If you’re a woman, mammogram screenings may just save your life. Learn how Kathleen Lee, a breast cancer patient, took her health into her own hands – and how you can take your own care into yours.
At the beginning of 2017, Rockford resident Kathleen Lee was a 36-year-old mother living a normal life. She certainly didn’t have any symptoms of breast cancer. She didn’t feel any strange lumps. She wasn’t in any pain.
But since her grandmother had breast cancer before she reached age 40, Lee thought she’d ask to have a screening mammogram.
“It honestly just occurred to me to ask my gynecologist for a mammogram when I went in for a regular pap smear test,” she says. “I’m younger than the average age when most women start getting mammograms, but I knew that my grandmother had breast cancer. It’s in my family history.”
Lee’s intuition may have just saved her life. Despite her young age, she was diagnosed with stage 1 breast cancer in April 2017.
She’s still battling it today.
Mammogram Guidelines
According to Dr. Arvind Mahatme, a breast surgical oncologist and the medical director of Mercyhealth Women’s Center-Rockford, the recommended age to start regular screening mammograms varies among governing organizations.
A common guideline is that women should receive screening mammograms annually from age 40 to 55, and every two years from age 55 onward. But Mahatme says this can vary based on the patient’s health as well as personal and family history.
“Ultimately, what’s most important is for there to be a discussion between the patient and their gynecologist or primary care provider, and that a mutual understanding of what’s best for that specific individual be defined,” Mahatme says. “Guidelines are meant to give us direction, but it oftentimes depends on how healthy the patient is and what their family history is.”
Mahatme tells his patients with a significant family history of breast cancer to begin screening mammograms 10 years earlier than the youngest family member diagnosed.
For example, if the youngest family member was diagnosed with breast cancer at age 40, then Mahatme would recommend that his patient receive annual screening mammograms starting at age 30.
“I think significant family history changes the baseline guidelines,” he says.
Kathi Bouland, a breast cancer nurse navigator at SwedishAmerican Regional Cancer Center, urges women to stay true to a plan created with a gynecologist or primary care doctor – no matter how hectic life gets.
“That’s the hardest thing – many times women have kids and a career, and they don’t always take time for themselves. But they need to do that,” Bouland says.
In the nine years she’s been a nurse navigator, her youngest patient was 21 and her oldest patient was 96.
“I think it’s important for people to be aware of their bodies, to know if they’re high risk, and to be compliant when it comes to getting mammograms,” she says.
“Don’t go five years without one. Don’t be too busy to take care of yourself.”
Bouland herself isn’t high risk for being diagnosed with breast cancer, but she still thinks it’s important to receive screening mammograms annually, rather than every other year, as some guidelines suggest. Especially since many cases of breast cancer aren’t linked to a family history of the disease.
“What bothers me about going every other year is that of all the breast cancers that are diagnosed, about two-thirds of them are sporadic, meaning they just happen; there’s no family history or genetic mutation,” Bouland says. “Some women have to weigh how they feel about it, but I encourage everyone to get annual mammograms. I think it’s the right thing to do because if you wait two years, the cancer might be at a larger stage.”
Kathleen Lee’s Treatment
When Lee found out that her mammogram looked suspicious, she tried to stay positive. She knew it was common to complete more testing after a first-time mammogram. Her radiologist couldn’t compare her results to any prior years of screenings.
Lee went to the Mercyhealth Women’s Center-Rockford for a breast biopsy, and within two days, she learned her diagnosis.
“I was driving with my son in the car when I got a phone call from a radiologist who asked where I was and if I had to be somewhere right then,” Lee says. “I pulled over and she told me I had breast cancer. It was shocking, but she also told me a personal story about a friend of hers who survived breast cancer and she told me how optimistic my outlook was. I was very hopeful that everything would be ok.”
Still, Lee was thankful to have her family for support. Her husband, Dan, and two teenage children, Collin and Airianna, helped her to stay strong during treatment.
Luckily, Lee’s cancer was caught early enough that she was able to have a lumpectomy, where just the cancerous portion of her breast was removed, versus a mastectomy, where the whole breast is removed.
After that, she had four rounds of chemotherapy.
“The chemo made my hair fall out, which was hard,” Lee says. “It also caused me to feel really sick and tired. The first week in particular, I was just so exhausted. I’m really glad that part is over.”
Before the end of the year, Lee will undergo radiation therapy to make sure the cancer is gone. She’ll have treatments every day, Monday through Friday, for six weeks.
After that, she should be done with treatment.
“I’m really hopeful and optimistic about it,” Lee says. “I like to have that attitude or else it can get very overwhelming.”
The People Who Cure Breast Cancer
As a nurse navigator, Bouland’s job is to educate patients about their specific cases of breast cancer and what their next steps are. Patients at the SwedishAmerican Regional Cancer Center typically need to see an oncologist, a surgeon and a radiation oncologist throughout their treatment. Bouland guides patients throughout the entire process.
“I’m the one who connects the dots and pulls all the pieces together,” she says. “Breast cancer treatment is really individualized, so I’m always there as a resource.”
Another part of Bouland’s job is to tell patients the news when they’ve been diagnosed. It’s never an easy conversation.
“I try to approach it in a manner that yes, this is breast cancer that we found, but there is treatment, we’ve come really far with breast cancer research, and most women live a normal life once they’re treated,” Bouland says. “Optimism yet honesty is very important.”
