This patient paid attention to the breast cancer warning signs
Linda Steele was always diligent about her health.
She ate well, got plenty of exercise and had annual mammograms for more than 25 years.
But at age 51, she got in the shower after a 20-mile bike ride and felt a “good-sized” lump.
“And what was strange, I just had a mammogram just a month or couple months prior and it was clean,” said Steele, now 64 and the manager at the Cape Cod Five Cents Savings Bank in Mashpee. “And the next day, I went to the doctor, my gynecologist at the time. And they got me right in for another mammogram. And sure enough, there was something there.”
The lump, which was about an inch, turned out to be Stage 2 cancer.
“I was really frightened – and very angry! Suddenly, I am told that I am no longer healthy anymore,” she said. “I thought I was living a healthy life with eating right, exercising – and suddenly a scan is telling me that has changed.”
Steele’s fear and anger is hardly rare. More than 300,000 women in the United States -- about one in 8 women -- are diagnosed with some form of breast cancer annually. Her case is a reminder that even with annual mammograms, women and their doctors need to be vigilant, particularly if, like Steele, they are at greater risk because of factors like family history or dense breasts. Steele had a benign tumor at 24 -- the year she started having annual mammograms.
But Steele also is an example of how changes in attitude, as well as risk assessment, surveillance, screening technologies, and surgery techniques have affected breast cancer treatment in the last several decades, said Peter Hopewood, MD FACS, a Cape Cod Healthcare surgeon at Falmouth Hospital.
“You know these are things that a previous generation would never talk about at all,” Dr. Hopewood said. “They keep it quiet, try to hide it. And because of that, people weren't getting screened. They weren't getting mammograms.”
These days, the American Society of Breast Surgeons, American College of Radiology and the Society of Breast Imaging, recommend annual mammography at 40 for women at average risk of breast cancer, said Jill Oxley, MD FACS, a Cape Cod Healthcare breast surgeon based in Hyannis. They also recommend annual MRI screening for women who have a calculated lifetime risk greater than 20 percent based on factors like breast density, genetics, family history, weight and lifestyle. Healthcare should include regular clinical breast exams by a woman’s primary care physician or gynecologist. And, doctors say, women should be “breast aware” of what’s normal -- or not -- for their own bodies. In Steele’s case that paid off and her cancer was caught in time to save her breast.
After seeing Steele, Dr. Hopewood recommended that she have a lumpectomy -- meaning he would remove only the lump and some surrounding tissue -- followed by chemotherapy and radiation. She got a second opinion and was advised to have a mastectomy, which would have meant removal of her entire breast. But she felt confident in Dr. Hopewood’s decision and explanations. He allayed her fears and built her confidence.
“Dr. Hopewood was great. He just made me feel like I could do it,” Steele said.
Breast surgery has changed significantly in the last generation, Dr. Hopewood said. He estimates that 70 percent of the breast surgeries he now does are lumpectomies. And some noninvasive cancers, particularly those that are estrogen receptive, can be treated without any surgery but with medication or “active surveillance,” he said.
“We have some women now we're putting in active surveillance because they'll have noninvasive breast cancer that looks low-grade that we can monitor. Or, we put them on some hormone blockers to see if we can shrink them,” he said. “I have a group of women in their late 80s and 90s that we have on hormone blocker pills instead of doing surgery for their breast cancer.”
Other women might receive neoadjuvant or pre-operative systemic treatment before surgery to shrink the tumor and “convert them from a mastectomy to a lumpectomy,” Dr. Hopewood said. “So they don't have to do radical operation. We save doing a full lymph-node dissection and minimize the risk of getting lymphedema.”
Steele was very grateful that she only needed a lumpectomy and that her surgery, four months of chemotherapy and two months of radiation, were all available close to home.
“I could do that right here on Cape Cod and that was huge, because I was pretty sick with chemo, and being able to just have everything addressed right here was very helpful,” she said.
Her advice for other women?
“Well, words of advice would be of course to be vigilant; do self-exams on a regular basis and have yearly mammograms,” she said. “What really got me through this was the ability to reach out to a community of women who had been through breast cancer and offered me support throughout the treatment process. I think it is important to support each other and know that we are all part of a bigger community. We are in this together. I cannot imagine going through something like this alone. I am always happy to pay it forward and talk with anyone who may need support during cancer treatments.”