When Debbie Innis was diagnosed with breast cancer this past January, she had just one thought to herself.
“Why did you skip your last two mammograms?” she recalled.
Innis’ family history has a lot of cancer, none of it breast, which is why she “religiously” schedules colonoscopies. Even though she works at Baptist Hospital as an operating room nurse her yearly mammogram slipped her mind—twice. As soon as she realized, she did a self-examination.
“I reached over and I knew it was cancer,” she said. “It was that quick.”
One in eight women will be diagnosed with breast cancer at some point of their lives. Yes, breast cancer research has made leaps and bounds in recent years and the survival rate is 93 percent for stage 0 patients, but it doesn’t ease the minds of those women and their families about what to expect.
The Waiting Game
Not all tumors are diagnosed as quickly as Innis’. If your yearly mammogram ends in abnormal results, your doctor will run the least invasive tests first to investigate such as a diagnostic mammogram or ultrasound and then biopsy that area.
“The denser breasts—more tissue area—are harder to identify; they might also want to do an MRI,” said Nutan DeJoubner, oncologist with Baptist Medical Group.
Diane Lindemann was adamant about her yearly mammograms when she was diagnosed with breast cancer in July. Alongside the stress, the fear of the unknown, biopsies and surgery she says waiting was the hardest part.
“It was scary—very scary,” she said. “Waiting was very difficult.”
Once a tumor is found to be malignant, or cancerous, the speed picks up, which can add to the stress and fears that lie with cancer treatment.
“After the biopsy is read by a pathologist and found to be malignant, the patient is referred to a surgeon that same day,” said Patrick Dial, general and oncology surgeon at West Florida Hospital.
Mastectomy vs. Lumpectomy
One of the most common questions doctors hear from breast cancer patients is “Will I lose my breast?” With the progress of medical technology and early detection, women don’t always have to worry.
“It used to be, ‘Everybody has to have a mastectomy,’” Dr. Dial said. “Now you can pretty much tell a patient they don’t need a mastectomy. We shrink the tumor to where you only have to do a lumpectomy.”
Instead of a mastectomy—surgical removal of the breast and lymph nodes—a lumpectomy is when the cancer is removed with a rim of normal breast tissue with or without lymph node removal.
“Studies have shown that survival and risk of recurrence are comparable when done in the setting of a small tumor,” Dr. DeJoubner said.
For younger women or women that carry the BRC 1 or BRC 2 gene, recurrence rate is higher and a mastectomy may be recommended.
“Say you have a patient who is under the age of 35, recurrence is fairly high,” Dr. Dial said.
Women who test positive for the BRC1 gene have a 60 to 90 percent chance of developing breast cancer and with BRC2 is a 40 to 85 percent chance.
“If you test positive for the genes it’s recommended you have a bilateral mastectomy, which is removal of both breasts,” Dr. Dial said.
Often times, regular testing helps to avoid breast cancer and surgery all together.
“The biggest impact on survival is early detection,” Dr. Dial said. “That’s why women need to start screening at age 40. It’s lent itself to less surgery which equals better care and survival.”
Another thing that doctors test is the hormone receptors in breast cancer cells.
“The female hormone estrogen is known to stimulate the growth and development of breast cancer,” said Dr. DeJoubner. “It does so through receptors found on the breast cancer cells called estrogen receptors (ER) or progesterone receptor (PR).”
If these receptors are found in breast cancer cells, hormone therapy is used to block the hormones from their receptor to inhibit growth effects on cancer cells.
Both Lindemann and Innis had lumpectomies. After waiting for diagnosis and going through with radiation and/or chemotherapy after surgery, the surgery itself seems to be the easiest part.
“My surgery was amazing,” said Lindemann. “Oddly enough, it was an in-and-out procedure.”
Feeling “normal” before, during and after cancer is important. To wear a wig or opt for breast reconstruction is not vain. In fact, reconstruction is covered by insurance.
“It’s important that it’s available if they want it,” Dr. Dial said.
After surgery a patient will undergo radiation and/or chemotherapy.
“The treatment for cancer is more like personalized medicine,” said Dr. DeJoubner. “It is not only based on the cancer type but also on patient preference and so, one patient may be treated different from the other.”
Chemotherapy is the use of drugs to kill cancer cells to decrease the chances of recurrence. The drugs may be administered by mouth or injection through IV needles. Chemotherapy is usually given in cycles and can be as short as a few months or as long as two years.
“The treatment generally depends on the patient’s age, menopausal status, the stage of cancer, the risk for spread or recurrence and the patient’s general health,” Dr. DeJoubner.
Innis started chemotherapy in February and ended in July.
“It will knock you in the creek,” she said. “Everything else wasn’t bad.”
