breast cancer basics: part one

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Breast cancer by the numbers

Take control of your Breast Cancer risk and diagnosis

St. John’s Oncology Department offers information on:Screening & Education

Diagnosis & Staging

Treatment

Wellness

October is breast cancer awareness month.Call 739-7531 to schedule your annual mammogram.

months after chemotherapy.

St John’sOncology Services

Dr. John Ward, Huntsman Cancer Institute

Judy Basye, RN, OCN, Director and Certified Breast Cancer Navigator

Anna Schwartz, PhD, FNP, FAAN


5The number of

stages of breast cancer, with 0 being the least progressed

and IV being the most severe

The estimated number of new breast cancer cases in women for 2010 in Idaho*

1,970

October

is National Breast Cancer Awareness Month

The estimated number of new breast cancer cases in men for 2010 in the U.S.*

910

* Information from Cancer Facts and Figures 2010 – American Cancer Society

+ Centers for Disease Control and Prevention – Cancer Screening Vital Signs

** Susan G. Komen for the Cure Foundation

= Breastcancer.org

40,230

Estimated number of breast cancer related deaths in

men and women for 2010*

207,090The estimated number of new breast cancer cases in women

for 2010 in the U.S.*

Breast cancer by the numbers

50-74The ages of women who should have

a mammogram every two years+

$$60

MilliOnThe amount of money in grants the Susan G.

Komen for the Cure foundation has provided

for breast cancer research this year**

1 in 8Women in the U.S. will develop invasive breast cancer over the course of her life =

Breast Cancer’s rank among

the most commonly diagnosed

cancers in women (first is skin cancer).=

2

2.5 millionThe current number of breast cancer survivors in the U.S.=

5-10 percentthe percentage of breast cancers that are caused by inherited gene mutations=


Lisa NyrenTVN Staff

Participating in National Breast Cancer Awareness Month, Teton Valley Hospital is offering free and discounted mammograms.

The average cost of a mammogram is between $145 and $160, including a radiologists’ read, said TVH spokesperson Ann Loyola.

Discounts are available at TVH for women who book appointments through the end of the month. The appointments don’t have to be this month, but the appointment has to be made in October, she said.

Women with or without insurance can use the discount of $40, if they pay in cash. This program has been ongoing at the hospital for over a decade. Coupons are available all over the Valley, Loyola said.

TVH has also received some funding from the regional Susan G. Komen Rally for a Cure Foundation. A portion of the funds raised at the annual Teton Valley Rally for a Cure golf tournament go to the Susan G. Komen Foundation, and the remainder is up for the regional foundation to disperse. Two years ago they decided to put that money to use by helping women who couldn’t afford mammograms.

The free mammogram program is important, especially in these difficult economic times, Loyola said.

“So many women have been affected by this recession,” she said.

The paperwork for the free mammogram program used to be long and arduous, Loyola said, but this year women will only have to fill out a one-page form, and the hospital will rely on “the honor system” and leave it up to women to determine if they can’t afford the test otherwise.

This program will run “until the funds run out,” Loyola said.

Teton Valley Hospital currently operates a film mammography machine, and some women may have gotten digital mammograms at other facilities. If that is the case, TVH will help women get digital mammograms at a nearby facility, Loyola said.

TVH’s goal is to acquire a digital mammography machine, Loyola said. The Rally for the Cure Foundation gave TVH $12,000 to go toward the purchase of the $325,000 machine.

The hospital is now looking into private funding to come up with the rest in the future.

Even without the digital machine, Teton Valley Hospital has a fairly new mammography suite, funded in part by the Jon Huntsman family in 1999.

For more information on free and discounted mammograms, contact TVH at (208) 354-2383.To contact Lisa Nyren e-mail [email protected].

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Broulim's Plaza inTeton Valley, ID

Teton Valley Hospital offers free, discounted mammograms

The mammography machine at Teton Valley Hospital. This machine is the second since the beginning of the mammography suite at TVH. The hospital hopes to have a digital mammography machine in the near future.

TVN Photo/Lisa Nyren

Courtesy of Content that Works


Lisa NyrenTVN Staff

For Pauline Elliot, the worst thing about being bald was having to cover her head in the winter.

“It’s cold with no hair,” she said, laughing.

Now nine years free of breast cancer, Pauline’s cheery personality shines through even when she talks about that period in her life.

The seamstress from Australia has lived in Teton Valley for 15 years and has loved every minute of it.

She lived in Red Lodge, Mont. for a while but headed south for the same reason so many powder hounds find their ways to the Valley: the snow.

She loves skiing so much that she scheduled her chemotherapy treatments late in the afternoon, “just in case there was a good powder day.”

