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Breast Cancer Testing Overview:

In order to gauge your current state of health, our clinic will often request copies of your last two years of medical testing and will often recommend further testing as needed.  Our clinic does request some testing that is and not commonly performed in more "mainstream" medical clinics.  24-hour heavy metal testing with provoking agent, neurotransmitter analysis, food sensitivity testing, comprehensive stool testing and Candida antigen testing are commonly recommended by our medical staff.   Some of these are discussed in detail in the links in this section.

What to Expect on Your First Visit:

First office visits typically last 45-60 minutes.  Your doctor will review your intake form with you and gather a detailed medical history.  A partial physical exam is usually performed and medical records are often requested from your primary care physician and/or other doctors.  Specialty laboratory testing may be recommended.  Most clients are offered an initial protocol consisting of nutritional supplementation, dietary and life style recommendations.

First Visit: Blood Test

To assess and identify kidney, liver, blood sugar and other key factors such as blood cholesterols. The results are explained to the patient, giving him/her a fuller understanding of the blood chemistry, so that they may take control.

Patients are required to fast for 14 hours before the test. Water may be drunk freely, but not tea, coffee, juices or other beverages. Appointments are normally arranged for mid-morning so that food and drink can be consumed up to 8pm the previous evening. On the day of the appointment, any prescribed medication should be taken with water as normal.

Patients are recommended to bring food to eat after the blood sample has been taken. Diabetics should advise the clinic, and separate arrangements will be made.

First Visit: Urine Analysis

To establish exactly how the kidneys are functioning. Patients are required to collect urine over a period of 24 hours. This should be as near the date of the blood test as possible, but must not include the 14 hours fasting period prior to the appointment.

A recommended timetable is that the first urine of the day should be excluded, than all subsequent urine for the next 24 hours collected in clean plastic containers. (If collection starts at 8am, this process must be followed until 8am the following day.) Eg. Appointment 10am Friday, fasting commences Thursday 8pm. Urine collection starts Wednesday 8am. until Thursday 8am.

Containers should be clearly labeled with the patient’s names and brought to the clinic at the time of their appointment.

First Visit: Resting ECG for Doctors Report

The electrocardiograph (ECG) determines the condition of the heart and measures its actions and the pulse.

The doctor in charge reports any findings in his medical notes.

Specific Breast Cancer Testing:

1. Genetic Testing

What is Genetic Testing?

A predisposition to certain cancers can be inherited via altered genes. Genetic testing aims to detect a genetic alteration, through their blood or tissue samples, that might increase the chances of a person developing a particular cancer. BRCA-1 and BRCA-2 are the two genes associated to hereditary ovarian and breast cancer. Mutations of MLH-1 and MLH-2 genes are associated with  colorectal cancer.

Indications and Contraindications

This testing is recommended for families with a high risk of a genetic predisposition to certain cancers. Genetic testing is available to a small number of families. These families are likely to have an inherited predisposition to cancer.

Generally, it is necessary to test a person who has had cancer first to identify the genetic change causing cancer in the family. If a genetic change is found, it confirms that the cancers in that family are due to an inherited predisposition to cancer.

Blood relatives who have no signs of cancer can then choose to have testing to find out if they have inherited the altered genes that may make it more likely for them to get cancer.

Patients who will be undergoing a genetic testing must not have had any recent blood transfusions.

How do you prepare for a Genetic Testing?

There are no special preparations required for a genetic test. However, you must inform your doctor of if you are taking any OTC or prescription medications.

Genetic testing may also be an emotional process, consider talking to your family and friends about your decisions to undergo a genetic testing. Genetic counseling is recommended prior to undergoing a genetic testing.

How does it feel? How long will it take?

The blood sample is taken from a vein in your arm. An elastic band is wrapped around your upper arm. It may feel tight. You may feel nothing at all from the needle while your blood is being drawn, or you may feel a quick sting or pinch depending on your sensitivity to pain. Drawing a blood sample may take for only a few minutes.

Expected effects after the test:

Normally, there are no major effects after the test. Commonly, patients may feel a little sore and slight bleeding may occur on the needle site. Bruising or swelling may occur.

Special instructions after the test:

After drawing blood, cover the needle site with a clean and dry bandage. If advised by the health care professional, apply pressure or warm compress on the area several times a day to minimize swelling and bruising.

Results:

Normal Findings:

Negative- A negative test indicates that no genetic mutations found. If cancer is identified in a family, a negative test is not a guarantee that there will be no development of cancer in the future.

Abnormal Findings:

Positive-A positive test indicates that mutation on one of the cancer genes is found in the blood. There is a greater risk for cancer to develop.

Notes:

An inconclusive result indicates that a genetic alteration is present but it is difficult for your doctor to distinguish if it is a disease-causing gene change. A follow-up test and additional screenings are recommended.

CA 27.29 and CA 15.3 Tumor Marker

What is a CA 27.29 and CA 15.3 Tumor Marker?