Chemotherapy patients may experience nausea, vomiting, loss of appetite, diarrhea, constipation, fatigue, infections, bleeding, weight change, mouth sores, and throat soreness.
“Some of these problems may continue for some time after chemotherapy ends,” said Dr. DeJoubner. “Some drugs cause short-term hair loss.”
As hair does grow back some time after treatment, Innis points out—with a laugh—that it doesn’t always look like your hair when it comes back.
“It’s growing back in a real funny way,” she said. “But some hair is better than no hair. I’m lucky I wear a hat to work.”
Radiation uses radiation particles, like X-Rays, to treat cancer and it is most commonly used to treat breast cancer after surgery.
Lindemann is about halfway through her radiation treatment.
“It’s nothing that’s lengthy,” she said. “It only takes about 15 minutes from the time you go in and come out. And you go five days a week.”
She’s often tired, but that could be from her job as a ninth grade teacher at Pensacola High School.
One way that cancer treatment has changed throughout the years is the addition of care. Patients just don’t see doctors and radiologists. They may be assigned to a social worker and a patient educator and navigator. There are also more support groups than ever addressing the very important fact that cancer affects more than a patient’s physical health, but their mental health, too.
“Being diagnosed with cancer prompts immediate emotions, which can come like a total wave over patients and families,” said Blair Edgar, oncology social worker at Sacred Heart Cancer Center. “Fear, anxiety, sadness and even anger are the first emotions many cancer patients and families experience and it can be very overwhelming.”
Edgar helps patients and families understand, overcome and cope with the challenges they face as well as helping access cancer information and resources.
“We work with the entire family of a cancer patient because it is a family disease,” Edgar said.
As well as a wave of emotions, cancer patients have a lot of information thrown their way. Family members and caregivers are encouraged to go to appointments to help process important information, but there’s also a patient educator there to help.
“When you hear your spouse has cancer, you’re hearing maybe 90 percent of what the doctor is saying,” Lindemann’s husband Dan said. “You’re like a deer caught in headlights.”
Beth Matthews, patient educator at West Florida Hospital explains every aspect of cancer care that the patient will receive. As a registered oncology nurse, Matthews is well-informed about questions a patient might have such as dietary needs or the side effects that they may face from chemotherapy. She also becomes a friend to these patients.
“They tell me things they wouldn’t share with anyone else—their fear of death, family problems or financial problems,” she said as she started to cry. “I love what I do. We are here because we love what we do. When you see the gratitude in their eyes, as a patient becomes my sister and my friend—you become validated.”
Both Edgar and Matthews help caregivers and families manage their own stress and teach them how to care for the patients at home. Innis and Lindemann note they are blessed with caring families who have supported and continue to support them through care.
“You learn to listen,” said Dan. “Sometimes, it’s better to not say anything and just give a big hug. Be as attentive as possible, be at the meetings, just be there.”
You don’t have to have the answers—just making your patient smile can make a difference.
“You have to allow people to help,” Innis said. “My husband was awesome. All of my friends and family did everything they could to cheer me up.”
“Keeping a sense of humor has been our saving grace,” said Lindemann. “Laughter is a great medicine.”
DR. NUTAN DEJOUBNER
WHERE: Baptist Medical Towers 1717 North E St. Tower 3, Suite 231
Ciano Cancer Center (Behind Gulf Breeze Hospital) 1114 Gulf Breeze Pkwy.
DR. PATRICK DIAL
WHERE: 2130 E. Johnson Ave. Suite 140
WHERE: 1545 Airport Blvd. Suite 2000
Mobile Mammography Unit
Scheduling your yearly mammography is easier now than ever. You can make your appointments online, sign up for mammography reminders or wait for West Florida Hospital’s mobile mammography unit to come to you. Here’s a list of upcoming dates and times.
October 25 – 8 to 11 a.m.
Office of Dr. Gordon Couch, Bayou Corporate Center, 4900 Bayou Boulevard, #104
October 29 – 7 to 11 a.m.
West Florida Immediate Care, 2360 U.S. Highway 29, Cantonment
October 29 – 12 to 3:00 p.m.
Cantonment Medical Center, 748 N. Highway 29, Cantonment
October 30 – 8:00 a.m. to 12:30 p.m. & 1 to 3:30 p.m.
West Florida Medical Group, 3521 Limbaugh Lane, Pace
October 31 – 8:00 a.m. to 12:30 p.m. & 1 to 3:30 p.m.
West Florida Medical Group, 321 S. Fairfield Drive
November 1 – 2:30 to 6:30 p.m.
Moorings Apartment Complex Clubhouse, 8491 Old Spanish Trail