Breast cancer runs in Pauline’s family. Her mother had it, her aunt died because of it, and two of her cousins on her father’s side had it; one didn’t survive. Pauline also has symptoms associated with increased risk of breast cancer: she began menstruating early, at 11, and she’s never had children.

“In a way I was expecting it,” she said, sitting in her kitchen at her home in Driggs.

Now 53, Pauline was 44 when she discovered a lump in her breast and immediately got a mammogram. She had been getting mammograms annually since she was 35 due to the prevalence of breast cancer in her family. She found the lump in-between checkups.

Pauline had estrogen-receptive breast cancer, which means that the cancer relies on estrogen to help it grow. A good thing about hormone-receptive cancers is they can respond to hormone-blocking medications.

Opting not to have a mastectomy, Pauline had a lumpectomy as well as a lymphadenectomy (she had the lump and some lymph nodes removed). She also went through chemo and radiation treatment.

The lymphadenectomy was especially painful, and she recommends other women who have the option to have their lymph nodes checked without having them removed “do it.”

Though she lost her hair, Pauline gained weight during chemo treatment.

“I got fat,” she laughed. She put on about 20 pounds.

Pauline’s husband at the time, Lee, was extremely supportive and helpful during her ordeal. He drove her to Idaho Falls for chemo treatment every day, and he shaved his head when she shaved hers.

It’s obvious from the briefest meeting with Pauline that she and Lee kept a sense of humor about life throughout her treatments. They sent friends and family a Christmas card of the two of them out in the snow, both bald and with broad smiles on their faces.

Pauline is still smiling.

“I’ve got a great life,” she said. “I’m exactly where I want to be.”

And she never let her cancer or treatment keep her from doing the things she loves.

“I lived life exactly how I’d been going,” she said. “The only thing was having to go to Idaho Falls every day.”

Having had breast cancer and beaten it

once, Pauline has let go of the fear associated with it.

“I’m not even scared of getting breast cancer,” she said.

It took Pauline about a year to recover from the lumpectomy, the lymphadenectomy, and chemo and radiation.

Her best advice to people newly diagnosed is to keep moving and

remain positive. Annual checkups and self breast exams are also important.

“Just try and keep on top of things because if you catch it early it’s not a death sentence.”

And the whole losing your hair thing has its upside, too.

“It sure cuts your shower time in half,” she said.

If you would like to share your story how you or someone you know has dealt with breast cancer, contact Lisa Nyren at [email protected].

I lived life exactly how

I’d been going. The only thing was having

to go to Idaho Falls every day.

Pauline Elliot, breast cancer survivor

Pauline Elliot tells her storylocal voices

A sense of humor will help get you through:Pauline Elliot stands in her sewing room at her home in Driggs. Elliot is a breast cancer

survior.

Pauline Elliot and her husband, Lee, made a Christmas card of this photo

to send to family and friends the year she underwent chemotherapy

treatment for breast cancer. Pauline said a good thing about being bald

was that “it sure cuts down on your shower time.”

Photo courtesy of Pauline Elliot

Photo by Lisa Nyren


Lisa NyrenTVN Staff

Sue Beard is a doting grandmother and a proud mother of two. She loves photography and

enjoys living in Teton Valley. She’s a retired nurse and a loving caregiver for her husband, Leon. Sue is also a breast cancer survivor.

Now, with three years of clean checkups under her chest, Sue has an enhanced appreciation for life. Her face lights up when she talks about her granddaughter, Isabelle, and about her son, Kerry, who is majoring in music performance at Brigham

Young University – Idaho. She’s also thankful for her daughter, Katie.

“It’s one of those things that you just couldn’t do without family and friends’ support,” she said.

Sue, 59, developed a rare kind of breast cancer, one that occurs in just .7 percent of people who get cancer in the United States. Of that .7 percent, 25 percent are soft-tissue sarcomas, the kind Sue had.

Until her diagnosis, she led a wonderful career as a nurse for 37 years, 20 of them at Teton Valley Hospital.

After graduating from Ricks College in her early 20s, Sue worked in Utah for a little over a decade until her mother was diagnosed with Alzheimer’s disease. Sue returned to the valley to take care of her.

While she was here, Sue met her husband, nine years her senior, who also grew up in the Valley. The two of them hadn’t know each other, but it didn’t take them long to realize they were a perfect match. Sue and Leon were married within four months of meeting.

When she was in her late 20s, Sue had breast implants put in after she developed fibrocystic disease (also known as fibrocystic changes), which actually isn’t a disease at all but a condition where women get benign cysts or lumps in their breasts, often due to hormonal changes.

