Pink Purpose 2011

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October is Breast Cancer Awareness Month. Pink Purpose honors those who have fought the disease. The Republic encourages women to receive annual screenings to ensure early detection.

A SPECIAL EDITION OF THE REPUBLIC

Dear readers, That pink paper has popped up again this year.

That means it’s time for the special breast cancer awareness section we call Pink Purpose.

The section is a joint effort of The Republic and two sister newspapers, the Johnson County Daily Journal and the Brown County Democrat.

Why a special section about breast cancer?

Simple.

Breast cancer is the most common cancer among women after skin cancer. And, October is Breast Cancer Awareness Month.

We have interviewed doctors, nurses and patients to learn more about the disease, how it affects people, the battle against it and the journeys of survivors.

We hope you will find the information in this section useful and inspirational.

— Kirk Johannesen Special Projects Editor The Republic

FRIDAY, OCTOBER 7, 2011

CONNECTED CANCER by

INSIDE

CATCHY T-SHIRTS AID CANCER FIGHT

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MRI GIVES WOMEN NEW OPTION

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NAVIGATORS CONSTANT IN CARE

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MAN SHARES CANCER BATTLE

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ANDREW LAKER | THE REPUBLIC

Lola Speer, clockwise from bottom left, Sandy Cantrell, Janie Gordon and Betsy Helber comprise a group of women connected through breast cancer and committed to helping others through it.

Breast cancer survivors part of large family motivated to help newly diagnosed

RISK PROMPTS PROACTIVE STEPS

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By Chrissy Alspaugh, calspaugh@therepublic.com

T

HE paths of Betsy Helber and Lola Speer had

She couldn’t help noticing that not all of the

never crossed. The two were connected only

women receiving treatment around her had the

through breast cancer — paying forward sup-

same kind of support.

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Helber was there for Gordon’s first day of chemo.

She sent prayer books, pink M&Ms and was there

So when an acquaintance found out she had

to cheer her on for her last day of treatment. Most

“For me, personally, being a breast cancer sur-

breast cancer in late 2008, Helber jumped in. She

importantly, Helber was there to field 3 a.m. phone

vivor, having people to support me along the way

texted messages of support, went along for doctor

calls, and she could answer questions too personal

made my journey much easier,” Helber said. “The

visits, gave gifts on chemotherapy treatment days

to ask doctors.

hope is that any help I can give to someone makes

and gave the woman a crown when her hair began

“Not only are you dealing with a potentially

their journey easier.”

to fall out. It was the first of about 20 times Helber

terminal illness, you’re dealing with a total image

has mentored breast cancer patients.

change as a woman,” Gordon said.

port they’d received during treatment, actually.

HUSBAND’S ROLE AS INFO KEEPER

tances before cancer.

Helber, who lives in Center Grove, was diagnosed with breast cancer in March 2007. A strong group

One of those women was Columbus North High

of family and friends stood by her side through

School choir director Janie Gordon, who was diag-

eight rounds of chemotherapy, a bilateral mastec-

nosed in June 2009. The women’s husbands work

tomy and reconstructive surgery.

together, but they were little more than acquain-

“I don’t think we know who else to go to than other women who know what we’re going through.”

Gordon became the support system when

See CONNECTED on Page C11

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The Republic, Columbus, Ind., Friday, October 7, 2011

After skin cancer, breast cancer is the most common cancer among women, accounting for approximately 1 in 4 cancers diagnosed in U.S. women.

PINKpurpose PAGE C3 The Republic, Columbus, Ind., Friday, October 7, 2011

Finding a cure, priceless

Rothrocks’ T-shirt slogans aid in battle against breast cancer

BY CHRIS SCHILLING cschilling@therepublic.com For Paula Rothrock, inspiration springs forth onto cotton and in bright colors.

It comes with catchy sayings and fun designs.

This year it’s tie-dyed and football themed.

But always, it serves one purpose.

Rothrock wants women to take breast cancer seriously but have fun doing so.

That’s why she and her husband, Paul, design and sell T-shirts every year to raise money for breast cancer research and mammograms.

Paula survived breast cancer.

She discovered AGE: 52 the cancer during JOB: Registered nurse its early stages at Columbus Regional in 2008. Less than Hospital Emergency three months Department. later, on a January day in 2009, HUSBAND: Paul she underwent a CHILDREN: Erika Burton, double mastecNathan Perry, Lillian tomy and reconVannice, Penny Ahrmann structive breast DISCOVERED BREAST CANCER: surgery, all in one Nov. 11, 2008. day.

TREATMENT: Double The two-doctor mastectomy on Jan. 23, procedure moved 2009. along efficiently.

Rothrock went into surgery at 8 a.m. and left by 5 p.m.

Paula’s experience with the disease motivated her and Paul to make T-shirts to raise money and awareness.

“It’s easy, everybody loves a T-shirt, and you get them in cool colors,” Paula, a registered nurse at Columbus Regional Hospital’s Emergency Department, said in mid-September while showing some of their designs.

One design proclaims, “We’ve taken our lumps.”

Another spells out like an old MasterCard commercial: “Mammogram assistance program, $5; Double Mastectomy, $20,000; Finding a cure, Priceless.”

Paula’s favorite came about this spring when she and Paul were designing shirts for the Susan G. Komen Race for the Cure in Indianapolis.

It featured a tie-dyed design and a graphic of a heart with a ribbon in it. “Share the love,” it says in 1960s-style lettering.

This fall, the Rothrocks will debut their fourth design.

Paula said they are planning a blue-andwhite, football-themed shirt with a pink football on it. The shirt will carry messages that say “Tackling the cure” and “Don’t be blindsided.”

When Paula discovered a lump in her breast while vacationing in Florida on Nov. 11, 2008,

Paula Rothrock

ALTON STRUPP | THE REPUBLIC

Breast cancer survivor Paula Rothrock shows off the T-shirts she and husband, Paul, have designed to raise money for the Susan G. Komen Foundation and Columbus Regional Hospital’s mammography assistance program. she didn’t feel blindsided.

She had mammograms performed regularly since she was 30, and the way the lump felt did not overly concern her.

“I wasn’t anxious about it at all,” she said.

Paul felt differently. He panicked.

“I was almost uncontrollable,” he said.

Doctors initially found no reason to be concerned. But after a biopsy, the Rothrocks learned Paula had cancer.

She attributed her quick turnaround, from finding the lump to the double mastectomy, to early detection, research, knowing her body and the support of her spouse.

“Every day I would sit in front of the computer and read more and more and more,” Paula said. “I don’t know where it came from, but it’s gone now.”

The Rothrocks found out after the mastectomy that there were three other smaller masses growing that weren’t there when they discovered the first lump.

“Then you go, ‘How fast was that thing growing?’” Paula said.

