Breast cancer is not entirely preventable, but patients can make choices that can help decrease their risk. Exercising regularly, staying at a healthy weight, avoiding excessive alcohol, and not taking hormone replacement therapy can all decrease the risk of breast cancer.
Cancer is a horrible and terrifying disease. There is so much great information out there, but sometimes it is very difficult to filter out the noise. What causes cancer? Can it be prevented? How do you detect it? What are the odds of survival today? What are the different forms of cancer? What are the best treatments? And what is the best way to support someone impacted by cancer?
In this interview series called, “5 Things Everyone Needs To Know About Cancer” we are talking to experts about cancer such as oncologists, researchers, and medical directors to address these questions. As a part of this interview series, I had the pleasure of interviewing Sarah Kilic.
Sarah Kilic, MD attended Wesleyan University for both her undergraduate and graduate degrees in molecular biology and biochemistry. She went on to receive her medical degree from Rutgers New Jersey Medical School before completing an internship in internal medicine and a residency in radiation oncology at the Cleveland Clinic.
As a general radiation oncologist, Dr. Kilic is experienced in treating cancer in every part of the body. She has a particular interest in treating brain, breast, and gynecologic tumors. Dr. Kilic specializes in advanced image-guided external beam radiation therapy techniques, including stereotactic body radiation therapy/stereotactic radiosurgery and intensity-modulated radiation therapy, as well as high-dose-rate gynecologic brachytherapy.
Dr. Kilic is passionate about scientific research and advancements in radiation oncology. She has authored over 30 publications in various medical journals, including JCO Oncology Practice and the International Journal of Radiation Oncology, Biology, Physics. She has also published several book chapters and presented her research at multiple oncology conferences, including the American Society of Radiation Oncology and the American Society of Clinical Oncology annual meetings.
Thank you so much for joining us in this interview series! Before we dive into the main focus of our interview, our readers would love to “get to know you” a bit better. Can you tell us a bit about your childhood backstory?
I was fortunate to have a very diverse upbringing — I was born and spent the first ten years of my life in California, and then moved abroad with my family to the Middle Eastern country of Qatar, where I lived until I graduated from high school. Growing up in Qatar, my friends and classmates were from all around the world, and I was lucky to have the opportunity to travel to so many countries that I never would have been able to had we stayed in California. Although it doesn’t seem directly related to medicine, I think my upbringing among such a diverse group of peers and with opportunities to experience so many cultures really formed the foundation for my career in the field of oncology: open-mindedness and curiosity were really embedded in me from an early age, which I think directly translate into not only a constant drive for learning and knowledge as it relates to the science behind what I do, but also a deeper empathy for the people from all backgrounds and walks of life who I care for.
What or who inspired you to pursue your career?
Medicine was a bit of a career change for me. I was initially pursuing my PhD in molecular biology and planned to become a research scientist, spending essentially all of my time in the lab. A few things happened simultaneously that amounted to a wake-up call in terms of how I wanted to spend my time. My mother was diagnosed with breast cancer, and at the same time as her diagnosis, I was working in a radiation biology research lab. So I was exposed to the field of radiation oncology simultaneously from a deeply personal perspective, seeing my mom go through surgery, chemo, and radiation, and at the same time I was studying the basic science of how radiation can cure cancer. I ultimately realized that while I loved the basic science process, I really wanted to be face-to-face with the people I was helping, and I had, just by these life circumstances, come across the perfect field to do so. Radiation oncology offered what for me is the perfect blend of these interests: it’s a cutting-edge field with so much research and innovation, but the core of what I do is really sitting down with my patients, caring for them, educating them, and getting them through their treatment journeys.
What is your primary motivation and drive behind the work that you do?
My patients, without question. The amount of trust and vulnerability patients — especially patients with cancer — place in their physicians is so vast and meaningful, and probably not truly comprehensible to anyone who has not been a patient themselves. The magnitude of this responsibility is not lost on me. Taking care of my fellow human beings is truly a privilege, and the gratitude I feel for my role is the foundation of everything I do.
Can you briefly let us know why you are an authority about the topic of breast Cancer?