When Sue felt a lump in her right breast in 2007, she assumed that her implant had shifted or broken. So did her plastic surgeon. So she went in for surgery to fix the implant and when she woke up

her doctor told her she had cancer. There is no known link between the implants and her cancer, however.

“I was very, very surprised,” she said.

Being a nurse helped her understand her doctor’s terminology, but it didn’t necessarily prepare her for this news.

“Even though you’re a nurse there’s a lot of things you don’t know,” she said.

By the time her doctor found and diagnosed the angiosarcoma, it had penetrated Sue’s chest wall. Soft-tissue angiosarcoma is a rapidly progressive cancer that eventually spreads into the lungs.

At first Sue wasn’t sure whether she wanted a mastectomy, but her plastic surgeon told her it was the best chance for a cure for her type of cancer.

Anticipating the surgery and chemotherapy treatment, Sue took leave of absence from work. She was 56.

Sue had a radical mastectomy. Her right breast was removed and her doctor took muscles from her back and moved them to her chest area to reconstruct her breast. There are scars on her chest and back from the procedure.

Sue said she’s had some “owy” surgeries in her life, including intestinal surgery, which she thought was the worst, but this surgery topped even that.

Sue is right handed, and she had to rehabilitate her right arm after the surgery. It’s gotten a lot better, but she still can’t throw a softball as well as she’d like to.

Chemotherapy came after the surgery. A common method of treating cancer, chemotherapy uses chemicals to stop the growth of cancer cells. It is usually accompanied by a cancer-fighting drug regimen. The chemo chemicals, however, cannot tell the difference between cancerous cells and normal cells, so they eliminate healthy ones as well, including hair and blood cells.

“Chemo was pretty hard,” Sue said. “They come as close to killing you as they can without really killing you.”

Sue had four months of chemo treatment, and she had to go to Rexburg to get it. The treatment “is exhausting because of just what it does to the body,” she said.

Friends and family members accompanied her on her trips Out Below.

Sue is a low maintenance kind of woman and she’s not generally fussy about appearances, but loosing her hair during chemo treatment was difficult.

“I was surprised at how tender that was for me to be bald,” she said.

After her first round of chemo, Sue’s doctor told her she’d be bald within two weeks, so instead of waiting, she shaved her head. Her hair has since grown back and she wears it short, with just a little spunk.

Her whole experience with breast cancer heightened Sue’s appreciation for the little things in life and increased her willingness to stop and enjoy the beauty of her daily surroundings.

The benchmark for being “cured” of breast cancer is five years, and Sue is well on her way. Still, she says, it’s something that she thinks about often.

“It’s always in the back of your mind.”

But a positive, glass-half-full attitude is what Sue is all about. She advises others battling breast cancer to

“Stay positive. Nurture your friendships and family.”She is also a believer in early detection.“Early diagnosis is key,” she said. And annual

mammograms are a must. “The fact of the matter is, they save lives.”

Women of all ages should conduct self breast exams, and Sue said people need to realize that breast cancer is not just an “old lady” disease; younger women, and men, can develop this cancer.

As research and technology improve, Sue hopes that better diagnostic tests will become available that will make it easier to detect breast cancer.

Sue never returned to work, but that has been a blessing in her life.

Within two weeks of her final chemo treatment, Sue’s first granddaughter was born, and Leon suffered a head injury after an accident with a buzz saw.

Now, she takes care of her husband and spends as much time as she can with Isabelle.

Sue looks at her diagnosis as something that helped her retire, a move she may not have been willing to make otherwise.

“The good thing is I’m home,” she said.

If you would like to share your story how you or someone you know has dealt with breast cancer, contact Lisa Nyren at [email protected] Beard and family enjoying the Fourth of July celebrations

in 2008: Back row from left to right: Deanne Woolstenhulme, Adam Wynn, Katie Wynn, Isabelle Wynn, Sue Front row: Royce Woolstenhulme and Leon Beard

Photo courtesy of Sue Beard

Sue with granddaughter Isabelle in July of 2008, just over two months after Sue completed her chemotherapy treatment.Photo courtesy of Sue Beard

After rare breast cancer: Sue Beard survives with a positive outlook

local voices

They come as close to killing you as they can

without really

killing you.

Sue Beard, Breast cancer survivor

Stages of breast cancer


Stages of breast cancerStage 0 is sometimes used to describe abnormal cells that are not invasive cancer.

For example, Stage 0 is used for ductal carcinoma in situ (DCIS). DCIS is diagnosed when abnormal cells are in the lining of a breast duct, but the abnormal cells have not invaded nearby breast tissue or spread outside the duct. Although many doctors don’t consider DCIS to be cancer, DCIS sometimes becomes invasive breast cancer if not treated.

