Early detection is still key
TAMI BICKLEY
Staff Writer
Jill Rose has some advice for other women: conduct monthly breast self exams; schedule annual mammograms; and, most importantly, if you find something that shouldn't be in your breast, have it removed.
Rose is not a doctor, but rather her message carries the weight of her own experience as a victim of breast cancer, and now, a survivor. At 49, Rose looks back on the past year as a time of mixed emotions, worries and triumphs that she never wants to re-visit. She also doesn't want other women to endure the physical and emotional toil of the disease, and she says that if women take charge of their health as she did, they, too, stand a good chance of beating one of the top killers of women over age 40.
A Scottsdale wife and mother of one child, Rose discovered a lump in her breast during a routine self exam in November 1998. She made an appointment with Breast Net, a team of doctors who specialize in breast health in the Valley, and Gabriel F. de Freitas, a surgical oncologist who specializes in diseases of the breast at Breast HealthCare Associates in Phoenix.
After an initial mammogram that didn't show anything abnormal, de Freitas performed a core biopsy, or needle biopsy, on Rose, in which a needle is inserted into the breast, and a plug of tissue is removed from the area in question. Tests performed on the tissue showed that Rose had a tumor, the kind that rarely shows up on a mammogram. Rose notes that if she had not discovered the lump through self examination, she may not be alive today.
De Freitas removed Rose's tumor and infected lymph node. All told, Rose underwent four months of chemotherapy, seven weeks of radiation and two surgeries. Through it all, she says, she refused to alter her life. She continued to run seven miles a day, occasionally climbed Squaw Peak, worked out with a trainer and worked full-time as part owner of H2O Rentals, a water purification company.
"I did really well with this," Rose says. "I kept saying to myself, 'You have everything in the world to live for; you will not give into this.' "
Now that Rose has been declared free of cancer by her doctors, she is thankful that she still has two breasts. Rose underwent a lumpectomy, a surgical procedure in which only the affected area of the breast is removed, rather than a radical mastectomy, in which the entire breast is removed. According to de Freitas, mastectomies are overused, and he does them only as a last resort.
"I advocate saving the breast when it is medically safe to do so," he explains. "For those patients on whom we do perform mastectomies, we prefer to do immediate reconstruction on them."
In some cases, de Freitas removes the interior portion of a breast and leaves the outside skin intact, he says, which is called a skin-sparing mastectomy. In this procedure, an expander (a temporary implant filled with saline) is placed under the muscle behind the breast. For several weeks afterward, the expander is "pumped up" at the doctor's office. When the breast is completely healed, the expander is replaced with a permanent implant.
"This helps to take away the horrible fear women have that they will be mutilated," says de Freitas. "It should be done more commonly."
He sees promise in a medical advancement in breast-cancer prevention - the drug Nolvadex, also known as tamoxifen citrate. Recently approved by the FDA for breast cancer prevention, it is already the most commonly used prevention drug worldwide, used by more than 10 million patients, says de Freitas.
A prevention trial by the National Cancer Institute using women at high risk for the disease proved that the drug can prevent breast cancer in 50 percent of cases when prescribed to women age 35 or older who are known to be at high-risk. Tamoxifen is an estrogen drug, and therefore, also can reduce the risk of fractures and lower cholesterol. On the other hand, it can increase the risk of stroke, deep vein thrombosis and has been shown to increase the chances of endometrial (lining of the uterus) cancer.
People who are particularly at risk for developing breast cancer, according to de Freitas, are women who: are age 50 or older; have a family history of breast cancer; have early onset of menstruation or late menopause; and/or have had no children by age 35.
Risk factors aside, early detection can make all the difference in one's fate when dealing with breast cancer. De Freitas says that as challenging as it is to convince women of this, it is a particularly difficult message to spread to men.
"Males are macho and don't want to deal with it," he says. "I have seen 13 breast cancers, or gyneecomastias (lumps in the breast region), and they were all men who came in late and had had it for a year or two. By then, it's already spread, and the cure rate is low."
It is estimated by the American Cancer Society, according to Phoenix Memorial Health System, that nearly one-third of breast cancer deaths could be prevented if women ages 20 to 39 would conduct monthly self exams and have a clinical exam every 1-3 years. Women age 40 and older should receive annual mammograms. A baseline mammogram should be taken at about age 35.
Some signs and symptoms to watch for, says de Freitas, are: a lump or thickening in the breast; swelling or dimpling of the breast; distortion or change in breast shape; a change in breast vein patterns; nipple changes, such as crusting, discharge, rash, retraction, tenderness or ulceration; and skin changes on the breast, such as redness or scaliness.
Survivors, such as Rose, are proof that taking the time to notice changes can be life saving. Rose says now she is ready to continue her life with her husband, Neil, and daughter, Stacy, knowing that with her firsthand knowledge, she can talk to other women, and help them save their own lives, as well.
"Self awareness is the key," she says. "When I talk to women who say to me, 'I haven't had a mammogram in five years,' I go nuts. ... Yes, when I was diagnosed, I was frightened. But you can choose to live your life in fear, or you can choose to go on. It's much healthier to just go on."
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