What Matters Most?

Diseases and Surgery of the Breast

I was just getting home from a long day at the hospital when I received a phone call from a woman in her 50’s who had just been diagnosed with breast cancer. She was frightened, unsure what her diagnosis would mean for herself or her family. This woman was unsure why cancer had chosen her because no other members of her family had breast cancer.

Unfortunately, she did have the two most common variables associated with breast cancer which are being female and getting older. Most women who have breast cancer do not have a significant family history. Because we can’t always predict who will get breast cancer, mammograms help effectively screen. Most women if they don’t have a strong family history should get a baseline mammogram from 35-40 years of age, and a yearly mammogram after 40.

Fortunately, she was vigilant about getting her mammograms. Although mammograms will not prevent breast cancer, they will find many cancers when they are small. This women’s tumor was still very small. So small it could not be felt; only seen by her yearly mammogram. The size of a tumor and the extent of spread throughout the lymph nodes and the body are very important factors in determining a women’s survival. In fact data from National Cancer Institute suggests that 98% of women with breast cancer localized to their breast are alive 5 years from their cancer diagnosis, yet only 23% of women with breast cancer that has spread to other parts of the body are alive at 5 years. A number of factors, including other tumor characteristics, a person’s age and general health, can also affect outlook, but the size and spread of the tumor matter most.

I spent the next few weeks vicariously walking through this woman’s many doctor visits, further tests, and many decisions. One of the main decisions she had to make was what type of surgery to have…a lumpectomy versus a mastectomy. This is a very personal decision. Before 1982, all women with breast cancer received a mastectomy for any size cancer. In the 80’s several randomized trials showed that women who had a lumpectomy and radiation had the same survival as women who had a mastectomy. In 2002, follow up of these women who participated in these trials in the 80’s became available. They still after 20 years had the same survival despite which operation they chose. Today, the majority of cancers can be treated with a lumpectomy and radiation.

She recently celebrated her 11 year cancer free anniversary. Currently, she travels the country in her RV with her husband, plans a yearly family reunion, spends many hours caring for her neighbors and family, and walks every year in the American Cancer Society’s Relay for Life. Over the past 20 years this woman has been my friend, loved me through life’s triumphs and valleys, and been grandmother to my children and a mother to me even though she is actually my mother-in-law. I’m thankful she was vigilant with her mammograms and breast exams.