WHAT IS BREAST CANCER? WHAT YOU SHOULD KNOW ABOUT BREAST CANCER MAMMOGRAM RESOURCES
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Breast Cancer Awareness Month PNJ • 2017
Sponsored by Quint and Rishy Studer
In memory of Rishy’s mother, Mary Perdue, who lost her courageous battle with breast cancer when she was far too young.
DID YOU KNOW?
7
Things to know about getting a
mammogram
WHAT CAN I DO TO REDUCE MY RISK OF BREAST CANCER?
A mammogram is an x-ray of the breast that’s used to find breast
DIVISION OF CANCER PREVENTION AND CONTROL,, CENTERS FOR DISEASE CONTROL AND PREVENTION
changes. X-rays were first used to examine breast tissue nearly a century ago. Today, the x-ray machines used for mammograms
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any factors over the course of a lifetime can influence your breast cancer risk. You can’t change some factors, such as getting older or your family history, but you can help lower your risk of breast cancer by taking care of your health in the following ways: • Keep a healthy weight.
produce lower energy x-rays and expose the breast to much less radiation compared with those in the past.
Find a center that specializes in mammograms. The US Food and Drug Administration certifies mammogram facilities that meet high professional standards of quality and safety. Ask to see the FDA certificate if one isn’t posted near the receptionist’s desk. And when you find a facility you like, stick with it. Having all your mammograms at the same facility will make it easier for doctors to compare images from one year to the next. If you’ve had mammograms done at other facilities, have those images send to your new facility.
• Exercise regularly (at least four hours a week). It’s best to schedule your mammogram about a week after your menstrual period. Your breasts won’t be as tender or swollen,
• Research shows that lack of nighttime sleep can be a risk factor.
• Don’t drink alcohol, or limit alcoholic drinks to no more than one per day.
• Breastfeed any children you may have, if possible.
• If you are taking, or have been told to take, hormone replacement therapy or oral contraceptives (birth control pills), ask your doctor about the risks and find out if it is right for you. • Limit exposure to radiation from medical imaging tests like X-rays, CT scans, and PET scans if not medically necessary. • Avoid exposure to chemicals that can cause cancer (carcinogens) and chemicals that interfere with the normal function of the body. If you have a family history of breast cancer or inherited changes in your BRCA1 and BRCA2 genes, you may be at high risk for getting breast cancer. Talk to your doctor about more ways to lower your risk. Staying healthy throughout your life will lower your risk of developing cancer, and improve your chances of surviving cancer if it occurs.
which means less discomfort during the x-ray.
Wear a 2-piece outfit because you will need to remove your top and bra. Do not apply deodorant, antiperspirant, powder, lotion, or ointment on or around your chest on the day of your mammogram. These products can appear as white spots on the x-ray.
The entire procedure takes about twenty minutes. The breast is compressed between two plastic plates for a few seconds while an x-ray is taken. It is repositioned (and compressed again) to take another view. This is then done on the other breast. Flattening the breast can be uncomfortable, but is needed to provide a clearer view.
You should get your results within 30 days. If you don’t, you should call to ask about them. If doctors find something suspicious, you’ll likely be contacted within a week to take new pictures or get other tests. But that doesn’t mean you have cancer. A suspicious finding may be just dense breast tissue or a cyst. Other times, the image just isn’t clear and needs to be retaken. If this is your first mammogram, your doctor may want to look at an area more closely simply because there is no previous mammogram for comparison.
Under the Affordable Care Act, Medicare and almost all private insurance plans now cover yearly mammograms, with no co-pay or other out-of-pocket costs. Medicaid also covers mammograms. For uninsured or low-income women, free or low-cost programs area available. Some programs are held during Breast Cancer Awareness Month in October, while others are year-round. Call the American Cancer Society at 1-800-227-2345 to find a program near you.
BREAST SELF-EXAM The BSE can help you become familiar with what’s normal for you and alert you to changes. There are different ways of doing a breast self-exam. Your nurse or doctor may teach you a different method from what is shown here, and that is OK.
a mirror to 1. Use look for changes in: Size, shape, contour, dimpling, rash, redness, scaliness of nipple or breast skin With arms by your side
With arms over your head
With hands on hips, chest muscles tightened
Lie down and feel for changes in each breast with the opposite hand.