Breast cancer is, unfortunately, very common in the United States and around the world, and radiation treatment plays an enormous role in the treatment of breast cancer. Radiation treatment is used in multiple different ways for patients with breast cancer, but probably one of the most impactful uses of radiation for breast cancer is the ability to spare many patients from having a mastectomy — a surgery to remove the entire breast — by undergoing a much smaller surgery, a lumpectomy, to remove just the area of the breast where the cancer is, followed by radiation treatments to the breast after surgery. This combination of a less invasive surgery followed by radiation treatments is just as effective as a mastectomy for many patients with breast cancer, and has improved quality of life for countless patients who were able to avoid a mastectomy. Given this hugely important role that radiation treatment plays in the treatment of breast cancer, I see patients with breast cancer virtually every day in my practice, and many of these patients are able to go on to have excellent outcomes both in terms of eliminating their cancer and giving them aesthetic outcomes that they are happy with.
What exactly is breast cancer?
In general, cancer is a disease in which cells in a certain part of the body start growing in an abnormal way, escaping the normal control mechanisms our bodies have to prevent this uncontrolled growth from happening. Breast cancer is when this uncontrolled growth process happens in the tissue of the breast. This most commonly happens in the ductal tissue, the tissue that forms the lining of the passageways that carry milk out of the breast, but it can also happen in the lobular tissue, the tissue that lines the actual milk-making glands, or, more rarely, in other types of tissue in the breast. As an aside, this is why breast cancer is much more common in biological females, but still rarely possible in biological males — females have much more breast tissue than males, but males do have slight amounts of breast tissue, making breast cancer very rare, but not impossible, in males.
What causes breast cancer?
Breast cancer is not just one single disease. There are multiple subtypes of breast cancer, each with their own set of causes. When categorizing breast cancers by cause, the most common type of breast cancer is what we call hormone receptor-positive breast cancer. The growth of these breast cancers is fueled by the native female hormones, estrogen (and also progesterone). So, many of the risk factors for breast cancer are related to estrogen exposure: being a biological female, being older in age (because the breast tissue has had more years to be exposed to estrogen), and early menarche or late menopause (because more menstrual cycles in one’s lifetime expose the individual to more estrogen), among others. Genetics are also important in breast cancer risk: having a first-degree family member (i.e., mother, sister, or daughter) with breast cancer increases one’s risk of having breast cancer themselves. We have a good understanding of some of these genetic factors, most notably the BRCA genes, which received a lot of attention in the media when Angelina Jolie announced that she is a carrier of the BRCA1 gene and underwent a prophylactic bilateral mastectomy (preventative removal of both breasts) to decrease her risk of breast cancer. However, there are still other genetic factors that we haven’t yet identified that can increase families’ risk of breast cancer even without mutations in BRCA or other known genes. These factors are unfortunately not modifiable — we have no control over our family history or when we start having periods or go through menopause (with rare exceptions for menopause due to surgery).
How can breast cancer be prevented?
As mentioned, many of the risk factors for breast cancer are nonmodifiable — we cannot change that we were born as biological females or that our relatives have been diagnosed with breast cancer. Therefore, unfortunately many cases of breast cancer cannot be entirely prevented. However, it may be some comfort to know that we can still do things to decrease our risk of breast cancer by changing some aspects of our lifestyle — these are called modifiable risk factors. For example, regular exercise, maintaining a healthy weight, not taking hormone replacement therapy, and avoiding excessive alcohol can reduce the risk of breast cancer.
How can one detect the main forms of breast cancer?
In the United States, the most important method of breast cancer detection is mammography. Guidelines differ between medical organizations regarding at what age biological females should start receiving screening mammograms, but I personally agree with the American Cancer Society’s guideline that women start getting their screening mammograms annually at age 40. In developed countries like the United States where patients have access to mammography, the benefit of breast self-exams with regard to breast cancer screening is less clear. That being said, I encourage everyone who is a biological female to be in tune with how their breasts normally look and feel, so that if they notice a change, they can let their doctor know immediately. And in developing countries where access to mammography is limited, breast self-exams and clinical breast exams (physical exams of the breast performed by doctors) play a very important role in breast cancer detection.