The idea for the shirts first came about after Paula joined the hospital’s “Breast Buddies” Race for the Cure team, which had shirts made for their participation in the race.

After that, the Rothrocks decided to start designing and selling their own shirts.

They design shirts in the spring for the Race for the Cure and in the fall for Breast Cancer Awareness Month.

The shirts are advertised through word of mouth and emails, and orders keep growing with each new design.

They went from selling about 100 shirts the first time around to 250 this spring.

Paula said they plan to have about 300 printed for the fall.

All the profit from the shirts, which usually amounts to $5 to $7 per shirt, goes to the Susan G. Komen Foundation or the CRH Breast Center mammogram assistance program.

The shirts also make those who wear them a promoter for breast cancer awareness.

“It’s very nice. Some people will become very relaxed and just want to talk,” Paula said. “They’ll have questions. I say, ‘If it doesn’t feel right, get it checked out.’ You’ve got to know your body.”

Rothrock said she never thought she would be marketing T-shirts and be so involved in supporting breast cancer awareness.

“It happened for a reason,” she said.

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The chance that breast cancer will be responsible for a woman’s death is 1 in 35, or about 3 percent.

The Republic, Columbus, Ind., Friday, October 7, 2011

Breast MRI gives women new option

BY PAUL MINNIS pminnis@therepublic.com Just two years ago, mammograms were the be-all and end-all for detecting and treating breast cancer at Columbus Regional Hospital.

Women who wanted breast magnetic resonance imaging — a noninvasive procedure that uses a magnetic field, radio frequencies and a computer to produce detailed pictures inside the breast — had to go to larger cities like Indianapolis.

Today, however, the test is available at Columbus Regional and the Breast Health Center.

Dr. Jay Jones, a radiologist at the health center, said the hospital already had MRI machines but spent thousands of dollars to modify them for breast imaging.

The process has pros and cons compared with traditional mammography.

Mammography, which uses X-rays instead of magnets, is less expensive, takes less time and is better at detecting cancer during routine screening, Jones said.

Breast MRI involves less breast compression and provides doctors with a better look at the extent of any cancer.

Mammography generates two-dimensional pictures for doctors to examine, while MRI shows all the cross sections, Jones said.

Unlike mammography, MRI involves injecting a contrasting agent that gives doctors an idea of a tumor’s size based on blood flow.

Benefits of the injections are obvious. But a big disadvantage compared to mammograms is that the process involves the injections at all.

Columbus Regional and the Breast Health Center use MRI most commonly to determine the extent of cancer before surgery, Jones said.

He said mammography is the better choice for screening.

People can choose mammography without breast MRI, he said, but should never do MRI by itself.

The Breast Health Center has performed about 50 breast MRIs a year since the service began in 2009, Jones said. The center performs perhaps 8,000 mammography screenings per year.

“Mammography definitely is a lot more popular,” Jones said, “but it’s nice to be able to give our patients another option.”

Preparing

ALTON STRUPP | THE REPUBLIC

Columbus Regional Hospital MRI technologist Steve Low works on preparing a special breast-scanning table for a patient.

Pink Purpose In Brief Survivors event

for MRI

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SEYMOUR — Schneck Medical Center’s second cancer survivor event, “Celebrating Life,” is 5 to 7 p.m.

Thursday at the Schneck Cancer Center.

All people affected by cancer and their families, friends, and caregivers are invited to celebrate their fight against this disease.

The open house will feature free hand and foot massages, tours of the cancer center and an art competition and exhibition.

Pink Philharmonic

The Columbus Indiana Philharmonic will celebrate the 25th anniversary of Breast Cancer Awareness Month by inviting people to wear pink clothing at Saturday’s concert featuring guest artist Charles Webb.

The concert is at 7:30 p.m. at Columbus North High School’s Judson Erne Auditorium.

Concert seating starts at 7:05 p.m. A pre-concert discussion with David Bowen, the philharmonic’s music director, is at 6:40 p.m.

Tickets start at $10 for adults, $9 for seniors and $5

for students. Tickets and information: 376-2638, ext. 110; or thecip.org.

Town’s pink event MEDORA — A 5k run/ walk headlines a community breast cancer awareness event here Saturday.

The run/walk will take place at 8:30 a.m. Participants should meet at the gym entrance of Medora High School, on Riley Street. Cost is $15 until today and $20 afterward.

A community walk will take place at 11 a.m. and will begin in front of the 237 Building on George Street.

People also can take part in a car cruise-in, for a $10 fee.

Money raised will be used to buy gas and food gift cards for people battling breast cancer.

Health care information booths, craft booths, food, children’s games and live entertainment also will be part of “HOPE — Medora Goes Pink.”

Register for the run/walk at State Bank of Medora, Medora School, Qwik Stop, Krazy Kats or mag7raceseries.com. Information: Debi Wayman, 966-2754 or Tammy Wilson, 966-2825.

— Staff Reports

The Republic, Columbus, Ind., Friday, October 7, 2011

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Breast cancer is the second-leading cause of cancer deaths in women, after lung cancer.

The Republic, Columbus, Ind., Friday, October 7, 2011

Navigators provide constant for cancer patients

BY ANDREA ZEEK azeek@therepublic.com There are few phrases as life-altering as this one: “You have cancer.”

Questions zoom through your mind: How bad is the cancer? What about treatment, and how will you pay for it? What do you tell your family, your friends?

To bear the burden alone, said Columbus resident Marilyn Hinton, would have been unimaginable.

That’s why Hinton, who received a breast cancer diagnosis in 2010, said she was so grateful to have Columbus Regional Hospital’s team of breast health navigators by her side.

“They were there when I needed them,” Hinton said. “They, as well as the doctor, helped to calm my fears. Any questions I had, they had all the answers, more or less.”

CRH’s Breast Health Center employs three nurse navigators, Deana Tuell, Tammy Creech and Beth Staker, who serve as resources for breast cancer patients, from biopsy through treatment. The nurses attend patients’ appointments and are available to answer questions by email, text message and even latenight phone calls.

New approach The navigators program — the first of its kind in southern Indiana — was started at the hospital in 2000, when Tuell, manager of the Breast Health Center, said she saw a need. “(Patients) had to digest it all themselves,” she said.

Tuell said she remembered trying to support her mom, who died of breast cancer at age 48, with little guidance.

“There was no one,” she said. “I don’t want anyone else to go through what I did.”

CRH’s nurse navigators are part of a trend toward more individualized cancer care.

In 2007, Schneck Medical Center in Seymour started a breast health navigators program.

Recently, Schneck added a nurse practitioner who specializes in breast cancer

and reconstructive options. Schneck also has a breast health clinic that provides preventative care for women who are at high-risk for breast cancer.