2. Start by placing a pillow under your right shoulder, and your right arm behind your head. Light
Medium Use the pads of your middle fingers to feel for lumps in the right breast, using overlapping dime-sized circular motions.
3.
Firm
Use light, medium and firm pressure to feel all the breast tissue. Use an up-and-down pattern to check all of your breast.
Repeat the exam on your left breast.
Sit or stand, and feel each underarm area.
With your arm only slightly raised, feel the area under each arm.
See your doctor or nurse if you notice any of the following: • Lump, hard knot or thickening • Change in size or shape of the breast • Dimpling or puckering of the skin • Rash, redness or scaliness of the nipple or breast skin • Nipple discharge that starts suddenly • New pain that does not go away
Examine your breasts at the same time every month, usually about a week after the start of your period.
Source: American Cancer Society; Graphics: American Cancer Society, Andy Marlette
Diet, exercise play huge role in preventing breast cancer
BREAST CANCER
What is BREAST CANCER? DIVISION OF CANCER PREVENTION CONTROL, CENTERS FOR DISEASE CONTROL AND PREVENTION
Breast cancer is a disease in which cells in the breast grow out of control. There are different kinds of breast cancer. The kind of breast cancer depends on which cells in the breast turn into cancer. Breast cancer can begin in different parts of the breast. A breast is made up of three main parts: lobules, ducts, and connective tissue. The lobules are the glands that produce milk. The ducts are tubes that carry milk to the nipple. The connective tissue (which consists of fibrous and fatty tissue) surrounds and holds everything together. Most breast cancers begin in the ducts or lobules. Breast cancer can spread outside the breast through blood vessels and lymph vessels. When breast cancer spreads to other parts of the body, it is said to have metastasized. KINDS OF BREAST CANCER
The most common kinds of breast cancer are— • Invasive ductal carcinoma. The cancer cells grow outside the ducts into other parts of the breast tissue. Invasive cancer cells can also spread, or metastasize, to other parts of the body. • Invasive lobular carcinoma. Cancer cells spread from the lobules to the breast tissues that are close by. These invasive cancer cells can also spread to other parts of the body. There are several other less common kinds of breast cancer, such as Paget’s disease, medullary, mucinous, and inflammatory breast cancer. Ductal carcinoma in situ (DCIS) is a breast disease that may lead to breast cancer. The cancer cells are only in the lining of the ducts, and have not spread to other tissues in the breast. BREAST CANCER FACTS
Both women and men can get breast cancer, though it is much more common in women. Other than skin cancer, breast cancer is the most common cancer among women in the United States. Some women are at higher risk for breast cancer than others because of their personal or family medical history or because of certain changes in their genes.
(Photos: Division of Cancer Prevention Control, Centers for Disease Control and Prevention).
Muscle Lobes
Nipple Areola Fat
Ducts
The lobules are the glands that produce milk. The ducts are tubes that carry milk to the nipple. The connective tissue (which consists of fibrous and fatty tissue) surrounds and holds everything together. Most breast cancers begin in the ducts or lobules.
