Portraits of Breast Cancer
It’s a diagnosis―breast cancer―no one wants to hear. But every year nearly 200,000 women will. Getting through it takes strength and grace―something the women featured here have in spades.
Helena Chang, M.D.Director of the Breast Cancer Program at the Revlon/UCLA Breast Center and a professor and a surgical oncologist at the David Geffen School of Medicine, at the University of California at Los Angeles
Chang directs the Gonda/UCLA Breast Cancer Research Laboratory and the Clinical Trials Unit for Breast Cancer. She has been studying the disease since 1981.
Q. What are the biggest advances in research in recent years?
A. In the past 10 years, the most progress has been made because of the Human Genome Project. We now know that there are many types of breast cancer, and each is affected by a particular set of genes. We also better understand the biology behind cancer progression.
Q. Over the course of your career, how has public perception about breast cancer changed?
A. People aren’t afraid to talk about it. And doctors are engaged in promoting breast cancer screening.
Q. Recently a study suggested that breast self-exams may not help save lives. What’s your take on that?
A. The largest randomized study showed that self-exams have no effect on survival rate and that those who routinely did self-exams ended up having more biopsies that were noncancerous. (But another recent study showed that more cancers were found in women who did self-exams.) Self-exams are still something we should do. Our breasts are part of our body, and it’s our responsibility to be aware of changes―even if it might not have a big impact on saving lives in general. The newer screening tool, breast MRI, is now available for those with a strong family history or those who have tested positive for BRCA mutations, the breast cancer genes that are associated with an excessive risk for the disease, or those with other conditions that put them at high risk. MRI also works well in women who have dense breast tissue, often young women, or those on hormone-replacement treatment. For those who can’t have an MRI―for example, due to pregnancy or kidney problems―we recommend a breast ultrasound in addition to mammography.
Q. Where do you see the most need for new research?
A. We have to figure out a way to target the cancer cells specifically, as opposed to medicine that affects the whole body taking a huge hit, as it often does in chemo. We also have to get rid of the idea that one magic treatment will work for all breast cancer patients. And I think that in the future other types of prevention need to be developed to reduce the incidence of breast cancer in women with average risk of getting the disease.
Q. How has treatment improved in the past few years?
A. Medications have evolved. Chemotherapy, the traditional medicine, kills the tumor cells with more ease than it kills normal cells, but it makes us sick and we lose our hair. The newer drugs, like Herceptin and Lapatinib, have better therapeutic value and fewer side effects.
Q. How are the drugs used?
A. We combine them with chemo. Either one alone is not that magical, but together they’re synergistic. For women who have chemo and take Herceptin, the recurrence rate is over 50 percent lower. And Lapatinib works well for those whose cancer is resistant to Herceptin.
Q. What about the link between chemicals and breast cancer―are the concerns founded?
A. In the olden days, we weren’t exposed to as chemically complex an environment as we are today. Now we eat more processed foods, and we also don’t do as much physical activity. We tend to get married and have children later. We have the Pill and hormone replacement. Breast cancer incidence is associated with better-developed countries―some of that must be environmental.
Q. How do you determine risk and improve a woman’s survival rate if she develops the disease?
A. Some of the most powerful risk factors are being a woman, having a family history of two or more diagnosed first-degree relatives, and getting older. Incidence in your 20s is low, 30s is less likely, but women in their 40s account for 18 percent of all breast cancers. Obesity is linked with an increased risk of cancer―period―and also with postmenopausal breast cancer. The longer you do hormone replacement, the higher your risk. Women with a history of drinking―on average, two to three glasses of alcohol a day―have a 20 to 40 percent increase in risk compared with those who drink less. When it comes to improving the prognosis, research has shown that patients diagnosed with breast cancer who exercise have a 20 to 50 percent lower risk of death from the disease. It’s hard to conduct studies to tell if exercise suppresses recurrence or how it works for healthy women. But we are animal, not vegetable. We are supposed to move and use our physical strength.
Q. How do women who have been diagnosed find the best care?
A. The most important thing is to talk to your doctor in a very open way, to make sure that he or she is addressing all your concerns and that the proposed treatment sounds logical. You will have a multidisciplinary team, with a surgeon and a medical oncologist and a radiologist. If something doesn’t sound right, then get a second opinion.
The New Patient
Laura Stratte, 36Whitefish Bay, Wisconsin
Married to Jim, 55; mother of Ned, 6, and Freya, 3; stepmother to Isabelle, 16
Jim is 55 and I’m 36, so our joke was that I was always the one who was supposed to be healthy. I started feeling that something was up in January 2008, when I was in nursing school, taking a course on pathophysiology, or the study of abnormal bodily changes due to disease. I think I have a neurotic mind-set to begin with, and I had these symptoms―pain in my right breast, in my underarm, down my arm. When I went to see my doctor, he asked me, “Are you really stressed?” But I knew I had a physical problem, not a mental problem. My breast exam was totally normal. However, the pain didn’t go away, so I had an ultrasound. (I couldn’t get a mammogram because I was breast-feeding.) That was normal, too.