Since SwedishAmerican is a division of UW health, multiple medical professionals, including breast surgeons and genetic counselors, travel to Rockford from Madison to help treat patients.
“Since becoming a division of UW, we have more resources for our patients than we’ve ever had,” Bouland says. “I think treatment is only getting better.”
As a breast surgical oncologist, part of Mahatme’s job is to operate on patients who have breast cancer. In fact, he performed Lee’s lumpectomy about two months after she was diagnosed.
Mahatme says patients are very involved in making decisions throughout their treatment.
“Usually, there are four modalities of treatment: surgery, chemotherapy, antihormonal therapy and radiation,” Mahatme says. “Whether the patient needs all four really depends on the type of cancer, the extent of cancer and also what the patient wants done.”
Typically, if the cancer is noninvasive – meaning it is confined to the breast duct – surgery, antihormonal therapy and radiation are the main course of treatment. If the cancer is invasive, chemotherapy is often part of the treatment. With surgery, Mahatme tries to perform lumpectomies over mastectomies whenever possible to conserve the breast.
“It’s very individualized,” he says. “Whenever we have a new patient diagnosed, we discuss their case at a multi-disciplinary conference. So what happens is we have about 20 to 25 people in the room – medical oncologists, radiation oncologists, pathologists and others – and we rotate and review every single finding. We present how cancer was found, the genetic history, the physical exam, and we look at all the films and pathology slides, and as a group we put a plan together.”
Recently, the Mercyhealth Women’s Center -Rockford gained accreditation by the National Accreditation Program for Breast Centers, meaning it’s one of 500 programs in the world that meets about 30 parameters for treating breast cancer patients.
These parameters include establishing a leadership committee that oversees care; making sure lumpectomies are done rather than mastectomies whenever possible; conducting biopsies through image guidance versus excision; offering genetic services and physical therapy services, among other standards.
“It took us about two years to make sure all of these facets are present,” Mahatme says. “What does this mean to our patients? It means we’ve got a team of individuals who are dedicated to taking care of patients with breast cancer and that it’s done up to national and international standards.”
Lee’s Advice
Although Lee hasn’t heard the words “cancer free” yet, she’s hopeful she’ll end her breast cancer journey as a survivor and a stronger person.
“I know this is cliché, but having cancer really makes you realize what’s important in life,” Lee says. “I definitely do not sweat the small stuff. It’s just not worth it to let little things get to you.”
Lee advises women to know their health history and to ask their doctors any questions.
“Don’t be embarrassed or afraid to bring something up,” she says. “I’m really glad I spoke up when I did.”
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Screening for and Treating Cervical Cancer
Dr. Tamer Refaat Abdelrhman, a radiation oncologist, treats all types of cancer at the FHN Leonard C. Ferguson Cancer Center in Freeport, but he has a particular passion for treating cervical cancer.
After attending medical school, Refaat earned his doctorate degree in clinical oncology and nuclear medicine from the University of Alexandria, in Egypt. His thesis dealt specifically with cervical cancer research.
“I treated 40 cervical cancer patients with radiation therapy and monitored them for at least three years,” Refaat says. “My thesis showed that survival was 100 percent with this treatment. The data were published in 2014 after the thesis was defended in 2011.”
Women with cervical cancer oftentimes experience fatigue, vaginal bleeding and/or discharge and pain during intercourse, Refaat explains. That’s because cancer cells in the cervix are dividing rapidly, leading to abnormal growth, local symptoms and regional symptoms.
However, this doesn’t just happen overnight.
“It takes time to develop,” Refaat says. “The normal cells gradually change into pre-cancerous cells. It can take several years to change into cervical cancer. The earlier you seek medical advice, the faster the care, the better the treatment outcome.”
The easiest way for women to prevent and early detect cervical cancer is to regularly see a gynecologist for a Pap test, Refaat says.
If cervical cancer does occur, concurrent radiation therapy and chemotherapy should be the standard for treating bulky cervical cancer – a more advanced form of the disease.
“This not only decreases the likelihood of recurrence, but it prolongs survival,” Refaat says. “This treatment also improves the patient’s quality of life compared to combined surgery and radiation for bulky and advanced cervical cancers. Typically, cervical cancer is treatable as long as it hasn’t spread to other organs.”
As a radiation oncologist, Refaat uses high-energy beams to kill cancer cells. This may be delivered outside the body from external beam radiation or internally with brachytherapy – where radioactive implants are inserted directly into the tissue, or in proximity of the tissue. But first, a patient must undergo a CT scan to optimally evaluate the location and extent of the cancer. Then, the exact radiation dose is calculated accordingly.
“In general, cervical cancer patients come in five days a week for five weeks to receive external beam radiation therapy, which is followed by four to five brachytherapy treatments,” Refaat says. “We can use 3-D image guidance to focus the radiation on the tumor itself and spare nearby organs.”
Refaat additionally urges parents to make sure their daughters age 11 to 12 receive a vaccination for human papilloma virus (HPV). Infection from HPV is the most common risk factor for cervical cancer and is linked with multiple other cancers, he adds.
“HPV is very difficult to eradicate, so vaccination is very important,” Refaat says. “Also, I can’t emphasize enough the importance of regular screening with a gynecologist. It’s very easy, and it might save your life.”