MARIANNE CARTER, USA TODAY NETWORK-DELAWARE
Not all cancers are inevitable – there are steps you can take to be pro-active and drastically reduce your risk. The American Institute for Cancer Research estimates that about one-third of breast cancer cases could be prevented with weight control, exercise and cutting back on alcohol. The evidence that being overweight puts you at increased risk of cancer is stronger now than ever before – especially postmenopausal breast cancer. A study published in the Journal of the American Medical Association Oncology used data from 67,000 women and found that the heavier the women, the higher the risk of breast cancer. Women in the most obese category were at almost double the risk of the most common forms of breast tumors. Breast cancer deaths were also more than two-fold higher among women who were the most obese compared to those with a normal body mass index (BMI). Even for survivors of breast cancer, research has uncovered that extra pounds are linked to a higher risk of recurrence of the most common type of breast cancer. Extra body fat causes hormonal changes and inflammation that may drive some cases of breast cancer to spread and happen again despite treatment. Tried and true strategies to lose weight include decreasing portion sizes, limiting fast foods, splitting oversized restaurant entrees, replacing high-fat snacks with fruits and vegetables, and choosing lower fat dairy and meat products. If you consume a lot of sugary beverages (regular soda, sweet tea, fruit punch), replace them with water. That will also promote weight loss. There’s also a strong correlation between the use of alcohol and increased risk of developing breast cancer. The risk increases with the amount of alcohol consumed. Women who have two to five drinks daily have a far higher risk of developing this disease than women who drink no alcohol. For that reason, the American Cancer Society recommends that women limit their consumption of alcohol to no more than one drink a day. One drink is defined as 5 ounces of wine (a small glass), a 12-ounce beer or a mixed drink made with 1.5 ounces of liquor. Increased physical activity is also an important breast cancer prevention strategy. It’s also a tool for managing your weight. Exercise can help reduce body fat, which in turn lowers levels of cancer-promoting hormones such as estrogen. Adults should strive to accumulate a minimum of 150 minutes of moderate physical activity weekly. Ask any survivor. Preventing breast cancer is easier than treating it after the fact. An investment in weight management, physical activity and moderation in alcohol consumption is well worth the effort. An added bonus – these same healthy lifestyle habits will also reduce the risk of several other chronic diseases. Marianne Carter is a registered dietitian and certified health education specialist. She’s the director of the Delaware Center for Health Promotion at Delaware State University
BREAST CANCER
What women should know about BREAST CANCER
SHARI RUDAVSKY, SHARI.RUDAVSKY@INDYSTAR.COM
Quick: What’s the current recommendations on how frequently women of a certain age should undergo screening mammograms for breast cancer? If you don’t have an easy answer, you are certainly not alone. Two highlyrespected medical organizations have issued conflicting guidelines on what women should do. Upending what until then had been widely accepted guidelines that women should start having annual mammograms at age 40, the United States Preventive Task Force Services recommended screening women from age 50 on every other year until age 74. The American Cancer Society said women between 45 and 54 — the menopausal years when the risk of developing breast cancer rises — should have annual screening. After that, they should go every other year. However, women in their 40s should discuss the matter with their doctors and reach their own conclusions, the Task Force said, while the American Cancer Society encourages such so-called informed decision-making for women under 40 to 44. “Things are a morass right now,” said Dr. Robert Goulet, medical director of breast services at Community Breast Care in Indianapolis. No one disputes that screening more women will detect more cancers. What some do question, however, is whether the number of additional cancers found outweighs the downsides of screening, such as the high number of false positives that comes with screening.
A woman’s individual risk factors also may affect her decision. That is where shared decision-making between doctor and patient enters the picture. “I think people get really nervous if there’s not a set rule. But I don’t think there’s going to be a set rule, and I think that we as consumers and the medical community, honestly, are going to have to deal with that,” said Dr. Anna Maria Storniolo, a professor of medicine at the Indiana University School of Medicine. “It’s not one size fits all, and I don’t think it’s ever going to be one size fits all.” Here are some other things experts want you to know about breast cancer:
v What the doctors think:
Many do not agree with the new recommendations. Dr. Katherine Patterson, a breast radiologist with Eskenazi Health, says she still recommends annual mammograms starting at age 40, in agreement with the guidelines of her specialty’s professional organization. Said Dr. Erika Rager, a breast surgeon with Franciscan St. Francis Health: “In all age categories over age 40, regular screening mammography detects breast cancer earlier and leads to improved survival, but it’s not a perfect screening test. There is no perfect test.”
v Not all women have the
same risk. On average, women have a 12 percent risk of developing breast cancer at some point during their lives, but there are some women whose risk is even higher.
Anyone with a risk more than 20 percent is considered high-risk. Doctors can now screen patients for a number of genetic abnormalities that predispose women to develop breast and ovarian cancer, Goulet said. Nor is it only women with firstdegree relatives, such as a parent or sibling, with breast cancer who should have these tests. Women with second- or even thirddegree relatives such as an aunt, cousin or grandmother may also benefit.
v When to stop screening.
