Your First Visit
Beyond the Front Desk
by Dr. Lana Shikhman
It is 8AM at the Elliot Breast Health Center and concerned
women and men flood the office with breast lumps, nipple discharge, and skin changes. Most of these findings will be benign, but the anticipation of “bad news” is palpable. More so, it is the fear of the unknown that slows the
footsteps and quiets the crowded changing room. Perhaps if someone shed some light on what happens aside from a change of clothing and the anticipated mammogram; the heart might slow down a bit and soften the alarming pang in the chest.
So how does it all work?
We want to meet you and get to know you. If you are here for screening, only imaging studies will be performed. If you are here for specific symptoms then you will spend a bit more time with us. We want to see how long things have been concerning you and interfering with your lifestyle. This may, at first seem uncomfortable, dressed in a gown talking about your breast health and sharing intimate details with someone you have just met. But we need to hear your concern, see it, and be able to feel it. The more we know about you the more accurate the diagnosis.
Once we have seen, heard, and examined you, we need to obtain imaging studies. These studies allow us to see deep into the breast tissue and give us even more information to decide on the best course of action. The most common imaging modalities include mammography and ultrasound. These studies function in tandem, like two close friends, stronger and more accurate in combination.
Once we have the information from your imaging studies and physical exam we will decide whether your symptoms are harmless and/or suspicious and require additional work up. Suspicious findings on mammogram, physical exam, or both require more direct confirmation. That means we need to get some tissue in the area of concern: a biopsy. This is done with the help of ultrasound, mammogram or MRI depending on which picture shows it the best. We inject numbing medication into the skin and then use a specialized needle to obtain tissue samples through a small skin opening. The results take about three to five days at which time someone from the office will call you or schedule an appointment to discuss things in person. If the lesion is benign (the majority are), then the phone call will be a reassuring one and you will be informed of the next imaging study or/ and follow up you may need. If the biopsy yields a cancer diagnosis, we have a lot to talk about and we get you back into the office immediately.
The cancer diagnosis visit is a long one. We encourage you to bring someone with you during your appointment. You will meet with one of our dedicated breast surgeons and discuss the next immediate steps that are necessary to achieve a cure. Most of the time, a specific surgical procedure is required. Depending on your age and cancer type you may meet with our nurse practitioner for a genetic assessment and counseling. You may also need radiation therapy and/or chemotherapy. The order of these therapies may be switched or eliminated altogether depending on the type of cancer you have. The therapy is tailored to you and a multidisciplinary team of specialists will help you make these complex decisions. Once the treatment is complete you will have a yearly visit with us to make sure you remain healthy.
Most importantly, if you are a woman over the age of 40, please continue with your yearly screening mammograms. Eat plenty of fruit and veggies. Exercise at least three times a week for 30 minutes to maintain a healthy lifestyle. And if any trouble should arise, please contact us, now having a better understanding of what happens beyond the front desk.
Dr. Shikhman joined the Elliot Breast Health Center in September, 2014, after completing her Breast Surgery Fellowship at the University of Massachusetts. She received her medical degree at Ross University and completed her internship and residency at Robert Packer Hospital in Sayre Pennsylvania. Dr. Shikhman is Board Certified by the American Board of Surgery. She is a member of the American College of Surgeons, the American Society of Breast Surgeons, and a member of Women in Surgery.