Stage I is an early stage of invasive breast cancer. Cancer cells have invaded breast tissue beyond where the cancer started, but the cells have not spread beyond the breast. The tumor is no more than 2 centimeters (three-quarters of an inch) across.

Stage II is one of the following:The tumor is no more than 2

centimeters (three-quarters of an inch) across. The cancer has spread to the lymph nodes under the arm.

The tumor is between 2 and 5 centimeters (three-quarters of an inch to 2 inches). The cancer has not spread to the lymph nodes under the arm.

The tumor is between 2 and 5 centimeters (three-quarters of an inch to 2 inches). The cancer has spread to the lymph nodes under the arm.

The tumor is larger than 5 centimeters (2 inches).

The cancer has not spread to the lymph nodes under the arm.

Stage III is locally advanced cancer. It is divided into Stage IIIA, IIIB, and IIIC.

Stage IIIA is one of the following:

The tumor is no more than 5 centimeters (2 inches) across. The cancer has spread to underarm lymph nodes that are attached to each other or to other structures. Or the cancer may have spread to lymph nodes behind the breastbone.

The tumor is more than 5 centimeters across. The cancer has spread to underarm lymph nodes that are either alone or attached to each other or to other structures. Or the cancer may have spread to lymph nodes behind the breastbone.

Stage IIIB is a tumor of any size that has grown into the chest wall or the skin of the breast. It may be associated with swelling of the breast or with nodules (lumps) in the breast skin:

The cancer may have spread to lymph nodes under the arm.

The cancer may have spread to underarm lymph nodes that are attached to each other or other structures. Or the cancer may have spread to lymph nodes behind the breastbone.

Inflammatory breast cancer is a rare type of breast cancer. The breast looks red and swollen because cancer cells block the lymph vessels in the skin of the breast. When a doctor diagnoses inflammatory breast cancer, it is at least Stage IIIB, but it could be more advanced.

Stage IIIC is a tumor of any size. It has spread in one of the following ways:

The cancer has spread to the lymph nodes behind the breastbone

and under the arm.The cancer has spread to the

lymph nodes above or below the collarbone.

Stage IV is distant metastatic cancer. The cancer has spread to other parts of the body, such as the bones or liver.

Recurrent cancer is cancer that has come back after a period of time when it could not be detected. Even when the cancer seems to be completely destroyed, the disease sometimes returns because undetected cancer cells remained somewhere in your body after treatment. It may return in the breast or chest wall. Or it may return in any other part of the body, such as the bones, liver, lungs, or brain.* Source: National Cancer Institute, cancer.gov

Types of breast cancers There are several types of breast cancer. In some cases a single breast tumor can have a combination of these types or have a mixture of invasive and in situ cancer.

Ductal carcinoma in situ

Ductal carcinoma in situ (DCIS; also known as intraductal carcinoma) is the most common type of non-invasive breast cancer. DCIS means that the cancer cells are inside the ducts but have not spread through the walls of the ducts into the surrounding breast tissue.

About 1 in 5 new breast cancer cases will be DCIS. Nearly all women diagnosed at this early stage of breast cancer can be cured. A mammogram is often the best way to find DCIS early.

Lobular carcinoma in situ Although it is not a true cancer,

lobular carcinoma in situ (LCIS; also called lobular neoplasia) is sometimes classified as a type of non-invasive breast cancer. It begins in the milk-producing glands but does not grow through the wall of the lobules.

Most breast cancer specialists think that LCIS itself does not become an invasive cancer very often, but women with this condition do have a higher risk of developing an invasive breast cancer in the same breast or in the opposite breast.

Invasive (or infiltrating) ductal carcinoma

This is the most common type of breast cancer. Invasive (or infiltrating) ductal carcinoma (IDC) starts in a milk passage (duct) of the breast, breaks through the wall of the duct, and grows into the fatty tissue of the breast. At this point, it may be able to spread (metastasize) to other parts of the body through the lymphatic system and bloodstream. About 8 of 10 invasive breast cancers are infiltrating ductal carcinomas.

Invasive (or infiltrating) lobular carcinoma

Invasive lobular carcinoma (ILC) starts in the milk-producing glands (lobules). Like IDC, it can spread (metastasize) to other parts of the body. About 1 out of 10 invasive breast cancers is an ILC. Invasive lobular carcinoma may be harder to detect by a mammogram than invasive ductal carcinoma.

