Kathy Parara pulled out all the stops to avoid breast cancer.
She went above and beyond doctor's orders, including having a dozen mammograms, all of which came back clean. Each time she received the thumbs-up from her doctor, she breathed a bit easier, comforted by the thought of being cancer-free, at least for one more year.
Here are some American Cancer Society recommendations for detecting breast cancer in its early stages:
"I started going in for yearly mammograms at age 35," Parara said. "I did everything I was supposed to do, and look what happened."
Despite her best efforts, Parara nearly paid the ultimate price.
In September 2011, Parara received a follow-up call after one of her mammograms. The results showed a 3-inch tumor had developed in one breast, and three smaller tumors showed in the other.
A 3-inch tumor doesn't grow overnight. It would take years for one to reach that level.
"I just kept asking myself, 'How could this happen?' Parara said. "The tumor was 3 inches and had been there for years. I'm just lucky the cancer didn't spread to my lymph nodes."
In late fall 2011, Parara, 51, underwent a bilateral mastectomy, meaning both of her breasts were removed. The operation left her cancer-free, but she emerged seeking answers as to why she had ended up in this position.
Weren't mammograms supposed to have high success rates in detecting cancer in its early stages? What went wrong?
She decided to order a copy of her medical records covering her hospital and doctor visits over the past two decades. What she found was shocking.
Doctors had known Parara had dense breast tissue at the time of her first mammogram. This fact was noted in the records but never communicated to her.
She would soon learn that mammograms are not the ideal procedure to detect cancer in patients with dense breast tissue. Other options such as ultrasounds and MRIs are more effective.
"If I had known what it meant to have dense breast tissue, I could have requested an ultrasound and found the tumor eight to 10 years earlier," Parara said.
Parara likes to use an analogy when describing the difficulty a doctor has in seeing a tumor in dense breast tissue using mammography.
"It's like trying to see a snowball in a snowstorm," she said.
Parara has recovered and moved from the Bay Area to settle in Shady Cove.
Kate Newgard, the oncology nurse navigator at Providence Medford Medical Center's Leila J. Eisenstein Breast Center, has assisted Parara in her journey through cancer.
Newgard praised Parara's strength and determination through what could have been a fatal experience.
"She's an amazing woman," Newgard said.
Newgard notes that breast cancer treatment and detection have come a long way since she entered the medical field in 1996.
Gone are the days when an umbrella treatment was prescribed to all breast cancer patients.
"Not everyone gets a mastectomy anymore," Newgard said. "That used to be the case years ago."
Oncologists now try to tailor a treatment to the individual patient. Some women still require mastectomies, but many receive less intense surgeries to remove lumps and other abnormalities.
In addition, new digital imaging equipment has replaced traditional analogue mammograms, allowing doctors a far more detailed look into breast tissue.
Mammography remains the "gold standard" for breast cancer screening, though Newgard does recommend that women with dense breast tissue receive ultrasounds or MRIs on a yearly basis.
"We recommend that women at age 40 should get yearly mammograms," Newgard said.
Another option for women with histories of breast cancer in their families are preventive mastectomies. These surgeries are performed after women are genetically screened and found to carry traits that give them a high risk of developing breast cancer.
Women with hereditary risks of developing breast cancer should begin monthly breast self-exams at age 18, with clinical exams every six months beginning at age 25. These women should also begin yearly mammograms or ultrasounds at age 25.
"We have embraced prevention," Newgard said. "Prevention is the key."
In all, Newgard said between 100 and 150 women per year are diagnosed with breast cancer at Providence's local breast center.
In recent years, hospitals have opened up to holistic treatments following breast cancer surgery. Many women are encouraged to take up yoga and eat a healthful diet of organic foods, Newgard said.
"Those are things that are relatively new," Newgard said. "Also, it's important to keep your weight in check. There is a link between obesity and cancer."
Parara's experience inspired her to become political. She has successfully lobbied the Oregon and California legislatures to require that doctors inform patients of their breast density and explain what that means.
Beginning Jan. 1, 2014, Oregon doctors will be mandated to provide breast density information to all of their patients.
"It will give patients options they might not otherwise know they had," Parara said.
Parara remains active in getting the word out on breast tissue density.
For more information, Parara welcomes everyone to visit her Facebook page, titled KYOBD (Know Your Own Breast Density), as well as www.areyoudenseadvocacy.org.
Reach reporter Chris Conrad at 541-776-4471 or firstname.lastname@example.org.