Each time I went to the doctor, I felt better mentally for a day or two, but the pain would return. Then my right breast and lymph nodes started swelling up and felt achy. Breast pain isn’t typically a symptom of cancer, though, and I had no family history. In April, I went to a breast surgeon and got another ultrasound, which was clean. I also stopped nursing so I could get a mammogram. Afterward they told me to come back for a biopsy because they saw something suspicious. Hearing that was almost a relief. The radiologist called on Saturday. No one could believe it―even my husband had thought I was crazy. I felt angry yet vindicated; I had known all along that something was wrong.
In July, I had a mastectomy and breast reconstruction. That was in some ways the easiest part. My cancer was estrogen-receptor positive (ER-positive), meaning the estrogen in my body signaled the cancer cells to divide. I also tested HER2-positive, which stands for human epidermal growth factor receptor 2, a protein that can promote the growth of cancer cells. I went on Tamoxifen, a treatment given to ER-positive patients that inhibits estrogen receptors from binding and spreading. My oncologist thought it would offer the best benefits, and I wouldn’t have to take a semester off for chemo.
Then I read a study about chemo for HER2-positive patients and decided to get a second opinion. That doctor said it might be a good idea for me, in conjunction with the intravenous drug Herceptin. I had stage 1 cancer, meaning it was caught early, but I was told it had a 20 percent chance of spreading to other parts of my body, even after treatment. I was 35 with two little kids, and I didn’t want this to happen again, so I felt like it was a no-brainer.
I started chemo in April of this year. Before I began, I had a big party at my house to shave my head. I invited about 30 people, but the party was mostly for my kids. I didn’t want my son, especially, to freak out watching me lose my hair over time. So I let him hold the clippers. I wanted him to know that what I was going through was scary, but it wasn’t so scary that we couldn’t celebrate something. I still get chemo every three weeks, and in between those treatments I get Herceptin.
I really like to see the silver lining in everything―and throughout this whole process, I’ve gotten such support from my family and friends and even acquaintances. It has actually been an amazing experience despite it all.
Carla Copeland, 44Long Beach, California
Breast cancer totally surprised me. I don’t have a family history, but one day in 2002 I was in the shower and I felt a lump. I was 37 at the time. The doctor didn’t think it felt like cancer and said I was so young I shouldn’t worry about it. But he told me to get a mammogram and an ultrasound just to make sure. I put that off for a few weeks, but when I finally got the tests, they knew immediately after the ultrasound that it was cancer. The supervising doctor said she had seen thousands of cases and was sure about it.
They rushed a biopsy and set me up with an oncologist; I was diagnosed with HER2-positive stage 2 cancer. Stage 2 is considered middle-of-the-road, but the type of tumor I had is very aggressive. When you hear something like that, you’re not even thinking straight: I was supposed to go on a cruise through western Europe the following week with my family, and I remember thinking, Can I still go on my cruise?
The doctor let me go, and I made myself enjoy that time with my family. Because when I got back home, it was right into treatment. I had surgery to remove the lump and 10 lymph nodes, one of which was cancerous. Three weeks later, I started chemo and Herceptin treatment and had seven weeks of radiation. I’m very lucky that I got into a yearlong trial study of Herceptin, which had been used for metastatic HER2-positive breast cancer, to see how it would work for earlier stages of the disease.
Because of the chemo, I lost all my hair, and I did the wig, the hats, the scarves. I actually gained weight. You hear about cancer patients losing weight, but with the steroids I took to better tolerate the chemo, I became bloated and moonfaced. What kept me positive was sticking to my daily routines―going to my job in telecommunications, walking my new dog, having dinner with friends and family, seeing local bands, and having the occasional beer or glass of wine ( just one).
And then I discovered something new: Chinese dragon-boat racing. There was a woman I saw in the chemo room―she had a bubbly personality and these amazing biceps. Her name is T. K. (short for Takako Kimura), and when we started talking, she told me about her involvement in the Los Angeles Pink Dragons, which is a dragon-boating team for breast cancer survivors. I had never really been athletic. Still, I went out to try it, and I met such amazing, positive women―mostly in their 40s, 50s, and 60s, and one in her mid-80s. Paddling in sync with them helped me regain confidence in my body. I couldn’t believe how hard it was, but I wanted to keep doing it. That’s how I found my true love, outrigger ocean canoeing, which I do three days a week. I’m in better shape now than I was before cancer.
My oncologist followed me very closely, and two years ago he told me I was cured―he didn’t even use the word remission. He has never seen my type of cancer recur after five years and said that when you get beyond that point, you’re a pioneer.
It’s funny, because now when I consider my cancer, I realize that if I hadn’t gone through it, my life wouldn’t have opened up the way it has. When I think of all I’ve achieved, I look at cancer like, “You didn’t get me. See what I’m doing now?”