Decatur County Memorial Hospital and St. Vincent Jennings Hospital have preventive care options available, such as mammograms and other screenings.

Tuell said the success of the Breast Health Center’s navigators program has prompted CRH officials to think about expanding the service to patients with other types of cancers.

Breast cancer, she said, was chosen first because of the huge emotional impact it has on patients and the number of people — one in every 12 women — affected by the disease.

Dr. Michael Dorenbusch, one of three surgeons who perform breast surgeries at CRH, said the nurse navigators also are a great resource for doctors.

Better relationship Before the navigators program, Dorenbusch said, doctors would tell patients their diagnosis and treatment options in one conversation, which didn’t always work so well.

“As soon as they hear that word, ‘cancer,’” they shut down, he said.

Now, navigators have an initial conversation with patients, Dorenbusch said. Then, navigator and patient will meet with a doctor together. “(The nurses) will prod with other questions,” he said. “At the end of the meeting, I always ask the nurse navigator if she has anything else to add.”

Nurse navigators know patients on a more personal level — something Dorenbusch, who typically spends half his workday in the office and the other in surgery, just doesn’t have enough time to do.

But most important, he said, having a navigator helps patients, who, through the course of treatment, are bounced around to several different specialists and buildings.

“It’s nice to have a constant,” Dorenbusch said.

Local navigators z Columbus Regional Hospital — Breast Health Center, phone: 3765064; website: crh.org/services/breast-health-center. z Schneck Medical Center (Seymour) — Cancer Center; phone: 5220408; website: schneckmed.org/FindAService/SchneckCancerCenter.

JOE HARPRING | THE REPUBLIC

Deana Tuell was the original nurse navigator for breast cancer patients at Columbus Regional Hospital. Today, Tuell is joined

by Tammy Creech and Beth Staker as navigators, nurses who serve as resources for breast cancer patients.

Risk assessments indicate cancer chances, help with options

BY KIRK JOHANNESEN johannesen@therepublic.com Deana Tuell knows she’s at risk for breast cancer, and it’s not just because her mother had the disease.

She has received a detailed risk assessment, which indicates her chances of developing breast cancer in the next five and 10 years, and for the rest of her life.

Tuell, a breast health nurse navigator with Columbus Regional Hospital, has a greater risk of developing breast cancer than other women her age, 50, according to a model CRH’s Breast Health Center prefers. Her risk is more than three times greater for 10 years and lifetime because her

mother had breast cancer, and she’s had biopsies for lumps — that proved non-malignant — in her breasts.

While that information can be difficult for some women to digest, she said, it’s an important tool in making decisions about one’s future health.

Tuell said knowing she’s more prone to breast cancer has made her vigilant with tests. She performs a self-examination monthly, and she notifies her doctor of any changes. She also has a breast exam by a doctor and a mammogram each year.

“My mom died when I was 23. …

Breast cancer took her life. They did not do this kind of testing then. No one ever talked to me about being high risk,” said Tuell, who has a 23-year-

old daughter.

“It wasn’t until I got into breast health, and learned all I learned about breast health, that it came to pass that, ‘Oh, gosh, I need to do some of these tests and see what I am.’”

Informative tool At the Breast Health Center, Tuell has helped women learn their risk for breast cancer with assessments.

They use personal information to give a best estimation of a person’s chances of developing breast cancer, although which information is used depends on the assessment model, of which there are several.

Determinant information includes

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The Republic, Columbus, Ind., Friday, October 7, 2011

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Death rates from breast cancer have been declining since 1990. The declining rates are thought to be due to earlier detection through increased screening and awareness.

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The Republic, Columbus, Ind., Friday, October 7, 2011

ON LIVING: ZeBell focuses on life instead of aggressive cancer

BY CHRISSY ALSPAUGH calspaugh@therepublic.com When Judy ZeBell learned in 2006 that her breast cancer had returned, she didn’t want to know too many of the details or hear any of the worst-case scenarios.

Especially since her kind of cancer — HER2-positive, which accounts for about 20 percent of breast cancers — grows and spreads the fastest.

“I tried not to think about it, because that just creates tension and anxiety,” said ZeBell, who believes that stress makes the body less able to fight cancer. “So I just told the doctors to do what they had to do.”

HER2, or Human Epidermal growth factor Receptor2, is a gene in the DNA of each normal breast cell that helps the cell grow. The gene contains information for making the HER2 protein.

In HER2-positive breast cancer, the cells have too many HER2 genes, and the excess protein is thought to make cancer cells grow and divide more quickly, according to the Mayo Clinic.

Dr. Anita Conte, a hematology and oncology specialist at the Cancer Center at Columbus Regional Hospital, said very effective, targeted treatments have made HER2 breast cancers some of the most successfully treatable.

“It has become one of the better types (of cancer) to have because we have such effective treatments,” she said.

Ongoing battle Today, all breast cancers are tested for the HER2 gene, but ZeBell doesn’t know whether her first breast cancer in 1996 was tested or not.

She was diagnosed at age 42 through a mammogram with Stage I tubular carcinoma in her right breast and was treated with a lumpectomy and ra-

Judy ZeBell AGE: 57 RESIDENCE: Brown County.

BREAST CANCER: Stage I tubular carcinoma in 1996; Stage I invasive ductal carcinoma, HER2positive in 2006.

HUSBAND: Dennis ZeBell.

IN HER WORLD: Working as a part-time dental assistant at North Park Dentistry in Columbus and riding motorcycles. diation.

In 2006, she noticed a lump in the same breast during a self-exam but was uncertain whether she was feeling scar tissue since she’d had a mammogram just six months earlier.

A biopsy confirmed that it was Stage I invasive ductal carcinoma that was HER2positive.

ZeBell and her husband, Dennis, were in the early stages of having a cabin built in Brown County and initially planned to cancel the project.

But she decided that she was going to keep her mind off of cancer by carrying on with her regular life: picking out trim and doors and mowing the grass.

ZeBell underwent six weeks of chemotherapy, a year-anda-half of Herceptin treatments — which target HER2 cancer cells — and a mastectomy.

She had reconstructive surgery in November 2007, but two months later the incision opened and an infection forced doctors to remove the prosthetic implant.

Despite everything she’d been through, ZeBell said the “hardest blow” came in February 2009 when Dennis lost his job of 31 years.

She told her doctors that without insurance, she would have to stop taking Arimidex — a drug that starves HER2

JOE HARPRING | THE REPUBLIC

Breast cancer survivor Judy ZeBell relaxes at her Brown County home. ZeBell found the distraction of construction, and sharing that common purpose with her husband, Dennis, a few years ago, to be therapeutic as she twice battled cancer. cancers of estrogen and costs $386 per month. Fortunately, pharmaceutical company AstraZeneca agreed to provide it for free.