On this question, experts are more in agreement. As long as a patient can reasonably expect to live another 10 years, she should continue breast cancer screening, they say.
v What you can do to
lower your risk: • Maintain a healthy weight. Evidence conclusively shows that obesity leads to chemical changes in the body that can predispose one to develop cancer, Goulet said. Even a 5-pound weight loss can help reverse that risk. • Exercise regularly. While the experts differ on how many times a week and for how long a person should engage in physical activity, they agree that moderate exercise during which a person breaks a sweat several times a week
lowers a woman’s risk. • And what you should not do: Do not consume excessive alcohol. While the exact amount is not known, downing more than about five alcoholic drinks a week increases risk, said Storniolo, also director of the Komen Tissue Bank, a repository of healthy breast tissue.
v Know your body.
Although many guidelines no longer support the idea of performing monthly breast exams, Storniolo said, women should still pay attention. If they note any change that lasts two weeks, even if it’s not a typical lump but just a thickening, they should have a doctor check it out. “The worse that’s going to happen is you’re going to go to a doctor and someone will tell you it’s nothing,” Storniolo said.
MAMMOGRAM RESOURCES
FREE MAMMOGRAMS:
Options abound in local mammography Extended hours, assistance programs help meet patient needs FROM PENSACOLA NEWS JOURNAL STAFF REPORTS
O
ne in eight American women will develop breast cancer sometime in her lifetime, and the most important thing women can do is be vigilant by performing regular self-exams and undergoing regular clinical exams and mammograms, doctors say. Finding cancer early does not always reduce a woman’s chance of dying from breast cancer. But early detection and early treatment leads to the greatest possibility of success. A key component in early detection is having an annual mammograms beginning at age 40. A mammogram is a low-dose X-ray of the breast that’s used to detect and evaluate breast changes. It can detect breast masses years before they can be felt, and it may reveal other critical changes in the breast tissue. Women with certain breast cancer risk factors should begin clinical screenings and mammograms earlier. For example, women who have received thoracic radiation between ages 10 and 30 have a significantly increased risk of breast cancer. But getting a mammogram isn’t always easy. Many women have to overcome obstacles that can include cost, accessibility, finding the time, getting a doctor’s referral and the fear of the exam itself. Here, we provide information on some of the local breast services that are offered, from free to reduced-price exams to mobile units that come to your area.
• Not currently experiencing any breast problems. • Be uninsured — self-pay. • Meet or be at least 200 percent above Federal Poverty Guidelines. (Patients must have completed Financial Assistance Application, along with providing proof of income, proof of Food Stamps eligibility, prior year tax returns and two most recent bank statements, plus any other required documentation to prove financial hardship.) Upon meeting this criteria and as long as Baptist has spaces available (due to available funding), patient would qualify for a Free Screening Mammo. For information, 850-434-4080. REFERRALS: The hospital requires patients to have seen their physician within the last two years. For a screening mammogram, patients don’t need a referral. But patients having any kind of breast problem need an order from their physician. DIGITAL MAMMOGRAPHY — 3D BREAST IMAGING: In 2011, Baptist was the first hospital in Florida to gain FDA approval to perform digital breast tomosynthesis, or 3D digital mammography, which is available at these Baptist Health Care locations: • Baptist Hospital • Gulf Breeze Hospital • Baptist Medical Park — Nine Mile
BAPTIST HEALTH CARE FREE SCREENINGS: Baptist Hospital provides “Free DIGITAL MAMMOGRAPHY: Baptist offers the most Screening Mammos” for uninsured women within the advanced equipment available for digital mammogracommunity during October, which is Breast Cancer phy, Hologic Selenia Dimensions, Awareness Month. This program is funded by comat these locations: munity donations and fundraisers. To qualify for a free • Baptist Hospital mammogram, patients must: • Gulf Breeze Hospital • Have a primary care • Baptist Medical Park — Nine Mile physician. • Baptist Medical Park — Navarre What is a mobile • Be over age 35. mammography unit? • Not have had a DIGITAL MAMMOGRAPHY mammogram within the E-REMINDERS: For women over It’s is a customized vehicle past 12 months. that goes to various locations age 40, Baptist Health Care offers • Have had at least to offer mammograms. Mammography e-Reminders to help them five years of cancer-free The purpose is to make remember their appointments. screenings. (No diagnosscreenings convenient and to To schedule a mammogram, tic screening will be done increase community access to 850-469-7500. in this program.) mammograms. Details: www.ebaptisthealthcare.org.
