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.
Based on data collected between 2003 and 2006, showing outcomes from 2003 through 2011:
• 824 reported cases of breast cancer
• 89.3 percent overall survival rate
• 85.5 percent the national overall survival rate during same period
• 363 of the reported cases were Stage 1 at diagnosis, the earliest invasive carcinoma stage
• 92.2 percent of patients diagnosed locally at Stage 1 survived at least five years, identical to the national average for the same period
-Source: National Cancer Database
Current guidelines recommend that women receive annual mammograms starting at age 40 — even if they have no symptoms or family history of breast cancer. You might be eligible for a free mammogram if you are uninsured and cannot afford one.
For women who qualify for vouchers, Asante Imaging in Medford and Asante Women's Imaging in Grants Pass can provide mammograms at no charge through the Connie Fiske Memorial Fund and Asante Rogue Regional Screening Mammogram Fund. For more information, call 541.789.6150 in Medford or 541.955.5446 in Grants Pass.
Established by the Providence Community Health Foundation, the Sister Therese Kohles Fund is a charitable mammography fund administered by the Leila J. Eisenstein Breast Center. For more information, call 541.732.6100.
When it comes to checking for breast cancer, a screening mammogram is the first imaging exam ordered. If something looks suspicious, a diagnostic mammogram and ultrasound imaging typically come next. If the problem looks like cancer, a breast MRI and an MRI-guided breast biopsy will probably be called for. If that's what you need, Oregon Advanced Imaging (OAI) has got you covered.
"We started doing breast MRIs in the early '90s," says Tom Organ, executive director of OAI. "The technology is getting better and better."
OAI, a joint venture operated by Medford Radiological Group and Providence Medford Medical Center, specializes in MRI and PET-CT procedures.
MRI scans of the breast are painless and produce highly detailed, cross-sectional pictures of the breast with a tremendous ability to differentiate subtle tissue-type variances within the breast. Breast MRI is the ideal way to look for cancer, according to Organ. A contrast liquid is injected into a vein in the arm to enhance the anatomic details and outline the structures within the breast.
During a breast MRI, the patient lies on her stomach on a comfortably padded platform with specially designed spaces for her breasts. She must remain very still during the exam, which can take up to an hour. OAI's scanners are designed with breast MRI in mind and have a much wider scanner bore that affords considerably more space for enhanced patient comfort during the hour-long exam, Organ says.
Mack Bandler, a radiologist with Medford Radiological Group and OAI, reemphasizes that breast MRIs are used mainly after the initial screenings using mammograms and ultrasound imaging. MRI gives doctors a better image if an area needs clarifying and better data to make decisions on how to proceed with treatment. "We will use it when we are problem-solving," he says.
Bandler also concurs with Organ that women who are at high risk for breast cancer - women with a family history of breast cancer, have the BRCA gene mutation or have dense breasts - will benefit from MRI imaging.
The next advancement in breast imaging is breast tomosynthesis, according to Bandler. The U.S. Food and Drug Administration approved it in early 2011. "It's basically 3D mammography," he says. "We're not doing it here yet in Medford. We're looking at it." Simply put, the imaging is new-and-improved mammography, but it wouldn't replace MRI.
"Women can be cured of breast cancer now," Bandler emphasizes. "But we need to find it as early as possible."
Understanding the terms
Screening mammogram – a medical imaging technique of the breast that uses X-rays to detect and evaluate breast changes. It is usually the first imaging technique used to screen
for breast cancer in women who have no symptoms.
Diagnostic mammogram – a diagnostic mammogram is used if breast changes or symptoms are noticed, or if a routine screening mammogram has found a suspicious looking area. During a diagnostic mammogram, more X-rays are taken of the breast than during a screening mammogram and additional pictures are focused on the area of concern.
Breast tomosynthesis – a three-dimensional (3-D) imaging technique that acquires images of a breast at multiple angles. The individual images are then reconstructed into a series of thin, high-resolution slices. Tomosynthesis can reduce or eliminate the tissue-overlap effect.
Ultrasound imaging – a medical imaging technique that uses high-frequency sound waves to view soft tissues such as muscles and internal organs. Because ultrasound images are captured in real-time, they can show movement of the body's internal organs as well as blood flowing through blood vessels.
Magnetic resonance imaging (MRI) – a medical imaging technique that uses a very large magnet and radio waves to visualize internal structures of the body in detail. MRI can create more detailed images of the human body than are possible with X-rays.
MRI-guided breast biopsy – a medical procedure using MRI imaging and a hollow needle to remove tissue, cells or fluid from the breast for examination.
Positron emission tomography-computed tomography (PET-CT) – a medical imaging technique using both types of tomography so that images acquired from both devices can be taken at the same time and combined into a single image.
BRCA1 and BRCA2 – human genes that belong to a class of genes known as tumor suppressors. In normal cells, BRCA1 and BRCA2 help ensure the stability of the cell's genetic material (DNA) and help prevent uncontrolled cell growth. Mutation of these genes has been linked to the development of hereditary breast and ovarian cancer. The names BRCA1 and BRCA2 stand for breast cancer susceptibility gene 1 and breast cancer susceptibility gene 2.
Dense breasts – breast density is one of the strongest predictors of the failure of mammography screening to detect cancer. Women with high breast density are four to five times more likely to get breast cancer than women with low breast density.
Ductal carcinoma in situ (DCIS) – the most common type of non-invasive breast cancer. Ductal means that the cancer starts inside the milk ducts, carcinoma refers to any cancer that begins in the skin or other tissues that cover or line the internal organs and in situ means in its original place.
Breast Cancer in Oregon
Based on data from 2010:
• Breast cancer was the second most common cause of cancer-related death among Oregon women.
• 3,534 new cases of breast cancer were reported
• From 2001 to 2010, the incidence of breast cancer dropped 16 percent
• From 2001 to 2010, the mortality rate from breast cancer dropped 14 percent
-Source: Oregon State Cancer Registry
"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."