“I work full time. I even was able to run over to Hamilton on my lunch hour for treatments.”
Understanding risk and options helps in breast cancer diagnosis
Living between two major cities, Kathleen has never worried about finding quality health care.
“I grew up in Philadelphia. With a family history of cancer, I always thought that if cancer ever came my way, I would go to Philly for treatment,” explains Kathleen.
Then, she was diagnosed with breast cancer. Suddenly, ‘what if’ became ‘what now.’ She had to consider the reality of commuting to a major city on a regular basis for care.
The Right Providers
Kathleen spent some time researching her options both closer to home and in Philadelphia. She narrowed her field to a few physicians, and met with them to discuss their recommendations.
“I realized that for my stage and type of cancer, the guidelines mostly dictate the course of action, so all of the treatments were comparable,” she says. “Chemo first, and surgery second.”
Her decision became about the provider she trusts and convenience of care. She took a closer look at the doctors she met with at Rutgers Cancer Institute of New Jersey Hamilton, including Pauline Lerma, MD, her medical oncologist, and Firas Eladoumikdachi, MD, her breast surgeon.
“I determined I was going to have a double mastectomy. Dr. Eladoumikdachi was so knowledgeable and thorough. I am someone who wants to know everything— good and bad. I ask a lot of questions, and he answered all of them, and then some,” recalls Kathleen. “It was important to him that I felt comfortable with my care.”
Looking back, Kathleen believes treatment in Philadelphia may have made her experience much more challenging. “Travel to the city would have been difficult to manage,” Kathleen recalls. “I work full time. I even was able to run over to Hamilton on my lunch hour for treatments.”
Kathleen’s experience at Rutgers Cancer Institute of New Jersey Hamilton has met and exceeded all of her expectations for cancer care—from surgery through treatment, reconstruction with Matthew Lynch, MD, and follow-up. She credits her team of physicians and nurses with helping guide her through the cancer journey.
Family History or a Mystery?
There are a number of factors that can contribute to one’s breast cancer risk. First and foremost, a family history of breast cancer can be a major risk factor.
“My mother had breast cancer in her 40s. She also had ovarian cancer,” says Kathleen. “So my sister and I have been sure to stay on top of our screenings.”
Prior to her diagnosis, Kathleen—along with her sister—proactively had genetic testing to determine if either of them carried a BRCA gene mutation. The BRCA gene mutation can place carriers at a highly increased risk of developing breast cancer. Both Kathleen and her sister tested negative for all BRCA gene mutations.
“BRCA is just an example of a genetic mutation that has been found to contribute to breast cancer,” explains Dr. Eladoumikdachi. “We don’t know all of the genetic mutations that lead to breast cancer. If a person does not test positive for BRCA, it does not mean she will not get breast cancer.”
In Kathleen’s case, she developed breast cancer even with a negative test for the BRCA gene mutations.
“Not every woman needs to have genetic testing,” he explains. “Any woman with any family history of breast or ovarian cancer would benefit from an evaluation to determine if she fits the criteria to have genetic testing.”
Breast Cancer Risk
Since she was 30, Kathleen and her doctors have spent a lot of time monitoring her breasts for possible tumors. In addition to her family history, Kathleen has a personal history of cysts in her breasts.
“My breasts are cystic, so I’ve had to have many biopsies, and diagnostic ultrasounds. All were benign until this diagnosis,” she explains.
Dr. Eladoumikdachi looks at risk in four categories:
- Average risk – women with no family history of breast cancer and no additional risk factors
- Slightly elevated risk – for example, a woman with no family history, but may have other risk factors, such as: personal history of breast cancer, never pregnant, obesity
- Moderate/high risk – for example, strong family history, but no evidence of the BRCA genetic mutation
- Very high risk – a woman with a BRCA or other mutation
Screening guidelines from the American Cancer Society for breast cancer have changed recently for women with average risk, with the guidelines moving toward a later start, and less frequent mammograms.
One of the reasons for the changes is related to studies which found that women who have mammograms annually beginning at age 40 tend to have more biopsies.
“The guidelines are designed to minimize risk to the patient. However, there is emphasis on individual woman's preferences and risks, and therefore it is encouraged that women discuss risks and benefits of timing and frequency of screening mammography with their physician,” he says.
Dr. Eladoumikdachi also notes, “If you have a question about whether you should get mammogram or genetic testing, talk to a breast specialist. It’s not always easy to categorize who should have genetic counseling, and insurance coverage can vary.”
Supportive Surroundings
For Kathleen, her breast cancer experience has presented its share of challenges, including the loss of her more-than-20-inch locks. “I miss my hair and it was emotional to have it cut, but it felt good to donate it. I found a fantastic stylist in Mercerville, Victor Migliarese, who has an organization called the Helping Hand Fund* which makes wigs from donated hair. He showed me such dignity and kindness,” says Kathleen.
Through it all, Kathleen has relied on her family for support, and recommends anyone going through cancer get their own support system in place.
“My family is amazing. My friends are amazing. My co-workers are amazing. They build me up. If you don’t have the same circle of support, join a support group. Don’t go through this alone,” she says.
*To learn more, visit HelpingHandFund.org.