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A:
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Mammograms are usually covered at 100 percent by most insurance carriers. If a patient does not have insurance, there are several programs, such as those through the Escambia County Health Department to help with free or reduced-fee services to qualifying patients. Uninsured patients ages 50 to 64 are eligible. Details: 850-595-6650, ext. 1204.
OTHER MAMMOGRAM RESOURCES:
American Breast Cancer Foundation’s Key to Life Breast Cancer Assistance Program Eligibility: Need doctor’s referral and will be mailed an application. No age limit. Need proof of residency and must not make more than 300 percent above the poverty level. Details: 844-219-2223. Angel Williamson Imaging Center Offers 30 percent discounts on all medical services to the uninsured. Details: 476-1161 or www.awimaging.com. Baptist Hospital’s HealthSource Eligibility: Call for an appointment. Must be 35 and complete a short phone interview. Details: 434-4080. Mobile Mammography Van, West Florida Hospital affiliate Eligibility: 35 and up. Travels through Pensacola. Most insurance accepted. Details: 888-894-2113, ext. 1. Santa Rosa County Health Department’s Breast and Cervical Cancer Program Eligibility: Ages 50 to 64, must make no more than $20,800 in a one-person family, $28,000 in a two-person family or $35,000 in a three-person family. Must make an appointment, have a Pap test and exam completed and then will be referred for a mammogram. Patient must bring a driver’s license. Details: 983-5200, ext. 2235. Woodlands Medical Specialists Eligibility: Call 1-850-696-4000.
FACTS & MYTHS
MAMMOGRAM RESOURCES
About Breast Cancer • One in eight women will be diagnosed with breast cancer in her lifetime, and every 13 minutes, a woman in the United States dies from the disease. • Except for skin cancers, breast cancer is the most common among American women — one of the leading causes of death, according to the American Cancer Society. • The risk increases with age, and having a first-degree relative also increases a woman’s chance of being diagnosed. • But less than 15 percent of women with breast cancer have a family history. AfricanAmerican women have a higher rate of death from breast cancer than any other race. • The earlier breast cancer is detected, the more likely it can effectively be treated. At stages 0 and 1, cancer cells are confined to a limited area. Stage 2 is still fairly early, but at that point, the cancer has begun to grow or spread. Cancer at stage 3 is considered advanced, when there is evidence of further spreading to surrounding tissues. By the time cancer reaches stage 4, it has spread beyond the breast to other areas of the body. • By age 20, women should perform monthly self-exams to check for abnormalities in their breasts. Clinical breast exams should occur every three years until age 40. At that point, women should be participating in annual mammograms. Depending on family history and genetic tendency, some should be screened with MRI in addition to mammograms. — USA Today
SACRED HEART HEALTH SYSTEM FREE AND REDUCED-PRICE MAMMOGRAMS: Routine screening mammograms are covered by most major insurance plans. The Ann L. Baroco Center for Breast Health also provides a limited number of free and reduced-price mammograms to the uninsured throughout the year through the Ann Baroco Cares program. LOCATIONS: Sacred Heart Health System has two locations: Sacred Heart Hospital in Pensacola and Sacred Heart Medical Park in Pace. REFERRAL: No referral is needed for a routine annual screening mammogram. However, you do need to have a primary care physician for the hospital to send your results to. To schedule a mammogram, 850-416-8078. Details: www.sacred-heart.org. WEST FLORIDA HOSPITAL BREAST HEALTH SERVICES OFFERED: West Florida Hospital was the area’s first hospital to be designated as a Breast Imaging Center of Excellence and is fully accredited by the American College of Radiology. It offers a full range of breast health services. West Florida has an all-female staff of registered and certified mammography technologists. In addition, two board-certified radiologists read all mammograms. West Florida is certified as a Medicare Mammography screening facility. Breast health services include digital mammography, computer-aided detection (CAD), mobile mammography, breast ultrasound, breast MRIs, bone densitometry, stereotactic guided biopsy, ultrasound guided biopsy and MRIguided biopsy. MOBILE MAMMOGRAMS: West Florida Hospital provides mobile mammography services. The mobile unit is a customized 37-foot coach containing dedicated digital mammography equipment that is FDA-certified and accredited by the American College of Radiology. The unit travels throughout Northwest Florida and Southwest Alabama. REFERRALS: Patients do not need an order from their physician to have a screening mammogram, but they must designate a physician to receive the mammogram results. West Florida Hospital offers a discounted rate for mammograms for self-pay patients (uninsured).