Staying positive Dennis started a new job in Franklin in August, and Judy continues with annual blood tests to make sure she’s cancer-free.

She eats healthier and tries to limit her stress, but doesn’t spend much time wondering whether the cancer will come

back.

“I could just as easily get in a wreck today,” she said. “I just leave it in God’s hands.”

Judy said battling breast cancer has strengthened her faith and her marriage.

The best advice she has for others with cancer?

“You’ve got to be positive, and surround yourself with positive people. And don’t be afraid of all the worst-case stories people will tell you.

Everybody’s different, so form your own opinion.”

About HE

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The Republic, Columbus, Ind., Friday, October 7, 2011

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The Republic, Columbus, Ind., Friday, October 7, 2011

230,480

The estimated number of new cases of breast cancer that will be diagnosed in women in the U.S. this year.

2,140

The estimated number of cases diagnosed in men.

Genetic mutation increases cancer risk

BY BORIS LADWIG bladwig@therepublic.com

JOE HARPRING | THE REPUBLIC

Carol Fritts, right, and her daughter, Dawn McGraw, stand in front of a micrograph illuminating the BRCA mutation that increases a patient’s cancer risk.

SHARING THE FIGHT

Family, faith help mother, daughter endure cancer together

BY BRENDA SHOWALTER bshowalter@therepublic.com Mother and daughter Carol Fritts and Dawn McGraw went through a bonding experience they wish never would have happened.

Both were diagnosed with breast cancer, and they went through chemotherapy together in 2009.

Fritts also has spent the past two years fighting ovarian cancer.

“We lost our hair, eyebrows and eyelashes at the same time. Just too much togetherness for me,” said Fritts, as she talked at her Columbus home.

The shared experience was difficult for the women on many levels, including that they wanted to be there to support each other, but were struggling with their own illnesses.

Although Fritts and McGraw celebrated the end of chemotherapy with a party in September 2009, their medical journey has continued.

Ongoing fight Fritts was diagnosed with breast cancer in 2001 and with ovarian cancer in 2009 and 2010.

McGraw, 37, who lives in Indianapolis with her husband, Mike, and their two children, spent about two years dealing with chemo, radiation and reconstruction surgery.

She also will have a hysterectomy this month after genetic testing, called BRCA Analysis, and blood tests showed she was at high risk for developing ovarian cancer.

This was the most difficult decision McGraw has had to face.

“I love being a mother, and I would love to have more children,” said McGraw, whose daughter, Kate, is 5 and son, Joshua, is 3.

Carol Fritts

Dawn McGraw

AGE: 62 RESIDENCE: Columbus.

FAMILY: Husband, Orie, died in 2006; daughter, Dawn McGraw; sons, Joe, Kevin and Jeffrey Fritts; 8 grandchildren.

CANCER JOURNEY: Diagnosed with breast cancer in 2001 and with ovarian cancer in 2009 and 2010.

AGE: 37.

RESIDENCE: Indianapolis.

FAMILY: Husband, Mike; daughter, Kate; son, Joshua; brothers, Joe, Kevin and Jeffrey Fritts; mother, Carol Fritts.

CANCER JOURNEY: Diagnosed with breast cancer in 2009.

What also is frightening for McGraw is that the results from the gene testing she and her mother went through were positive, meaning that her children have a high risk of cancer and should be tested once they reach their mid-20s.

McGraw’s daughter will be at risk of breast and ovarian cancer, and her son, breast and prostate cancers.

Fritts has been thankful for her son, Kevin, who came to live with her after her husband died. He helps with another son, Jeffrey, who has muscular dystrophy and also lives with her.

“I don’t know what I would have done if (Kevin) wasn’t here,” Fritts said.

Through all the challenges, the mother and daughter have faced the realities of their situations and armed themselves with information to help them make the best decisions possible.

In some cases, the facts and decisions have been heart wrenching.

“In ovarian, there is no cure. You just deal with it,” said Fritts, who feels lucky that she has had more energy recently to be able to spend time with her grandchildren.

Over the last two years, dealing with the disease has included days of complete exhaustion, pain and missing out on time with her family.

Fritts also has had to deal with other family and health matters, including rheumatoid arthritis, a heart attack and the death of her husband, Orie, while he was on a business trip to China in 2006.

Help important Despite the difficult times the mother and daughter have faced, Fritts and McGraw feel they are stronger people today because of what they’ve been through. They also learned to accept help, even though they wanted to help themselves.

“I realized how much people loved me,” said McGraw, a former secondgrade teacher who now stays home with her children.

She said her husband was with her every step of the way, and her children loved her no matter how she looked or how sick she was.

McGraw was thankful for the many friends, family members and church friends who brought her meals, drove her to chemotherapy, helped with her children, cooked meals and sent flowers and cards.

Recommend testing She hopes that something good can come out of her struggle by recom-

mending women have BRCA testing if they have a family history of breast and ovarian cancer.

Fritts wonders if she had known about the testing earlier if she could have prevented her ovarian cancer by having a hysterectomy.

Fritts has two sisters and a niece who already have gone through mastectomies and hysterectomies because they all were BRCA positive — even though they had not been diagnosed with cancer.

One sister, however, learned from the post-surgery pathology report that early-stage cancer cells were in her breasts, even though she didn’t know it.

Fritts also has another sister who has had two occurrences of ovarian cancer.

McGraw recommends women listen to their bodies and see their doctors when they suspect there is a problem.

She first noticed the lump in her breast while breast-feeding her son.

She also recommends regular cancer screenings, including mammograms and Pap smears.

Ovarian cancer, however, has no definitive screening test and often is caught too late to be cured.

McGraw only hopes strides in cancer research and cure rates can be made by the time her children are grown.

Fritts becomes emotional when talking about how important her faith was through the process and how thankful she was for the support McGraw’s church, Fall Creek Wesleyan in Fishers, showed her daughter.

“They really showed the love of Jesus,” McGraw said.

“Having God to turn to,” Fritts said, “is the only way I was able to handle the things life has thrown my way.”

When Beth Ann Sullivan found out that her breast cancer might have been caused by a genetic mutation, she worried about her children and grandchildren.

Sullivan, a Columbus resident, was diagnosed with breast cancer in February 2010, at age 55.

Her older sister Ronda, of Texas, had cancer at age 57.

Their mother had breast cancer.

Their maternal grandmother had cancer.

Their paternal grandmother had cancer in her 20s.

With that family history, Beth, an outside plant engineer for AT&T, had been getting mammograms regularly since age 40.

After her diagnosis and biopsy, she discussed with her surgeon hereditary mutations of the BRCA1 and BRCA2 tumor suppressor genes. The mutations increase a patient’s risk for developing breast and ovarian cancers.

