Get Your Breasts Checked
October 15, 2008
By Dr. Jennifer Carney
Dr. Jennifer Carney
Oncologist
Interviewed by Melissa Moniz
What is your area of specialty?
As a cancer doctor, you go through internal medicine training first and then you do extra years of training called fellowship in oncology and hematology. The whole process culminates in tests, called the boards, that you should pass. So I am board-certified physician in internal medicine, oncology and hematology.
Can you talk about your background, such as where you went to school and received your training?
I did my college, medical school, internal medicine residency training at the University of North Carolina in Chapel Hill. I completed my fellowship in hematology and oncology at the University of Michigan at Ann Arbor.
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I moved to Oahu in 2003 and started at Kapiolani Women’s Cancer Center, focusing on breast cancer care. I was an assistant professor at the University of Hawaii in the Departments of Internal Medicine and OB/GYN. I also worked at the Queen Emma clinics. I completed a master’s in clinical research at the University of Hawaii last year. I really wanted to find a home base - a place I could really be a part of - and was so delighted to have the opportunity to join our Kaiser family.
Can you explain what you do and what your job entails?
We usually have members referred once they have been diagnosed with cancer. We see patients every day in the hospital and clinics. At Kaiser, we have five oncologists: one on the Big Island, one on Maui and three on Oahu. We have a full team of pharmacologists, oncology nurses, medical assistants and other staff to make our clinic complete. We believe in working as a team, so we work directly with our pathologists, radiologist, surgeons, radiation oncologist and a whole host of other doctors to provide team care for our members. We have regular meetings where doctors come together to make treatment plans for patients coordinated and comprehensive. We actively encourage clinical trials to improve cancer care.
What makes my job so fulfilling are the many wonderful patients we get to serve, and the team environment at Kaiser that I feel is so unique!
What are the most common types of cancers you see and treat?
I would say, for women, definitely breast cancer. Other common cancers include prostate, colon and lung.
Is the treatment for each of those three types very different? Can you discuss briefly the differences in treatment?
Absolutely! Every cancer is treated differently. And within each type of cancer are sub-types of the cancer, so we use many modalities for cancer care. This might include surgery, radiation therapy, different types of chemotherapy and non-chemotherapy medicines. We are using more and more targeted therapies. We use a lot of support medicines to make chemotherapy more manageable.
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We are really beginning to personalize medicine and tailor each person’s cancer. For example, since this is breast cancer awareness month, let me tell you about breast cancer. With certain types of breast cancer, there are gene assays which can be used to tell a patient exactly their chance of the breast cancer coming back. The assays can even tell you if you are unlikely to benefit from chemotherapy. This is important because we don’t want to give chemotherapy to patients if they don’t need it. We have anti-hormone drugs like tamoxifen and aromatase inhibitors to block breast cancer hormones. We have targeted therapies like trastuzumab (Herceptin) and lapatinib (Tykerb), which are not chemotherapy drugs. We have bevacizumab (Avastin) which blocks tumor blood vessel supplies. We have newer chemotherapy drugs because of clinical trials. We even have support medicines to help the bones of breast cancer patients.
There are so many options for breast cancer therapies. If people are interested in a complementary approach, Kaiser even has a specialist in holistic recommendations that does not conflict with the cancer treatments. I think it is very important for our patients to know that treatment is individualized today.
As you know, Oct. 17 is National Mammogram Day. Can you discuss the importance of getting tested?
Breast cancer is the leading cause of cancer in Hawaii for women. If you detect it early, most people are cured. As the disease becomes more advanced, the risk of cancer coming back gets higher. But I’d like to remind breast cancer survivors that even if you have stage four breast cancer, which is the highest stage of breast cancer, at five years a quarter of patients remain alive. We think this is because our treatments are getting better. Over time we hope survival rates will continue to improve.
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Annual clinical breast exams and screening mammograms are recommended for women 40 years and older. Self breast exam is encouraged but not mandatory. You should ask your doctor how to do a breast exam. If you’re between the ages of 20 and 39, it is recommended you have a clinical breast exam every one to three years. Again, self breast exams are optional. Any breast lump should be evaluated regardless of age.
Certain people may be at higher risk for breast cancer. If this is so, your screening recommendations would be different and this would be discussed with our doctor. We also can’t forget that men can get breast cancer, though it is very rare. Any man with a known genetic predisposition or breast lump also should be evaluated.
Do you think there will be a point when cancer will be 100 percent curable?
I think, if you catch cancer early, many types of cancer are curable. If you take good care of yourself, exercise, eat well and drink alcohol in moderation your overall health will be great and it can help with prevention or decrease recurrence.
For example, we know physical activity reduces breast cancer and colon cancer recurrence. When people are diagnosed with cancer, it really can also depend on the health of a person and the type and stage of a cancer they have.
I am optimistic that our treatments are getting better, we are targeting cancers and that this is an exciting time in oncology research. We still have lots to do to make people aware and encourage more research. This is an important goal for Kaiser Permanente. As our 50th anniversary approaches, we are grateful to our members and together strive for a healthy, happy and active lifestyle.