To schedule a mammogram, call West Florida Mammography Services at 494-3497 or toll-free 888-894-2113. Details: http://westfloridahospital.com. WOODLANDS MEDICAL SPECIALISTS FACILITY: Woodlands Medical Specialists’ breast health facilities were designed to provide an alternative to the standard experience for breast care. Mammograms and breast biopsies can be stressful, and this facility was designed to create a warm and inviting atmosphere. Its breast health team focuses exclusively on the detection and diagnosis of breast cancer. BREAST-IMAGING SERVICES: Woodlands Breast Health’s GE Digital Mammography system provides physicians with a clear and precise all-digital image rather than just X-ray films. This equipment allows for a large field of view to accommodate the breast size of most women. Woodlands’ imaging services for breast health include digital mammography, breast ultrasound, breast MRI, MRI-guided breast biopsy, ultrasound guided biopsy and stereotactic breast biopsy. REDUCED-PRICE MAMMOGRAMS: Insurance will cover a screening mammogram for women 40 and older. But if insurance does not, Woodlands provides screening mammograms for $99. REFERRALS: Referrals are not needed for a mammogram at Woodlands. However, any physician in the area can refer a patient to Woodlands. Woodlands handles all of the necessary referral paperwork and can transfer records upon the patient’s request. It can accept walk-in appointments and is now open on until 7 p.m. on Tuesdays to accommodate women who cannot schedule daytime appointments. DIAGNOSIS: If a mammogram patient is diagnosed with breast cancer, the Woodlands oncology team is located on-site and can be scheduled to see the patient during the follow-up visit. Its team of board-certified oncologists will help patients understand their diagnosis, develop an individualized treatment plan and coordinate all aspects of treatment and surveillance. The oncology team works collaboratively with other specialists to help expedite the healing process. To schedule a mammogram, 850-696-4000. Details: www.woodlandsmed.com.
NAVAL HOSPITAL PENSACOLA BREAST HEALTH SERVICES: The Naval Hospital has a breast cancer coordinator available to its patients. The Naval Hospital was the first hospital in the Pensacola area to provide this service and the first to have a breast patient navigator certified by the National Consortium of Breast Centers on staff. The breast cancer coordinator guides patients through the diagnosis and treatment of breast cancer or symptoms associated with breast cancer. The coordinator also works with the patient and family to deal with emotional stress associated with breast cancer. PATIENT QUALIFICATIONS: All TRICARE Prime beneficiaries enrolled at Pensacola Naval Hospital are eligible to receive a mammogram there. If you are enrolled, you can call your Medical Home Port Team or Central Appointments at 505-6719 to schedule a mammogram. Mammograms can be scheduled to coincide with other appointments in order to eliminate additional visits. SANTA ROSA MEDICAL CENTER BREAST HEALTH SERVICES: The Women’s Place at Santa Rosa Medical Center offers all-digital mammography, ultrasound, stereotactic breast biopsy and bone densitometry in a spa-like environment. It is the only center in Santa Rosa County with a certified breast health navigator who can provide education and guidance to women facing tough medical care decisions. Hours are 8 a.m. to 4:30 p.m. Monday through Friday. QUALIFIED PATIENTS: The medical center does see uninsured patients, and some of those are self-pay. REDUCED-PRICE CARE: For those who cannot afford mammograms, the medical center works to see if they are eligible for the Florida Breast Cancer Program. Inquire with the office for pricing and eligibility for discounts. The payment is typically due at the time of care, but if someone is unable to pay the full amount, the clinic is able to work with the patient to establish a payment plan. This applies not only to self-pay patients, but also to those who have not met deductibles or have high co-pays. To schedule a mammogram, 850-626-5130.