“In normal cells, BRCA1 and BRCA2 help ensure the stability of the cell’s genetic material (DNA) and help prevent uncontrolled cell growth,” according to the National Cancer Institute. “Mutation of these genes has been linked to the development of hereditary breast and ovarian cancer.”

The mutations likely occurred several hundred years ago and have been passed on through the generations, said Dr. Anita Conte, hematology and oncology specialist at Columbus Regional Hospital’s Cancer Center.

She said doctors will recommend — and insurance will cover — the tests for everyone who meets certain criteria, including anybody 50 or younger with a family history of breast or ovarian cancer and women who are diagnosed with cancer at age 45 or younger.

Without insurance, the test costs several thousand dollars.

See MUTATION on Page C11

When to get tested Your doctor might recommend that you get tested for a mutation of the BRCA genes in the following situations: z A woman with breast cancer diagnosis at age 45 or younger. z Anybody 50 or younger with family history of breast or ovarian cancers. z Younger than 60 with triple-negative breast cancer. z Ashkenazi Jewish descent. z Breast cancer diagnosis with previous ovarian cancer. z Male breast cancer.

— Source: Dr. Anita Conte, hematology and oncology specialist at CRH Cancer Center

Open House -Wednesday, October 12th 10am-2pm

Come See Our Pink!

Early detection.

A bright idea.

1697 W. Deaver Road, Columbus IN 47201 • 812.372.2546 • www.bcremc.com

Inside Cancer Care Center 200 S. Pine St., Seymour 812-523-5231

Bevers Home Health Boutique

PINKpurpose

Breast cancer is expected to claim 39,520 lives this year.

PAGE C11 The Republic, Columbus, Ind., Friday, October 7, 2011

MUTATION Continued from Page C10

Beth learned in early 2010 that her cancer was the same as the one her older sister had developed.

After Ronda tested positive for the genetic mutation, Beth submitted to the blood test as well. She also was positive.

The mutation also could have passed to another sister, Nancy, who has had abnormal mammograms but not cancer.

She has not been tested, Beth said.

The mutation also could have been passed to her three brothers, and they can pass it to their children. None of the brothers has been tested either, Beth said.

After testing positive for the mutation, Beth’s thoughts turned immediately to her two daughters, Jennifer, 36, and Carrie, 39, and Jennifer’s children.

Conte urges patients to talk to their physicians about the potential test results and what a positive diagnosis could mean.

Though most patients can deal with the repercussions of being diagnosed with the mutation, some, especially if they lack family support, risk depression, she said.

Some patients also don’t want to know whether they have the mutation, because they don’t want to worry their whole lives about getting cancer.

When Beth told her younger daughter, Jennifer, about having the mutation, her daughter immediately called her doctor

Mutation facts

to get tested.

Getting the results took three to four weeks, in which Beth kept thinking about what a positive result might mean for her daughter and her two children.

Beth wondered: How would the mutation affect Jennifer?

Would she have to get mammograms earlier? More often?

What about the grandchildren?

“It was excruciating … the worry,” Beth said.

Jennifer tested negative.

She did not have the mutation.

“To find out that she was negative was very emotional for me,” Beth said.

In part because it meant Jennifer’s children would not have the mutation either.

Beth said she understands

the downsides of getting tested, but she prefers knowing whether she has an increased risk.

She said she also did not want to worry her whole life about possibly having passed the gene to her children.

And, she said, having the information allows patients to prepare and take actions, such as more frequent mammograms or MRIs to catch any potential cancer early.

Beth, who had cancer on her left breast, also had a prophylactic mastectomy and reconstruction on her right breast.

She also had a prophylactic hysterectomy, because the mutation increases the chance of ovarian cancer.

Beth is healthy today. So are her siblings and children.

Some high-risk women follow up with a test to see if they have the breast cancer gene, she added. BRCA testing looks for a genetic marker that predisposes people to breast cancer.

“What it helps us determine is their risk of developing cancer in the future, both breast cancer and ovarian cancer,” said Dr. David Thompson, a Columbus surgeon who treats

breast cancer patients.

Women who learn they have the BRCA gene sometimes are proactive and have mastectomies, to prevent the possibility of developing breast cancer later.

Being proactive, such as with self-examinations, mammograms and risk assessments, is the best way to prevent breast cancer, Tuell said.

RISK

Continued from Page C6 relatives with breast cancer and how far removed from you they are on the family tree, a woman’s age when she had her first menstrual period, a woman’s age when she first gave birth, height, weight and previous biopsy results.

Many women who learn they are at greater risk become vigilant with self-examinations and yearly breast exams and mammograms, Tuell said.

Mutations of two tumor suppression genes, BRCA1 and BRCA2, can increase the risk of getting cancer over one’s lifetime.

HEREDITY: Half of all women with a BRCA mutation inherited it from their fathers.

RISK: Women with a BRCA mutation have a 33 percent to 50 percent risk of developing breast cancer by age 50, and a 56 percent to 87 percent risk by age 70. They also have a 27 percent to 44 percent chance of developing ovarian cancer.

OTHER CANCERS: BRCA mutations increase the risk for other cancers, including up to a 6 percent risk for male breast cancer.

GEOGRAPHY: Certain mutations of the BRCA genes are more common among people of Ashkenazi Jewish (central or eastern European) descent. Whereas the general population has a 1 in 300 to 1 in 800 chance of having a mutated BRCA gene, the chance for Ashkenazi Jews is 1 in 40.

IF YOU HAVE THE MUTATION Dr. Anita Conte suggests you talk to your: z Breast surgeon to discuss prophylactic mastectomy. z Gynecologist to discuss prophylactic oophorectomy (surgical ovary removal) and the impact of oral contraception. z Medical oncologist to discuss hormonal therapy and a more intensive screening schedule that might include earlier mammograms along with MRIs. — Source: Myriad Genetic Laboratories Inc., Dr. Anita Conte, hematology and oncology specialist at Columbus Regional Hospital Cancer Center

CONNECTED Continued from Page C1

Columbus North teaching assistant Linda Mustard learned that she had breast cancer in March 2010.

Gordon joined her in wearing pink bracelets, loaned her wigs and led more than a few prayers. What Mustard remembers most is the day she met Gordon at Bob Evans for lunch, and Gordon taught her how to turn a T-shirt into a head scarf in the restaurant’s bathroom.

“Just knowing that somebody else could make it through it helped,” Mustard said. “It’s a club you never want to be a part of, but once you’re in, it’s nice to know that you’re not alone.”

Gordon also is helping Sandy Cantrell, who attends church with Gordon’s parents, through her battle against breast cancer. Cantrell was awaiting biopsy results that would determine whether or not she had cancer this spring when she attended the Courage to Climb concert, raising funds for all kinds of cancer and organized by Gordon.

Cantrell said hearing Gordon tell her story on stage and hearing the uplifting music gave her hope.

