle. So in those situations, it’s very difficult to ascertain how we can try and help those patients. One thing that really helps seven out of 10 women with breast pain or mastalgia cause that’s what it’s otherwise called is evening Primrose oil. Now I’m someone that doesn’t advocate a lot of organic medication, but I will suggest anything that helps. And I know that evening Primrose oil does help.

Wendy Squires (08:04):

I’ve been recommended evening Primrose oil in the past, but what I’ve realized is you have to take a hell of a lot of it, don’t you?

Dr Nicole Yap (08:11):

Well, it’s an individual dose response. Initially, what I would do is start off with maybe two a day and always divide the dose. So one in the morning, one at night you need to build that up in your system. It’s not like taking a Panadol and half an hour later, your headaches a little bit less. So you need to take it for at least a week and then see whether that dosage is helping you. You can take up to four of these capsules a day, each one giving you added benefit. But if you get up to four capsules a day, first of all, you’re sick to death of taking these huge capsules. But secondly, you’ll probably, if it’s not helping you, you fall into that category. The three out of 10 women, it doesn’t help.

Wendy Squires (08:58):

Is there anything that can help those women?

Dr Nicole Yap (09:00):

Not a lot, not a lot. Unfortunately, there’s other things where people suggest taking anti inflammatories decreasing caffeine, decreasing chocolates, anything that makes you feel miserable. You know, if you have to decrease it, people say it’s good for you. But in fact, none of these have been really proven. And none of these are really as effective as the evening primrose oil.

Wendy Squires (09:24):

Another interesting factor with breasts I came to know is underwire bras. Is that a myth that they cause pain or that they can cause breast cancer?

Dr Nicole Yap (09:36):

Well, if you have it tight enough, any wire will be painful, but in general, if it’s fitted properly, it shouldn’t cause you pain. The pain is internal in general. Of course, if you’ve got indentations while you’re just lessen off on the load, but as far as breast cancer’s concerned, no, that is not a risk factor for developing [crosstalk 00:10:01] cancer.

Wendy Squires (10:01):

So that’s been proven.

Dr Nicole Yap (10:02):

There is no scientific evidence that it causes breast cancer.

Wendy Squires (10:07):

Oh, that’s good to know. Isn’t it? Because especially in big breasted women, you can’t really go without the underwire. So if anyone’s out there with bumps, lumps, again, we’ve talked in another episode about discharge from the nipple, things like that, your advice.

Dr Nicole Yap (10:25):

Yes. The three or the symptoms that you look out for in breast cancer issues are obviously a lump, nipple, discharge, nipple inversion. So it’s being pulled down into the breast, any contour changes or skin tethering of the breast, as well as in a few people eczematous changes around the nipple areola. These are the key symptoms that we can look out for.

Wendy Squires (10:51):

So those changes are like an X mark.

Dr Nicole Yap (10:53):

So it’s like it presents as an eczema, and it’s usually situated around the nipple areola. And if it doesn’t settle with normal eczema treatments such as steroid cream, we get very concerned because it may indicate a cancer that’s just sitting underneath the nipple areola complex.

Wendy Squires (11:16):

Very, very interesting. Well, I think this has been fascinating. And again, I think that the message that we should, everyone should take home is go and check it out. If you’re unsure.

Dr Nicole Yap (11:26):

Always check it out. And if you have a family history, be vigilant, be very vigilant too. There’s nothing like finding something early that can be treated because if you leave it too late, you just kick yourself that you left it too late. You cannot reverse time.

Wendy Squires (11:45):

Well, that was fascinating. Thank you so much. And I look forward to talking to you more in our next episode.

Dr Nicole Yap (11:50):

Looking forward to it.