While rare, breast cancer can affect the young KRISTEN JORDAN SHAMUS, DETROIT FREE PRESS
The pain nagged at Alexandria Miller. Then, she found a lump. When Miller, then a 22-year-old chemical engineering student at the University of Michigan, talked to her doctor about the symptoms in her right breast in June 2014, she was assured it was probably nothing. She had an ultrasound to be certain; the test picked up nothing. And yet, as the summer marched on, Miller knew that what she felt was anything but normal. Her right breast “was red, swollen and hard, and about double the size of my left,” she said. “All of the lymph nodes under my arm were huge. I couldn’t even put my arm down without it hurting, really.” She went back to the doctor, and saw a breast surgeon, but was universally dismissed — despite a family history of breast cancer. “They were like almost mocking me and laughing at me, saying I was being ridiculous because I was so young” it couldn’t be cancer, said Miller, who grew up in Macomb Township. “They made me cry. I just knew something wasn’t right.” By the time she finally was diagnosed with inflammatory breast cancer in October 2014, it had advanced to stage 3 and had spread to her lymph nodes. Having breast cancer at such a young age brings a unique set of challenges, and among the first of many hurdles Miller and other women have to jump is simply getting a diagnosis. STATISTICALLY RARE Statistically, it is very rare for a woman to develop breast cancer in her 20s, said Dr. Otis Brawley, chief medical officer for the American Cancer Society and a professor at Emory University in Atlanta. For women Miller’s age, just 1.4 in 100,000 annually will be diagnosed with breast cancer in the U.S., said Brawley, who grew up on Detroit’s west side and is a member of the Centers for Disease Control and Prevention’s Advisory Committee on Breast Cancer in Young Women. “Sometimes, doctors will have a patient who has a mass, and the line is, ‘Oh, she’s 25. This is not breast cancer. Let’s watch it,’” he said. “It very typically takes three to six months to make a diagnosis of a cancer, which is just unfortunate. There’s a lot of blaming the doctor, but … quite honestly, you simply cannot biopsy every mass.” Other barriers to diagnosis for women in their early 20s include being between doctors —
they’re too old to see their pediatricians but may not have yet found an internist, Brawley said. And though the Affordable Care Act has helped, he said many young women still lack health insurance coverage and don’t seek treatment when they first discover a lump or notice breast changes. Others don’t see a doctor out of fear, disbelief that it could be cancer at their age or because of lack of money or insurance coverage. ‘THEY WON’T LISTEN TO ME’ Initially, Miller’s doctors treated her for a breast infection called mastitis. But the lump, “kept getting bigger, bigger, bigger, and the physician’s assistant kept on dismissing her on the phone, calling her over dramatic,” said her mom, Tammy Miller. “She called me crying, and said, ‘Mom, they won’t listen to me. The lump went from the size of a grape to the size of the plum, but they kept telling us there’s no way this is breast cancer. “They very much dismissed her because she was young.” It was infuriating. “Finally, my mom insisted on a biopsy,” Miller said. “Thank God for my mother.” The day after her diagnosis, Miller moved back home with her parents. She dropped all of her classes and scheduled treatment that would include chemotherapy, a double mastectomy and the removal of 19 lymph nodes along with radiation. She had to put her education on hold to fight for her life. Like so many other women her age with cancer, Miller suddenly had lost her independence, and had to grapple with body image issues as her hair fell out and a surgeon’s knife took her breasts. She had to worry about what her diagnosis might mean to her love life and her ability to one day have children. These are issues that tend to be unique to younger women with cancer, said Megan Nikolich, youth program manager at Gilda’s Club of Metro Detroit, a nonprofit Royal Oak-based cancer support organization. “Some of these women ... might just be starting their careers, or might not be in a serious relationship yet,” Nikolich said. “And they’re forced to put their careers on hold or make certain decisions that would affect their careers. “And what if you are not even in a serious relationship, and you have to decide right now if you might want a family in the future because
