KNOWLEDGE GIVES YOU OPTIONS: KNOWING YOUR OPTIONS BEFORE THE DIAGNOSIS OF BREAST CANCER CAN SAVE YOUR LIFE

By April Woodyard

Here is a story of two similar women and their journey from detection to diagnosis of breast cancer.

Sharon, a 50-year-old African American mother of three children, goes into an imaging center for a screening mammogram after being told by her primary care physician that she has not had a mammogram in three years. Life has gotten a bit stressful, and she simply has not made the time to see the doctor for a physical. After all, she has not had any health issues as far as she knows. She is not even taking any prescription medication. She is 5’6’, and the last time she stepped on the scale, she weighed 190 pounds, for which she quickly subtracted the three to five pounds for her clothing and shoes.

The imaging center has her fill out a questionnaire before the mammogram is done. One of the questions is regarding her family history. She can only remember that her Aunt Christine had breast cancer around age 44 or 45. Her maternal grandmother also had breast cancer, but she can’t remember the age. She already dreads this test and the compression that she must endure, so she is not too enthusiastic to be there. She survives the test and is happy that she doesn’t have to be nagged by her primary care physician. She checks that off the list of many things she has not done this year.

Five days later, Sharon gets a call from the imaging center. They inform her that the radiologist saw something unusual and asked if she could return for an ultrasound scan of her breasts. Sharon is a little concerned but not enough because she doesn’t get around to returning to the imaging center until two months later for additional testing due to the unavailable appointment times.

A technician performs the ultrasound and then Sharon waits for the doctor to come back into the room to talk to her. The radiologist, the healthcare professional who reads the mammograms, comes into the room, and tells her that something was seen on the mammogram and ultrasound that appears to be a benign, “complicated cyst.” He recommends that she follows up in six months to confirm that it does not change. Sharon trusts that radiologist because she has faith in her caregivers and so she agrees to return in six months. Unfortunately, Sharon discovers a lump in her breast while taking a shower three months later. She panics and immediately requests a visit with her primary care physician.

The primary care physician confirms that there is a lump in the breast and after reviewing the image results (the mammogram and ultrasound results done three months ago), it appears that the lump is in the same area. The primary care physician immediately informs the radiologist, and Sharon is scheduled for an ultrasound guided core biopsy of the lump. After waiting intensely for five to seven days after the biopsy was performed, the primary care physician calls Sharon back and confirms that the lump is cancerous, and it appears to be Stage 2 breast cancer.

Sharon, like many other women, never saw the importance of having a clinical breast exam every year. She examined her breast periodically throughout the year, but she always felt like her breasts were just “lumpy all over.” She wasn’t aware that she was at a higher risk for breast cancer and that she needed to be tested to see if she had a gene mutation due to her family history of a female diagnosed on or before the age of 45. She never even mentioned her family history until the day she filled out the questionnaire for the recent screening mammogram. She did not realize that although she had not been diagnosed with any illnesses, that obesity was a risk factor for breast cancer. Sharon never knew that she should have been having screening tests more frequently due to her risk even before age 40.

One in eight women will be diagnosed with breast cancer in their lifetime. According to the American Cancer Society, the five-year survival rate is greater for women diagnosed with early stage, localized breast cancer (this is invasive breast cancer and not ductal carcinoma in situ, which is the presence of abnormal cells inside a mild duct in the breast, and this does not include triple negative breast cancer). The Center for Disease Control reports that each year approximately 264,000 women in the United States are diagnosed with breast cancer and 16 percent of those women die from breast cancer. Sixteen percent does not seem like a lot to some until it’s a loved one or even their own prognosis. Breast cancer is the second leading cause of death in women.

Melody has a different story. She is also a 50-year-old African American mother. However, she has been having breast imaging and exams every year since she was 35. Her sister was diagnosed with breast cancer at age 45. Melody has some medical issues that are related to her family history. She has diabetes and high blood pressure, but they are both controlled with medications. Her primary care physician calculated her lifetime risk for breast cancer when she was 35 years old, and Melody had a risk of over 20 percent. She was advised that she should consider clinical breast exams (a breast exam by a doctor) once or twice a year and she was also given the option to have mammograms alternating with MRIs of the breasts each year due to her family history and personal history of having very dense breasts. She also had genetic testing and tested positive for a gene mutation that increased her risks for breast cancer to over 40 percent by age 70.

Melody had a small lump discovered during her annual physical by her primary care physician. Her primary care physician then ordered “diagnostic imaging” (imaging including mammogram and ultrasound). A small suspicious mass was noted in the breast that had not been present on the mammogram the year prior. The radiologist recommended a biopsy considering the member’s family history and personal history of a gene mutation. The pathology revealed early-stage breast cancer, Stage 1. Melody has a greater prognosis due to the steps that were taken prior to her diagnosis.

I have been a health care provider for more than 25 years, specializing in breast cancer for more than 11 years. I named my business Caretaker’s Heart Speaks because I am a caring individual with a huge heart, and I have to speak out about how we fight breast cancer! There is a great need in the community for people to be educated on this disease and to be empowered to navigate through the healthcare system effectively to get appropriate screening and monitoring for breast cancer. There is so much work to be done, but it is my passion to do my part in helping people understand how impactful this can be in reducing the number of people who die from breast cancer each year. I am committed to this task, and I take immense joy in joining in the fight to make a difference in this world!

April Woodyard, breast care consultant, is the owner of Caretaker’s Heart Speaks, a breast care consulting business that supports, advocates for and educates women before and after the diagnosis of breast cancer. Visit chsbreastcare.com for more info.