Breast cancer from a surgeon

General surgeon Dr. Pamela Gruchacz understands the ins and outs of surgery, especially breast surgery. About 30 percent of her practice at Bartlett Regional Hospital involves breast surgery.

• Photos

Courtesy Of Bartlett Regional Hospital

"I'm a general surgeon, but being a female general surgeon, you tend to get a lot of breast surgery cases," she said, "because I think females just like to go to a female OBGYN. They like to go to a female surgeon for breast problems."

Among the hundreds of lumpectomies and mastectomies Gruchacz has done, she completed about eight breast surgeries in Juneau alone, including lumpectomies, an operative breast biopsy and a few mastectomies.

Gruchacz explained the differences between each surgery.

"A lumpectomy, you're just taking out the lesion with about a centimeter of good clean tissue around it," she said. "With a lumpectomy, you need to have radiation post-operatively."

In a mastectomy, doctors take out all the breast tissue.

"So you don't need radiation after a mastectomy," Gruchacz said. "That's the difference between the two. They both have the same 10-year recurrence and survival rate, but one you're going to need radiation afterward and the other one you're not going to."

In talking with Gruchacz about newer methods in breast surgery, she described the difference between 1) a lymph node dissection, an established surgical removal of all or some lymph nodes under the arm, and 2) sentinel lymph node biopsy, a procedure developed about 10 years ago that looks for breast cancer.

According to breastcancer.org, sentinel lymph node biopsy involves injecting "a blue dye, a radioactive substance (tracer), or both into the area around the cancer or behind the nipple. The dye or tracer works its way from the breast area to the lymph nodes."

"It used to be, when you had breast cancer, you had to sample all the lymph nodes in the armpit, and that was the worst part of the case, because you can get about 20 percent incidence of arm-swelling lymphodema, and it's the hardest part of the surgery to recover from," Gruchacz said. "So, ... they started doing what's called a sentinel lymph node biopsy, which they developed with melanoma initially, and what that involves is you inject a radioactive tracer right where the tumor is, and the tracer goes down the lymphatic channels and drains into the first lymph node or two in the armpit that drains the breast.

"And then, during surgery, you can take a little hand-held guider counter, and make a small incision over those two lymph nodes and then take them out, identify them as the sentinel lymph nodes, and you take them out, and the pathologist can tell you in surgery if there looks like there's any cancer in it. If there's no cancer, then you're done. You don't need to take out all the lymph nodes."

In addition to avoiding lymphodema and arm pain, which result from lymph node dissection, sentinel lymph node biopsy is highly effective in avoiding any dissection.

"Probably it saves you from doing a lymph node dissection at least 85, 90 percent of the time," Gruchacz said. "It makes it less of an operation for women to recover from."

With breast cancer, doctors must continually check the status of the lymph nodes.

"Whether the lymph nodes have cancer is going to determine if you need to have chemotherapy afterward," Gruchacz said. "So what you're trying to do is find out if the breast cancer has moved from the breast to the body yet. If it hasn't moved to the lymph nodes, then the majority of people are not going to require chemotherapy."

Gruchacz said the most common reaction she witnessed from patients diagnosed with breast cancer is shock.

"I always tell them to come back and bring somebody with them, because when they come back and they get that news, there's just pure shell shock," she said. "You can talk to them, and they're not going to hear you. They're not going to remember what you said. It's just always best for them to bring a pad of paper and bring somebody else who can listen and understand what's going on. It's very traumatizing. All of a sudden you go from being a healthy person and now somebody with cancer."

Gruchacz also illustrated the need for early detection.

"In general, about three to four times a year, I'm going to see somebody walk in with a huge mass in their breast," she said. "And a lot of times, it's just a state of denial. People know that they've got something, but they figure if they don't go to the doctor, they're not going to hear that they have breast cancer."

As a doctor, Gruchacz believes the most pressing issue surrounding breast cancer today is early detection.

"It's like night and day. If you have a woman come in with a Stage 1 breast cancer, there's a 95 percent change that she's not going to have positive lymph nodes, and surgery is going to take care of her, and she's going to survive, and she's going to be around in five years," Gruchacz said. "If you don't have early detection, and they're walking with these later tumors, the prognosis is not good by the time you get to lymph node-positive breast cancers, you're looking at five year survivals of 50 percent, 60 percent as opposed to a 95 percent for Stage 1."

Gruchacz exhorts education, mammograms starting at age 40, and really being aware of family history.

"There are syndromes within breast cancer where there's a higher incident of breast cancer in families," she said. "It's called BRCA 1 and 2. ... If you've had a BRCA 1 gene, positive, you've probably had a mother or sister with breast cancer before, and your chance of getting breast cancer during your lifetime is 85 percent."

And according to Gruchacz, sometimes women choose, once they've learned of a high predisposition to breast cancer, to have a mastectomy.

"So it's really important to know your family history and genetically what you may be predisposed to," she said, "and to get your early screenings."

• Contact Neighbors editor Kim Andree at 523-2272 or neighbors@juneauempire.com.

To read this and other articles celebrating Breast Cancer Awareness Month, visit juneauempire.com/breast_cancer.