The CA 27.9 and CA 15.3 antigens are tumor-associated serum markers available for breast cancer monitoring.

Indications and Contraindications

The CA 27.29 and 15.3 tumor markers are used to monitor cancer patient’s response to treatment for breast cancer.

These tumor markers are not used for detection of early breast cancers.

How do you prepare for a CA 27.29 and CA 15.3 Tumor Marker?

There are no special preparations required for this test.

How does it feel? How long will it take?

The blood sample is taken from a vein in your arm. An elastic band is wrapped around your upper arm and it may feel tight. You will feel nothing at all from the needle while your blood is being drawn, or you may feel a quick sting or pinch depending on your sensitivity to pain. Drawing a blood sample will only take for a few minutes.

Expected effects after the test:

Normally, there are no major effects after the test. In most cases, patients may feel a little sore and slight bleeding may occur on the needle site. Bruising or swelling may occur.

Special instructions after the test:

After drawing blood, cover the needle site with a clean and dry bandage. If advised by the health care professional, apply pressure or warm compress on the area several times a day to minimize swelling and bruising.

Results:

Normal Findings:

CA 27.29 <38 U/ml
CA 15.3 < 22 U/ml

A decline in CA 27.29 and 15.3 levels indicate that the patient is responding well to the cancer treatment.

Abnormal Findings:

Increased levels of cancer antigens indicate metastatic breast cancer.

Mammography

What is a Mammography?

A mammography is an x-ray examination of the breast. It is used to detect breast cancers, tumors and cysts.

Indications and Contraindications

Women should undergo a mammography if they have the following conditions:

• Ages 40-80
• Women of any age with a history of breast cancer
• BRCA-1 and BRCA-2 genetic alteration
• Lumpy breasts
• Breast skin thickening
• Nipple discharge
• Breast pain

Pregnant women should not undergo a mammogram. Women under the age of 25 with no risk for breast cancer are not recommended to undergo a mammogram.

How do you prepare for a mammogram?

Mammograms are usually scheduled usually one week after menstrual period.  If you will be having your mammogram at a different facility, bring your old mammogram records.

Do not wear deodorants, anti-perspirants, talcum powder or perfume on the day of the exam. You will also be asked to remove jewelries around the neck as this can alter the visualization of the breast.

Fasting and sedation are not required for a mammogram

Inform your physician or radiologist if you are breastfeeding.

How does it feel? How long will it take?

A mammogram usually takes 20 minutes to complete with the breast compression lasting for only a few seconds. During a mammogram, you will be required to remove your top clothing and wear a gown. Your breast will be placed on a platform where it will be compressed for x-ray imaging. It may feel a little painful and uncomfortable as pressure is being put on your breast.  This is necessary for capturing an x-ray imaging of the breast. During compression, you will have to sit up straight and hold your breath.

What are the effects after the test?

The level of radiation is minimal and there are very little risks from a mammography procedure.

Special instructions after the test

You may resume to your normal activities after the examination. Follow your physician’s instructions on how to do a self-breast examination.

Interpretation of Results

The American College of Radiology (ACR) has recommended a standard way of reporting mammography findings:

• Category O: Assessment incomplete; additional screenings/imaging is needed
• Category I: Negative
• Category II: Benign (non-cancerous)
• Category III: Benign (short term follow up is recommended)
• Category IV: Suspicious for cancer (further evaluation is needed)
• Category V: High suspicion of cancer

Normal Findings:

No tumor found, no signs of mass or cysts and any  calcifications.

Abnormal Findings:Presence of lumps, tumors, cysts, masses, calcifications, damaged tissues, and dense areas

Abnormal findings indicate:

• Breast cancer
• Fibrocystic disease
• Suppurative mastitis

The Right Diagnosis and Treatment for Breast Cancer

Once the comprehensive review is completed for each patient, our doctors and our team of medical professionals will evaluate your diagnosis. At this point, our doctors will spend one on one time with you to interpret and explain your results. Together you will explore your goals and discuss your treatment plan options. These treatment plans can be implemented using multiple modalities such as medications, hormones, diet, supplements, behavior and lifestyle changes, and alternative therapies. Our doctors will prescribe a preventative and comprehensive treatment plan that is tailored to your needs and fits into your lifestyle.

Patients Medical’s Personal Approach to Breast Cancer

Our doctors and our team at Patients Medical will regularly monitor your progress and track the effectiveness of your program making adjustments if necessary. Our goal is to support you and advise you every step of the way.

We work in conjunction with your existing doctors. Any gaps between specialists are filled to ensure we support your overall health and well-being. While we treat serious medical conditions such as Alzheimer’s, Diabetes, Parkinson’s, Multiple Sclerosis, anxiety, depression, and heart disease; the primary objective of our staff is prevention and early detection of disease.

We are located at: Patients Medical PC, 800 Second Avenue, Suite 900 (Between 42nd & 43rd Street), Manhattan, NYC, New York, NY 10017.