Kendall Womble, 38Nashville
Married to Travis, 35; mother of Crosslin, 11; Cal, 8; and Cullen, 2
About six months before my diagnosis, I started feeling a burning sensation under my arm. I thought I was just out of shape. Then one night my husband and I were spooning and he touched me on the side and it hurt like crazy. When I saw my doctor three weeks later, she sent me for a mammogram just to make me feel better. After the test, when I had been sitting in the waiting room for 30 minutes, the doctor came in and said I should have an ultrasound immediately. Following that test, the doctor told me, “I’ve called your gynecologist, and I’m not going to lunch, because I want to do a biopsy right now.”
Luckily my gynecologist is a friend, so she rushed the test. At 2:30 the next day, I knew that it was cancer and that I needed chemo and radiation. I said, “Take both my breasts―I can’t handle not knowing and worrying.”
That was in April 2008. In May, I went in for a double mastectomy and reconstruction, expecting a full day of surgery. So when I woke up 2½ hours later, I knew something was wrong. They had found more cancer in my lymph nodes and removed them. The doctors said it was stage 3, which is pretty advanced, on the scale of stage 1 (very treatable) to stage 4 (often terminal). They warned me that the cancer might have started somewhere else in my body, so I had a brain and body scan two weeks later. As I waited for those results, everything was a blur.
When the scan came back, they didn’t find cancer anywhere else, and I took that as my call to fight back. I did chemo and radiation and went on the trial drug Avastin. I’m still on Tamoxifen.
Treatment was exhausting. I would walk out of chemo like an old woman. My joints were so sore, and my arm would get swollen like an elephant’s leg. Sometimes I was so tired, I couldn’t climb the stairs to tuck in my kids.
Still, I kept thinking, You have to bust through. You have to do the things you think you cannot do. In September, after my fourth chemo treatment, I did the Hope on Wheels 100 Women Cycling for a Cure 12-mile breast cancer bike ride. It was awesome and liberating. In October, I did the Susan G. Komen Race for the Cure in Nashville. Forty of my Kappa Alpha Theta sorority sisters from the University of Kentucky flew in from all over to surprise me and complete the 5K with me. They all wore pink “Re-Kendalled Spirit” T-shirts and helped raise more than $100,000 for breast cancer research. It was very emotional―I cried all day. I’ve also gotten involved in speaking at YMCAs, churches, and women’s groups. Last October, I even got Tennessee to issue a breast cancer– awareness license plate.
On January 2 of this year, when I had my last radiation treatment, I adopted a new motto: “ ’08 wasn’t great, but ’09 is going to be fine.” I sold my business, a stationery store, so I could concentrate on my kids. (The new owner is keeping the two pink awnings outside, which are hallmarks of the store, in my honor.) Cancer definitely changes your life, but I keep reminding myself that when it seems like everything is so bad, people come out in hordes wanting to help.
Evelyn LauderFounder of the Breast Cancer Research Foundation and senior corporate vice president of the Estée Lauder Companies, in New York City
Over the past 20 years, Lauder has helped raise more than $250 million for breast cancer research and treatment through the Breast Cancer Research Foundation. In 1992 she cocreated the pink ribbon for breast cancer awareness and opened the Evelyn H. Lauder Breast Center, a one-stop shop for breast cancer patients, which is part of the Memorial Sloan-Kettering Cancer Center, in New York City. In September the center moved to a new building that will allow it to treat even more patients.
Q. How do you motivate women to help raise awareness and funds?
A. I just have to cite statistics. There isn’t one healthy woman I know who doesn’t have a sister, a cousin, or a friend who has had breast cancer. According to the American Cancer Society, one in eight women are susceptible during their lifetime; and as we get older, our chances of getting it increase. And there will be almost 200,000 cases of invasive breast cancer diagnosed this year, with a death rate that is expected to be about 40,000. What inspires me most are some of my friends who are no longer with us. I got a call from my nephew, whose friend is 44 years old and was just diagnosed. She is the same age as my children, and I am fueled by the hope that I can help.
Q. What’s your biggest challenge?
A. People saying no when I’m fund-raising. But that’s never for very long. Another hurdle is passing on information about developments in research in a way that people can understand. In the past 15 years, advances have come at a much faster rate than in the previous 50. We’ve seen a tremendous number of accomplishments in clinical trials, and we now know that multiple genes are linked to breast cancer. This is real progress.
Q. Is it maddening to read studies that say self-exams don’t help?
A. Self-exams might lead to more unnecessary mammograms, but you don’t know that until after the test comes back clear. If a woman finds something early, that can save her life. And it’s cheaper in the long run to prevent or detect the disease early, as opposed to treating it at an advanced stage.
Q. Do you have a favorite use of the pink ribbon?
A. Delta has a pink plane with ribbons on it, and I like that. Ironically, I remember a flight attendant being the first person to recognize the pink ribbon on my lapel. I was boarding a plane, and she saw it and said, “Pink ribbon for breast cancer.” I think I kissed her―I was so happy.
Q. How does it strike you that people might now link your name more readily to the fight against breast cancer than to cosmetics?
A. It’s gratifying―I love doing this. I get to help people in both worlds: to look beautiful and to stay healthy. How can I mind it when people call me and say, “I have this disease and it’s killing me―what should I do?” It’s one thing to sell lipstick. It’s another thing to help save lives.