The support she received from Gordon throughout her cancer treatments helped Cantrell switch roles into mentor and advocate when her mother, Lola Speer, was diagnosed with breast cancer in August.

Speer, 87, said she was scared upon learning of the diagnosis, but her daughter’s support and personal experience with the disease provided comfort.

“She knows what I am going through and knows what we’re going to do next all the time,” Speer said.

“Anytime you hear the word ‘cancer,’ it makes you scared.

“It really does help when people are there who understand.”

Want to talk?

Some of the local ways to connect with other breast cancer patients and survivors: z Columbus Regional Hospital’s Breast Health Center connects individuals at any stage in their battle against breast cancer with survivors upon request. Information, 376-5064. z Community Breast Care South, 533 E. County Line Road, Suite 101, in Greenwood, hosts a breast cancer support group from 6 to 8 p.m. on the second Thursday of each month. Information, Sharon Bronnenberg, 317-887-7332 or Amanda Wood, 317-4976939. z Schneck Medical Center in Seymour operates a breast cancer support group called Reach to Recovery, an American Cancer Society program, which is open to anyone with breast cancer and their families and friends.

The group’s next meeting is planned from 5 to 7 p.m. Thursday at Schneck Cancer Center’s conference room, 411 W. Tipton St. Information, Sally Acton, 522-0480. z St. Vincent Jennings Hospital connects breast cancer patients with a support group at St. Vincent Breast Cancer Center in Indianapolis. Information, 352-4200. z Decatur County Memorial Hospital connects breast cancer patients with local volunteers through American Cancer Society programs, such as Reach to Recovery. Information: 663-1301.

C12

The Republic, Columbus, Ind., Friday, October 7, 2011

D

PURPOSE

SECTION

PINK BREAST CANCER STATS

Diagnoses 2000-04

A SPECIAL EDITION OF THE REPUBLIC Mark Boas thanks a man he never met and the color pink for saving his life from a disease he thought affected only women.

In October 2010, a pink newspaper at his mother’s house caught Boas’ attention. The Oct. 15 edition of The Republic contained a special breast cancer awareness section, and the entire paper

FRIDAY, OCTOBER 7, 2011

was the color that has become synonymous with the cause.

But had it not been for a story about Hope resident Larry Shepherd’s ordeal with breast cancer, Boas might have continued to ignore a lump in his sore left breast that had been bugging him for a month.

Mark Boas

Both genders Indiana: 20,981 Bartholomew County: 259 Brown County: 59 Decatur County: 65 Jackson County: 159 Jennings County: 85 Women Indiana: 20,830 Bartholomew County: 258 Brown County: 58 Decatur County: 64 Jackson County: 158 Jennings County: 85

AGE: 56 RESIDES: Columbus EMPLOYER, JOB: Edinburgh Premium Outlets, maintenance, DIAGNOSED: December 2010 TREATMENTS: Mastectomy, chemotherapy, radiation PARENTS: Joe (deceased) and Wilda Jean Boas SIBLINGS: Brothers, Randy, Greg, Tracy; sisters, Della Dolan, Susan Johnson

Diagnosis rates ’00-’04

Male breast cancer facts

Per 100,000 residents Indiana: 67.9 Bartholomew County: 68.5 Brown County: 68.4 Decatur County: 48.9 Jackson County: 73.7 Jennings County: 64.4 Per 100,000 women Indiana: 123.7 Bartholomew County: 125.1 Brown County: 133.2 Decatur County: 89.9 Jackson County: 132.6 Jennings County: 120.7

The ratio of female to male breast cancer in the U.S. is 100 to 1.

Breast cancer will be diagnosed in about 2,140 men this year, and about 450 will die from the disease.

The overall incidence rate of breast cancer is 1.3 men per 100,000 but 123 women per 100,000.

The number of breast cancer cases in men has been stable over the past 30 years.

The lifetime risk of a man getting breast cancer is about 1 in 1,000.

Common symptoms of male breast cancer are a lump or hard knot in the chest area, skin dimpling or puckering, redness of the breast, itchy or scaly sore or rash on the nipple, nipple discharge.

Because the male breast is smaller than the female breast, it is more likely the disease will spread to the chest wall.

Factors that increase the risk of breast cancer in men include genetic conditions, family history, chronic liver disorders, alcoholism, obesity, older age, radiation exposure, liver disease, estrogen treatments, testicular conditions.

Breast cancer deaths ’00-’04 Indiana, both genders: 4,593 Indiana, women: 4,533 Bartholomew County: 58 (all women) Brown County: 15 (all women) Decatur County: 13 (all women) Jackson County: 23 (all women) Jennings County: 12 (all women)

Death rates ’00-’04 Per 100,000 residents Indiana: 14.9 Bartholomew County: 15.6 Brown County: 18.2 Decatur County: 9.7 Jackson County: 10.7 Jennings County: 10.1 Per 100,000 women Indiana: 25.9 Bartholomew County: 27.3 Brown County: 31.7 Decatur County: 17.6 Jackson County: 19.8 Jennings County: 17.2

See FACTS on Page D3

one man’s ordeal, another man’s

Diagnoses 2004-08 Both genders Indiana: 20,647 Bartholomew County: 230 Brown County: 53 Decatur County: 72 Jackson County: 142 Jennings County: 67 Women Indiana: 20,497 Bartholomew County: 227 Brown County: 52 Decatur County: 71 Jackson County: 142 Jennings County: 67

Diagnosis rates ’04-’08 Per 100,000 residents Indiana: 63.0 Bartholomew County: 56.0 Brown County: 54.1 Decatur County: 52.2 Jackson County: 61.5 Jennings County: 45.7 Women Indiana: 115.9 Bartholomew County: 102.4 Brown County: 103.5 Decatur County: 76 Jackson County: 114.5 Jennings County: 87.3

Breast cancer deaths ’04-’08 Indiana, both genders 4,461 Indiana, women: 4,418 Bartholomew County: 62 (all women) Brown County: 7 (all women) Decatur County: 22 (all women) Jackson County: 29 (all women) Jennings County: 10 (all women)

Death rates ’04-’08 Per 100,000 residents Indiana: 13.6 Bartholomew County: 15.2 Brown County: 7 Decatur County: 15.7 Jackson County: 12.4 Jennings County: 7.5 Per 100,000 women Indiana: 23.8 Bartholomew County: 26.7 Brown County: 13.6 Decatur County: 28.1 Jackson County: 22.1 Jennings County: 13.6 — Source: Indiana State Department of Health

CALL ACTION to

“I

didn’t dream I’d get it,” said Boas, a 56year-old Columbus resident. “If he hadn’t been in the paper, if it was just women, I never would have thought about it.”

Instead, Boas became concerned. His older sister contracted breast cancer, and a cousin had died from it.