your treatment plan might involve a hysterectomy or infertility? That is just something that many women in their 20s are not ready to be thinking about.” EARLY DIAGNOSIS OFFERS HOPE Samantha Steckloff considers herself among the lucky ones. She was rubbing aloe onto her chest, trying to ease the sting of a sunburn in late May, when her fingers passed over a small lump near the top of her bikini. Steckloff, a 31-year-old manager of admissions at Wayne State University happened to have a gynecology appointment coming up the following week, and mentioned it to her doctor. “They didn’t really think it was anything,” said Steckloff, who also serves on the Farmington Hills City Council. “I work out a lot, so they thought maybe it was a calcification. “They said let’s get it checked out anyway.” She was walking through campus a week later when she learned she had breast cancer. “I almost dropped my phone,” she said. “I told my doctor, ‘I’m going to have to call you back.’ I was hysterically crying through campus trying to get to my office.” Her family rallied around her that night — along with the boyfriend she’d met two months earlier on Match.com. “He’s been amazing,” she said of Justin Strong, 33, of Sterling Heights. “If it was any of my former boyfriends, there was no way. They would have run for the door as soon as I got that call. “But Justin left work early, and took me out,” the day of her diagnosis. “He’s come to some of my meetings with my doctors, with my family. “He was there the entire night of my double mastectomy,” Steckloff said. “He stayed in my room with me and made sure my pain meds were coming on time.” Steckloff caught it early. Her cancer was stage 1. It had not yet spread to her lymph nodes. But the type she had would require six rounds of chemotherapy, followed by months of taking the cancer drugs Herceptin and Tamoxifen. Because her treatments were likely to damage Steckloff’s fertility, she started a GoFundMe account to raise the thousands of dollars she would need to pay for egg harvesting. “We got 11 eggs, and nine were mature. So they said when I left, ‘We’ll take care of your babies for a couple of years.’ They were so nice. They knew I had only one shot.” Still, it was awkward, she said. “We spent our four-month anniversary at a fertility clinic. I was like, this is not a normal
relationship. It’s going to show you the true colors of somebody. And if we can make it through this, we can make it through anything.” RISK OF INFERTILITY Steckloff caught her cancer early enough to preserve eggs for use when she’s healthy, and ready to start a family. Miller didn’t have the luxury of time. Her cancer was so aggressive — she has the triple negative form — she needed to start treatment right away. There’s a chance she’s now infertile. “Because my tumor was so large at the time, they just thought it was best if I started chemo right away,” Miller said. “It was something I guess I had to kind of like juggle in my mind. I thought, was it worth it? But at the same time, I knew I’d have to be alive in the first place to have children. So I wasn’t going to wait another month to start chemo and risk the cancer spreading even further. “I guess it wasn’t a hard decision when it came to my life. It’s something that still kind of bugs me. All the time, I think about how if somebody had just taken me seriously in May.” Doctors have said Miller is now cancer free, but she is enrolled in a double-blind clinical trial of a drug that’s been approved for use in women with ovarian cancer. “I am living on campus right now,” she said. Miller wears prosthetic breasts now that are heavy and uncomfortable. It’s been tough knowing she has to wait to have reconstructive surgery. Doctors suggested holding off to make it easier to spot any signs of recurrence, she said, which is most likely within the first two years. Until she has that surgery, Miller said she’ll probably stay out of the dating pool. “I’ve struggled to get back into the dating world,” she said. “I don’t think I will until after I have my surgery. It’s hard for somebody my age to understand what I’ve been through. I don’t want to share that with just anybody. I need to find somebody I can trust. It might not be as complicated as I’m making it, but it’s hard for me.” Steckloff hopes that by sharing her story, she’ll encourage women to do breast self-exams, get mammograms and be more body-aware. Miller’s message is this: “You’re never too young to have breast cancer. Listen to your gut if you think something’s wrong, even if you’re really young.” Contact Kristen Jordan Shamus: 313-2225997 or kshamus@freepress.com. Follow her on Twitter @kristenshamus.