Your mammogram comes back with the report that a small area of one breast needs a closer look. You're not worried yet, but your doctor wants you to schedule another mammogram and an ultrasound. You get rescreened and are told that the spot in question needs to be biopsied. Now you're worried. The biopsy is performed and you get the phone call — the test results are positive. You feel like you've been slammed in the gut with a sledgehammer. You have breast cancer.
Now what? Do you stay here and seek treatment? Should you head to a big city with a world-famous cancer center? You could. But you don't have to. The breast cancer care in Southern Oregon is first-rate.
"We have excellent outcomes for breast cancer patients in our area," says Susan Kilbourne, an oncology-certified nurse and director of cancer services at Asante Rogue Regional Medical Center in Medford. "Patients whose breast cancer is detected in very early stages have much better outcomes and survival rates. Stage I and II cancer patients' five-year survival rates are often above 98 percent."
As a mammography technologist and coordinator for the Leila J. Eisenstein Breast Center at Providence Medford Medical Center, Nicole McPheeters is well aware of the importance of yearly screening for breast cancer. That's why she decided last year to get her baseline mammogram at 35, even though she has no family history of breast cancer. Her decision most likely saved her life.
She had planned to be a surrogate for a couple and was already taking hormone supplements to prepare for the pregnancy when she had the mammogram that showed something suspicious. Further testing showed it to be malignant. "The hormones from pregnancy would have made this grow like wildfire," she says of the cancer.
Even though cancer was found in only one breast, McPheeters opted to have a double mastectomy. She had decided before she even had breast cancer that, should she ever get it, she would have both breasts removed. It would keep her from worrying about getting cancer later in the unaffected breast and having to go through the process all over again. "I'm a proactive person," she says. "I wasn't going down that road again."
Because the cancer was caught early, the mastectomy was all she needed for treatment. "I didn't have to do radiation or chemo," she notes. Even if she had to have more extensive treatment, she would have stayed at Providence rather than going to a larger cancer facility. "I have a lot of confidence in the people who work here," she confirms.
She encourages women to get yearly screenings. "I really do believe in the value of mammography," she says, adding that women who can't afford mammograms can seek help through Providence's Sister Therese Kohles Fund. "There's no reason not to get a mammogram."
Knowledge equals power
Megan Frost, a surgeon at Asante Three Rivers Medical Center in Grants Pass, says there are typically two groups of women in any given community. There are those who get their breast exams and mammograms regularly and there are those who don't. The women in the first group are the ones who have their cancers detected in the very early stages of development, which can make for a positive treatment outcome. "Fortunately, they are the majority of our patients," Frost says. Women in the second group seek medical help when the cancer is in its later stages. "Luckily, they are few and far between," she notes.
The surgeon credits education campaigns by the health care community that make women aware of breast exams and mammograms that can catch cancer early and breast cancer risk-assessment counseling.
According to the Oregon State Cancer Registry, between 2001 and 2010, there was a 14 percent decrease in female breast cancer mortality rates in the state. Early detection is the reason, Frost emphasizes. "Mortality has gone down because we are finding breast cancer earlier," she confirms.
"Digital mammography is still considered the gold standard," says Kate Newgard, oncology nurse navigator at Providence's breast center, regarding different screening techniques.
And if caught in the early stages, the medical care for cancer can be very specific. "We're working on spot-on treatment," Newgard says. "Because mammography has gotten so much better, we're seeing early-stage cancer sooner."
With tests conducted on biopsied tissue, doctors can learn specific characteristics about the breast cancer and follow the best course of treatment for that cancer. Today, small, early-stage breast cancer might be treated with a lumpectomy, radiation and anti-hormone drugs, whereas 20 years ago, it might have been treated with a mastectomy and systemic chemotherapy.
Newgard also assesses women for breast cancer high-risk factors, which are mainly based on family history. Factors include a family member under the age of 50 with breast cancer, a family member of any age with ovarian cancer and multiple family members who've had breast cancer. Providence's breast center offers free risk-assessment counseling. If a woman meets the criteria for possible BRCA 1 and BRCA 2 gene mutation (see Understanding the terms), she is called for follow-up testing at the center.
Asante also offers free breast cancer risk-assessment counseling through its Breast Oncology Nurse Navigators in Grants Pass and Medford.
Research and case studies
The Southern Oregon Cancer Research Institute is a partnership between Asante and Providence Medford Medical Center. The institute is staffed by oncology-certified clinical research registered nurses and is supported by local oncology physicians, Oregon Health & Science University Knight Cancer Institute, UC Davis Comprehensive Cancer Center and the local health care community. The institute participates in national and regional partnerships to provide access to clinical trials to the people of Southern Oregon and Northern California. Through these partnerships, the institute is able to offer patients participation in trials from National Cancer Institute-sponsored cooperative groups.
The hospitals also have a breast cancer committee made up of health care professionals including oncologists, surgeons, pathologists, radiologists and nurse navigators that meets every two weeks to discuss breast cancer cases. "It's a multidisciplinary committee all involved in treatment," Newgard says. "It creates communication, collaboration and the best patient care."
Frost concurs, saying the multidisciplinary team produces a specific treatment for each case. "There's no easy formula," she says. "Truly, each patient is unique."