Within a month, Boas went to a health clinic for a mammogram. An abnormal result prompted the need for a biopsy. A positive result for breast cancer necessitated a mastectomy on Dec. 22, followed by chemotherapy starting in January and radiation starting in August.

The past year has been a whirlwind for Boas, but he says he’s at peace with the fact that he has breast cancer.

“Once I knew the truth, I knew what I’ve got to do,” he said.

Boas first noticed how sore his left breast was in September 2010, when leaned over a toolbox on his truck to get a tool he needed for a construction job. He didn’t think too much of the pain.

When he read Shepherd’s story a month later, he reconLARRY SHEPHERD sidered what the pain could mean and took action.

A Dec. 7 telephone call from Tammy Creech, a nurse navigator at Columbus Regional Hospital’s Breast Health Center, confirmed what was suspected after the mammogram and biopsy: Boas had early Stage 3 breast cancer — which meant it had not spread throughout his body.

“His reaction was really positive, like it’s just something I’ve got to take care of, so get it done,” Creech said.

Days before Christmas, Dr. David Thompson, a surgeon, removed Boas’ left breast, including a 2.2-centimeter tumor, and 22 lymph nodes — 10 of which tested positive for cancer. A port was inserted in his chest for the chemotherapy drugs.

“Once you have cancer in the lymph nodes it means you need some type of chemotherapy because there’s the likelihood that the cancer has spread beyond the lymph nodes to elsewhere in the body, and the chemotherapy treats the whole

JOE HARPRING | THE REPUBLIC

Top: Mark Boas relaxes after undergoing a radiation treatment from a linear accelerator at Columbus Regional Hospital. Above: Natalie Pollert, radiation therapist at CRH, prepares Boas for treatment. Boas found it tough at first to grasp the idea he could have breast cancer. body,” Thompson said.

Patients who undergo surgery, chemotherapy and radiation after cancer is found in the lymph nodes have about a 60 percent chance of avoiding a recurrence of cancer over five years, Thompson added.

Boas started chemotherapy Jan. 17, receiving a dose of drugs once a week every three weeks, at CRH’s Cancer Center. Each treatment lasted about 90 minutes, and he received the last one in late June.

The first three or four doses weren’t too bad, Boas said, although he had trouble sleeping, lost his appetite because food tasted bland and lost all his body hair.

He lost only 5 pounds because he mixed a

protein powder with his milk.

Only after the last two chemotherapy treatments did Boas feel sick.

Radiation treatments took place on a different schedule. Treatment took about 20 minutes a day Monday through Friday, for a total of 28 sessions. Each used photons to kill cancer cells in his left breast area. Those sessions were followed by radiation treatments just for the scar from his mastectomy. It used electrons — which don’t penetrate as deeply as photons — to kill any cancer cells hiding in the scar tissue.

The treatments were easy, he said, except that he needed to remain still throughout.

By Kirk Johannesen, johannesen@therepublic.com

See ACTION on Page D3

PINK D2

purpose

The Republic, Columbus, Ind., Friday, October 7, 2011

“It’s not something we see very often, obviously. Male breast cancer makes up about 1 percent of all breast cancers. Normally, what we’re taught in training is you may see one male breast cancer in your career as a general surgeon.” — Dr. David Thompson, Columbus surgeon

Finding breast cancer early is important. Here is what the American Cancer Society recommends : Have a mammogram and a clinical breast exam every year starting at age 40.

Get a breast exam by a doctor or nurse every three years if you are in your 20s and 30s.

Know how your breasts look and feel. Tell your doctor or nurse right away if there is any change in your breasts.

BY CHRIS SCHILLING cschilling@therepublic.com

How to check your breasts: Sometimes, you can feel the underarm area better this way.

In front of a mirror While standing in front of a mirror, look at your breasts with your arms by your side, then raise them over your head, then press your hands on your hips and tighten your chest muscles.

Look for any changes in your breasts.

Look for a change in size, shape, contour, dimpling, rash, redness or scaliness of the nipple or breast skin.

While lying down

Sitting or standing

Lie down on your back, put a pillow under your right shoulder and place your right arm behind your head.

While sitting up or standing and with your arm slightly raised, feel the area under your arm.

Use the finger pads, not the finger tips of the three middle fingers on your left hand to feel for lumps in the right breast.

When you first begin checking your breasts, it is hard to know what you are feeling. With practice, you will become familiar with your breasts. You might ask your nurse or doctor to help you by letting you feel your breasts as they do your breast exam.

Use an up and down pattern, starting at your underarm and moving across the breast to the middle of the chest bone.

Repeat the exam on the left breast, using the finger pads of the right hand.

Source: American Cancer Society

Cancer costs high, but help abounds

The Republic graphic by Amber Pulley

The costs of breast cancer can mount up almost as quickly as you can name the procedures.

Mammograms. Radiation. Chemotherapy. Mastectomies. Prescriptions.

From early detection to lasting care, breast cancer can cost patients thousands of dollars.

Hospital and insurance officials say estimating what a single patient can expect to pay for breast cancer treatments can be tricky. Screening and treatment options are too individualized, they say.

But some basic costs are available, according to Columbus Regional Hospital.

The hospital tells patients that the approximate cost of a screening mammogram is $270.

Six weeks of breast radiation treatment costs about $72,000.

Those costs are before insurance providers get involved.

Paige Harden, Columbus Regional spokeswoman, said some insurance providers might cover the entire cost of a mammogram screening. The hospital encourages patients to call their insurance provider to find out about their coverage.

Columbus Regional Hospital’s Breast Health Center offers a mammography assistance program that provides digital screening mammograms for a $5 fee to uninsured women between the ages of 40 and 64, who need financial assistance for an annual mammogram.

Tony Felts, communications

See COSTS on Page D11

Mammogram guidelines uniform Yet many women still shying away from doctor’s visits

BY BRIAN BLAIR bblair@therepublic.com Six weeks could have been a lifetime for Sandy Bense.

“You often take it for granted that everything is all right,” said the Columbus resident.

No more.

Today, she counts her blessings — and counts her time invested in a simple mammogram as a life saver.

The procedure last year at Columbus Regional Hospital’s Breast Health Center caught her breast cancer at Stage 1, the earliest posSANDY BENSE sible time. Early detection allowed her plan of attack to be quick — six weeks long — though aggressive.

Without such early intervention, she realizes cancer could have cost her life.

A double mastectomy and breast reconstruction had her back at work before most peers and friends knew she’d faced anything serious. It also greatly reduced her future cancer

risk.