Healing usually takes place between doctor visits. What have you found to be most beneficial to assist a patient to heal?
Having not been a patient with cancer myself, I acknowledge that I will never be able to answer this question perfectly. That being said, there are certainly common themes in what I’ve seen has helped the most when caring for my patients during and after their treatment. Having an attentive medical team to help manage the side effects of the cancer itself as well as its treatments is, of course, essential. But aside from good medical care, I would say the most important factors for healing physically, mentally, and emotionally from cancer and its treatment are, firstly, a sense of spirituality, and secondly, a supportive network of family or friends. When I say spirituality, I don’t necessarily mean religion — I mean a sense of a deeper meaning and connection to the world, which certainly many patients find in religion, but just as many others who are not religious find in meditation, nature, or simply a sense of grounding that probably has a lot to do with their own innate personality, upbringing, and values. Aside from that, I think that having people to lean on, whether that be family, friends, coworkers, neighbors, community members — I don’t know if I’ve ever met a patient who hasn’t benefited in some way from having a good support system. This support can look different for different patients. For example, patients undergoing radiation treatment to the head and neck almost always have lots of side effects and will need support getting through the physical difficulties of treatment, whereas patients getting radiation treatment to other parts of the body may not have as many physical side effects, but may be struggling mentally and emotionally with, for example, fears about the future. Even though they may not need someone to help with physical tasks, it’s still just as important for these patients to have a trusted loved one to confide in.
From your experience, what are a few of the best ways to support a loved one, friend, or colleague who is impacted by cancer?
Again, not having had cancer myself, I don’t want to pretend that I know better than those who have, and I do think that every patient is different in terms of what is most helpful to them. That being said, I have seen some common themes among the patients I have cared for. I know that sentiments like “whatever is meant to be will be” or “someone always has it worse than you” are generally meant with good intentions, but I find that these are not always felt to be helpful or supportive. Aside from that, there is really no one size fits all approach: for example, many human beings find it difficult to ask for help, not just in “normal” times but even when they are facing a diagnosis of cancer. If your loved one tends to be like this, saying “let me know if you need anything” may not quite be the best approach, if you think they might have trouble with asking. For loved ones like this, trying to anticipate a need they might have based on what you already know about them and then doing something nonintrusive to help with that need might be best — for example, if they are struggling with getting good nutrition, maybe dropping off a meal or some goodies that you know would appeal to them. On the other hand, other patients are not shy about asking for help, and in that case, letting them guide you with what they need rather than trying to anticipate it might be more helpful. And if you’re not sure or if it’s someone you don’t know as well, I think it’s hard to go wrong with a sincere text, phone call, email, or face-to-face chat letting them know that you’re thinking of them and a specific offer of something you could help them with (a ride to treatment, a home cooked meal, their favorite coffee, etc).
Based on your experiences and knowledge, what are your “5 Things Everyone Needs To Know About Breast Cancer? Please share a story or example for each.
- 1 in 8 women in the United States will have breast cancer at some point in their life. The good news is that the rates of breast cancer in the United States have been dropping.
- Breast cancer can be detected early, and the earlier it’s detected, the more likely it can be cured. Get your mammograms!
- The idea that “If it hurts, it can’t be breast cancer” is a myth. A common urban legend is that breast cancer does not cause pain, so if a patient notes a painful lump in the breast, it can’t be cancer. It’s true that breast cancer is usually painless, but a significant proportion of breast cancers do cause pain. So, if you have breast pain that isn’t going away, see your doctor — it’s still more likely to be benign, but it’s essential to see your doctor so they can determine that for sure.
- Black biological females are more likely than biological females of other races and ethnicities to die of breast cancer. There is evidence that Black patients should start screening earlier or get screened more often than non-Black patients.
- Breast cancer is not entirely preventable, but patients can make choices that can help decrease their risk. Exercising regularly, staying at a healthy weight, avoiding excessive alcohol, and not taking hormone replacement therapy can all decrease the risk of breast cancer.
How can our readers further follow your work online?
arizonaoncology.com or follow me on twitter @sarahkilicMD
Thank you so much for these insights! This was very inspirational and we wish you continued success in your great work.