Less common types of breast cancerInflammatory breast cancer: This uncommon type of invasive breast cancer accounts for about 1- to 3 percent of all breast cancers. Usually there is no single lump or tumor. Instead, inflammatory breast cancer (IBC) makes the skin of the breast look red and feel warm. It also gives the breast skin a thick, pitted appearance that looks a lot like an orange peel. Doctors now know that these changes are not caused by inflammation or infection, but by cancer cells blocking lymph vessels in the skin. The affected breast may become larger or firmer, tender, or itchy. In its early stages, inflammatory breast cancer is often mistaken for an infection in the breast (called mastitis). Because there is no actual lump, it may not show up on a mammogram, which may make it even harder to find it early. This type of breast cancer tends to have a higher chance of spreading and a worse outlook than typical invasive ductal or lobular cancer.

Triple-negative breast cancer: This term is used to describe breast cancers (usually invasive ductal carcinomas) whose cells lack estrogen receptors and progesterone receptors, and do not have an excess of the HER2 protein on their surfaces. Breast cancers with these characteristics tend to occur more often in younger women and in African-American women. Triple-negative breast cancers tend to grow and spread more quickly than most other types of breast cancer. Because the tumor cells lack these certain receptors, neither hormone therapy nor drugs that target HER2 are effective against these cancers (but chemotherapy can still be useful if needed).

Mixed tumors: Mixed tumors contain a variety of cell types, such as invasive ductal cancer combined with invasive lobular breast cancer. In this situation, the tumor is treated as if it were an invasive ductal cancer.

Medullary carcinoma: This special type of infiltrating breast cancer has a rather well-defined boundary between tumor tissue and normal tissue. It also has some other special features, including the large size of the cancer cells and the presence of immune system cells at the edges of the tumor.

Metaplastic carcinoma: Metaplastic carcinoma (also known as carcinoma with metaplasia) is a very rare type of invasive ductal cancer. These tumors include cells that are normally not found in the breast, such as cells that look like skin cells (squamous cells) or cells that make bone. These tumors are treated like invasive ductal cancer.

Mucinous carcinoma: Also known as colloid carcinoma, this rare type of invasive breast cancer is formed by mucus-producing cancer cells. The prognosis for mucinous carcinoma is usually better than for the more common types of invasive breast cancer. Still, it is treated like invasive ductal carcinoma.

Tubular carcinoma: Tubular carcinomas are another special type of invasive ductal breast carcinoma. They are called tubular because of the way the cells are arranged when seen under the microscope.

Papillary carcinoma: The cells of these cancers tend to be arranged in small, finger-like projections when viewed under the microscope. These tumors can be separated into non-invasive and invasive types. Intraductal papillary carcinoma or papillary carcinoma in situ is non-invasive. It is often considered a subtype of ductal carcinoma in situ (DCIS), and is treated as such. In rare cases, the tumor is invasive, in which case it is treated like invasive ductal carcinoma, although the outlook is likely to be better.

Adenoid cystic carcinoma (adenocystic carcinoma): These cancers have both glandular (adenoid) and cylinder-like (cystic) features when seen under the microscope.

Phyllodes tumor: This very rare breast tumor develops in the stroma (connective tissue) of the breast, in contrast to carcinomas, which develop in the ducts or lobules. Other names for these tumors include phylloides tumor and cystosarcoma phyllodes. These tumors are usually benign but on rare occasions may be malignant.

Benign phyllodes tumors are treated by removing the tumor along with a margin of normal breast tissue. A malignant phyllodes tumor is treated by removing it along with a wider margin of normal tissue, or by mastectomy. Surgery is often all that is needed, but these cancers may not respond as well to the other treatments used for more common breast cancers. When a malignant phyllodes tumor has spread, it may be treated with the chemotherapy given for soft-tissue sarcomas (this is discussed in detail in our document, Soft-tissue Sarcomas.

Angiosarcoma: This is a form of cancer that starts from cells that line blood vessels or lymph vessels. It rarely occurs in the breasts. When it does, it usually develops as a complication of previous radiation treatments. This is an extremely rare complication of breast radiation therapy that can develop about 5 to 10 years after radiation. Angiosarcoma can also occur in the arm of women who develop lymphedema as a result of lymph node surgery or radiation therapy to treat breast cancer. * Source: American Cancer Society, cancer.org

Stages and types of breast cancer

A computer graphic rendering of a breast cancer cell.


Go into Broulim’s during October to donate to the Susan G. Komen Foundation.

Teton Valley News & Broulim’s have teamed together for National Breast Cancer Awareness Month

breast cancer basics: part one

Documents

breast cancer risk

invasive breast cancer

cancer facts

skin cancer

valleys tetonsbreast

ages of women

teton valley hospital

page c35the number of