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PrintGlad I Got Screened!
Ava Clark is a succ ess story in proactive health care. When her breast malignancy appeared, it didn’t stay undetected for long. By getting regular recommended screening mammograms, the Peekskill resident made it possible for doctors to spot her cancer very early and cure her of the potentially life-threatening disease.
Clark, 54, a certified nurse’s aide, is a single mother of two daughters, ages 23 and 25, with a new grandson born in August. She has a family history of cancer—one sister developed breast cancer, another uterine cancer. (The sister with breast cancer has since died, but not from that disease.) “Because of my sisters, I knew I had to keep an eye on the possibility of cancer,” Clark says. “And I’m glad I did.”
She began having annual mammograms around age 43. “I always stayed on top of my annual physical exams and self-exams,” she says. Her mammograms were performed at a community hospital until last year, when she switched to Westchester Medical Center. In March 2011, when Clark had her most recent screening mammogram, Julian Sanchez, M.D., the Medical Center’s Director of Breast Imaging, spotted something on the X-ray image.
“There was something that looked potentially suspicious, but we needed to compare it with previous images to be sure,” Dr. Sanchez says. Often there are spots on the film called calcifications that are benign and don’t change from year to year, he says. Fortunately, Clark was able to gather film from her five most recent mammograms—“I got them at the community hospital and drove them down to Westchester myself,” she says.
Dr. Sanchez’s suspicions were confirmed. “It turns out the masses I’d seen had not been there in the older mammograms,” he says. He recommended a biopsy of the area, and the pathology test diagnosed ductal carcinoma in situ (DCIS), one of the two types of stage 0 noninvasive breast cancer.
In DCIS, abnormal cells are located in the lining of a breast duct, one of the tiny tubes that carry milk from the lobule to the nipple. The “stage 0” rating—the least dangerous—means the cells are fully contained within the ducts (thus the phrase “in situ”). The American Cancer Society cites five-year survival rates of 93 percent or higher for patients whose breast cancer was found at stage 0.
“Ava’s diligence with regular mammograms really paid off,” Dr. Sanchez says. Clark was concerned, of course. “But I knew this cancer wasn’t a death sentence,” she says. “There was hope, and I was in the right hands.” Those hands belonged to Kathryn Spanknebel, M.D., Chief of Surgical Oncology, who cared for her.
“Our next step in cases like this is to determine the extent of cancer in the breast and to make sure no other cancers in either breast have been missed by the mammograms and ultrasounds, so we ordered an MRI [magnetic resonance imaging] scan,” says Dr. Spanknebel. That scan did in fact find a second suspicious area in the same breast, but a biopsy of that growth determined it was noncancerous.
There are several treatment options for DCIS. “We believe this cancer evolves, but we are not sure about the pace of these changes,” Dr. Spanknebel says. “Some cases probably evolve faster than others. Advocates of early treatment say that any DCIS poses a danger, while others say the condition sometimes doesn’t spread. Until we know which cases are dangerous, we aim to diagnose and treat them all early and completely.”
Some women opt for a full mastectomy, but because Clark’s DCIS was contained in a small area of the breast, she was eligible for a breast-conserving procedure, or lumpectomy, followed by radiation treatment. Breast cancer surgery can be combined with reconstructive surgery, and Clark decided to undergo both of these at the same time—a specialized approach called “oncoplastic surgery.” “Given the location and size of her tumor, the shape of the breast and Ms. Clark’s cosmetic goals, we performed the surgery using plasticsurgery techniques—a type of breast lift,” Dr. Spanknebel says. She did the lumpectomy first, and then plastic surgeon Matthew Schulman, M.D., completed the breast lift.
“It looks great,” Clark says. “They did a wonderful job.” Her surgery was followed by about 25 sessions of radiation treatment. “If, after those treatments, she elects to have surgery to make her breasts match more closely, she is already established with a plastic surgeon who knows her case,” Dr. Spanknebel says.
That multidisciplinary continuity of care is a big plus for patients. “Everything is under one roof here,” says Dr. Sanchez. “Nothing gets lost, patients become familiar to the staff, and everybody here becomes like a friend.” “Whenever I come in,” Clark adds, “it’s ‘Hello, Ms. Clark!’ And I know all their names too. They all talked and walked me through every procedure, held my hand, wiped my tears and were very supportive.”
It’s important for breast cancer patients to be treated at a fully integrated breast care facility like the one at Westchester Medical Center, the doctors say. But the best way to beat breast cancer is to find it early by following screening recommendations, as Clark did. That’s why Dr. Sanchez calls her “our poster child for the fact that breast cancer screening saves lives.”
MAMMOGRAPHY’S A MUST
If you’re a woman age 40 or older, consult with your doctor about what schedule of mammography breastcancer screenings is best for you.
It’s true that while all authorities recognize the value of mammograms, different groups have different recommendations for when to start getting screened—and how frequently to be screened in the early years. Insurance companies also differ in how early and at what frequency they will cover the scans. (Of course, if you have a family history of breast or other cancers, this is something your doctor should know—and it may mean that a more aggressive screening schedule is warranted.)
But don’t let these details obscure one central fact: Evidence has repeatedly shown that mammography is a woman’s best protection against breast cancer. A December 2011 study in the journal Cancer Epidemiology, Biomarkers & Prevention, for example, found that women who get routine mammograms can cut their risk of dying from breast cancer nearly in half.
Related Read: Total Care for Women
