It's October. That time of year when I once again remind ladies to
I know some women find them painful. Believe me. I hear it all the time. But a mammogram isn't nearly as painful as breast cancer. Trust me on this.
In June 2007, I had my screening mammogram. My friend and sister mammographer, Linda, "squeezed" me in after we'd finished our patients for the day. This was back when our hospital still had film screen, so the x-rays dropped from a processor. I pulled the curtain in the tech area and was standing in front of the view box in my pink floral cape when Linda began hanging the films. The Left CC (cranial-caudal--the film taken from the top of the breast) fell from the processor first. It looked fine. No different from the year before. Then the Right CC fell out. It looked--different from the mammogram I'd had 18 months earlier.
Yes, I was 6 months late getting my mammogram, but I had no pain, no lumps, no family history, and no reason to be concerned. Until I saw that Right CC. There, next to my chest wall on the inside of my right breast was a star-shaped lesion with a large calcification in the center. That same lesion was evident on the RMLO (right medial-lateral obligque image--the one taken from the side.) But it was the Friday before Father's Day and the radiologist had already gone home. So, I had all weekend to worry about that lesion. And suddenly, I had a BIG reason for concern. I'm not a doctor or radiologist, but I'd seen enough mammograms and enough cancers in my time to know that lesion didn't look good.
On Monday, the radiologist ordered additional images and an ultrasound. I had those procedures the following Friday. And the Friday after that, I had a biopsy. The results came back July 3, 2007. I had breast cancer. Stage 1, but on the cusp of being Stage 2 because the margins weren't clean and the cancer had a high proliferation rate...which meant is was aggressive and growing fast. I had DCIS (Ductal Carcinoma Insitu- an early cancer that is still contained in the ducts) and an invasive ductal carcinoma--a cancer in the duct that has spread to the surrounding tissue. And it was triple negative.
Triple-negative breast cancer doesn't express the genes for estrogen receptor (ER), progesterone receptor (PR) or Her2/neu. Prognosis for Triple Negative breast cancer is the same for other breast cancers at the same stage, but more aggressive treatment is require to achieve that prognosis.
Some types of triple negative breast cancer are known to be more aggressive with poor prognosis, while other types have a prognosis similar to or better than hormone receptor positive breast cancers. Studies of triple negative breast cancers suggest that with optimal treatment, 20 year survival rates are close to those of hormone positive cancer.http://en.wikipedia.org/wiki/Triple-negative_breast_cancer
Although my cancer was Stage 1, I had a lumpectomy where more tissue was removed from the breast to ensure "clean" margins and I had to have a lymph node biopsy to prove the cancer hadn't spread beyond the breast. Four nodes were removed and all four were negative. But because of my triple negative status, I had to have chemo and radiation. I had the chemo first.--two chemo drugs, Adriamycin and Cytoxan once every other week for eight weeks. Then after an MRI to prove there were no more lesions or DCIS, I was given the choice of a mastectomy and radiation, or radiation treatments five days a week for 6 weeks.
I chose to keep my breast, which meant mammograms every six months for 3 years and yearly MRI's for three. To this day, there are times when I second guess my decision to keep my breast. But, had I chosen a mastectomy, I'm sure I would have second-guessed that decision as well.
Triple negative breast cancer has a different recurrence rate and pattern than hormone-positive breast cancers. The risk of recurrence is much higher for the first 3-5 years but drops sharply and substantially below that of hormone-positive breast cancers after that.
On December 12 of this year, it will be five years since my last radiation treatment. I will officially reach the five year mark and my personal risk of a recurrence will drop to that of someone with hormone positive breast cancer. Which isn't to say that I'm no longer at risk, but by God, I still think I have a reason to celebrate!
If she claims she doesn't need a mammogram because she isn't having any problems, remind her that most breast cancers are silent and painless. By the time a woman feels a lump, she already has an active disease.
Remind her that if she has extremely dense breast, a mammogram can miss a lobular carcinoma hiding within the glandular tissue. So, if she feels a lump and the mammogram is normal, she needs an ultrasound and possibly a biopsy.
If she claims she doesn't have a family history of breast cancer, remind her that 70% of all NEW breast cancers are in women with no family history.
Hey, someone in the family has to be the first to screw up the gene pool. In my family, I was that person.
Although breast cancer is rare in women under 40 and the risk increases with age, no woman who has breasts is immune. That includes trans-gendered women.
Are you at risk? Check out the breast cancer assessment tool.
And for more information on breast cancer, please visit http://www.cancer.org/Cancer/BreastCancer/index?ssSourceSiteId=null