“I didn’t want Here are to worry about m Cancer S ammogram gu going back and idelines ociety: from the z Yearl finding out later y mamm America o g n a ra g e ms are re the cancer had 4 0 and c c o o n m t inuing fo mende d health. come back,” r as long s as a wom tarting at z Clinic said Bense, al breast an is in g ex years for ood explaining women am should be do in their 2 women n the extreme e ab ou 4 0 and o 0 s and 3 0s and e t ever y three z Wom choice. “I’ve en shou lder. ver y yea ld k r for and feel heard about and repo now how their b other people health c r re t a a ny bre st s n are prov ider. Bre ast change pro ormally look who faced women, a m s s t t a s that.”

The Ame rting in their 2 elf-exam is an ptly to their option fo 0 ri s c . a n Cancer S The 44women r ociety re — b e c commen year-old ause of th tendenc ds th eir y woman, in additio , or certain other family histor y, a at some fa gen n c to tors — b who still mam The num e screen etic ber of w mograms. ed with must visit om less than MR I 2 percen en who fall into her spet of all th this cate e g women cialist in the Un or y is small: every six ited State s. months for a screening, does all she can to urge other The task force women 40 and older to have an annual guidelines recommended that women mammogram.

This year, recommendations for with a normal risk for breast cancer the procedure are clearer and more begin screening and mammograms at uniform than last year. Then, a U.S. age 50, rather than age 40. The survey Preventive Services Task Force sur- said the change was meant to reduce vey went against most other national harm from overtreatment and patient mammogram guidelines, including anxiety.

Locally, the Breast Health Center the American Cancer Society.

Recomme n

dations

staff still believes those now-changed guidelines are hurting and confusing area women.

For instance, figures in the center’s records indicate that 400 female staffers age 40-plus at Columbus Regional Hospital have not yet had their 2011 visit.

Deana Tuell, Breast Health Center manager, knows there are plenty of others overdue, too, because they tell her so.

Moreover, hospital mammograms for 2011 still are about 100 behind the number done this time last year.

“I think a lot of people feel like they don’t have the money or just don’t want to take a chance,” said Tuell.

She said statistics show they’re taking a bigger chance by skipping appointments and missing an opportunity to find otherwise-hidden problems. And, she said, finances should be no factor.

One program allows those without insurance to have their exam for $5.

And Tuell is taking education beyond her gender.

“This is not just an us-talking-towomen thing,” said Tuell. “We all can encourage the men in women’s lives to ask the women, ‘Have you scheduled your mammogram yet?’”

Breast Health Center staffers

regularly set up booths at sites from offices to factories to educate and remind women of the importance of the procedure.

“We know it’s still on their radar,” said Tammy Creech, a breast health navigator.

Columbus’ A.C. Reeves wishes mammograms had been on most doctors’ radars years ago.

His wife, Dana, died in 1990 after a battle with breast cancer. She detected a lump in her breast long before that.

But her family doctor told her not to worry.

“A lot of women have fibrous tissue,” said Reeves.

Finally, two years later, the doctor recommended mammography. It revealed a mass.

A biopsy confirmed cancer. Reeves regrets he didn’t insist on a mammogram.

“Now, I’m aware that it very well may not have changed a thing in our situation,” he said. “But also, maybe it would have.”

He tells the story these days to encourage family members to be aware and educated.

“Maybe people can learn something from me,” said Reeves. “Maybe I can help somebody else.”

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PINKpurpose

Breast cancer incidence and death rates increase with age.

PAGE D3 The Republic, Columbus, Ind., Friday, October 7, 2011

Columbus Regional Hospital ADDRESS: 2400 E. 17th St. KEY DEPARTMENT: Breast Health Center PHONE: CRH main, 379-4441 or 800-841-4938; Breast Health Center, 376-5064 SERVICES OFFERED z Screening mammography — These look for the early warning signs of breast cancer. They are performed routinely on women over age 40 who have no clinical signs of breast disease, no serious family history of breast disease or no personal past history of breast disease. z Digital mammography — This is like using a digital camera

to take a picture instead of a camera that uses film. Image is captured by a special X-ray detector, which converts the image into a digital picture for immediate review on the computer monitor. Digital image provides a bit more contrast. z Diagnostic mammography — Gives additional and special digital mammo views, beyond screening mammograms. z Diagnostic and screening breast MRI — A supplement to mammography, magnetic resonance imaging is an advanced tool that provides more detail about a possible

abnormality. Useful in determining a course of treatment. Recommended for women with a history of breast cancer, and women with strong lifetime risks for breast cancer and some women with dense breast tissue. z Breast MRI guided biopsy — For areas to be biopsied but not seen well by mammogram or ultrasound. Biopsy performed with magnetic resonance imaging guidance. z Diagnostic breast ultrasound — Sound waves used to detect solid or cystic lesions in the breast. z Ultrasound guided core

needle biopsy — Small pieces of breast tissue removed under ultrasound guidance and examined for cancer cells. z Stereotactic guided breast biopsy — Tiny pieces of breast tissue removed with computer guidance and examined for cancer cells. z MammoSite — An advanced technology for targeted radiation therapy. z Genetic high-risk education and testing — Women who report high risk for breast cancer based on family or personal history can obtain a printout of lifetime risk and also

get information and genetic testing. Can help a woman and her health care provider determine her chances of getting breast cancer in her lifetime. z Breast Health Navigator Program — A navigator nurse serves as a resource and familiar face while assisting a patient through treatment and recovery, so the patient can focus on health and recovery. z Mammography assistance program — For people who need a mammogram but can’t afford one. Those who qualify for assistance can get

a mammogram for $5. To qualify, participants must be at least 40 years old, have not had a mammogram in the last year, cannot be pregnant or breast feeding, have no history of breast cancer or breast problems, be referred by a doctor, have a household income at or below 200 percent of poverty level and live in Bartholomew, Brown, Decatur, Jackson, Jennings, Johnson or Shelby counties. Call Breast Health Center to apply. z Breast Cancer support services z Same-day testing results and 24-hour pathology results

z Dedicated women’s center z Digital mammography z Breast ultrasound z Breast MRI z Same-day biopsies

z Stereotactic breast biopsy z Ultrasound-guided biopsy z Self-referrals for

screenings z Flexible scheduling for

mammograms z High Risk Breast Clinic — Provides individualized recommendations for prevention and surveillance for

those at increased risk. Also offers clinical breast exams, education about breast self-exams, screening tests and education about the risk of breast cancer.

biopsies and cyst aspirations

z Assistance programs: Komen Grant; Indiana Breast Cancer Awareness Trust Fund. These programs are for people who meet financial guidelines and

are eligible for screening and diagnostic mammograms, and imaging-guided biopsies at no cost. z Special screening

programs for industry. z Chemotherapy, massages, nutrition consultation, social work offered by oncology department. z Supportive care.

Physician Network Jennings.

Call 352-4300 to set up an appointment with one of our providers.

z Reduced rate mammograms — Offered in May and October. z Free screening mammograms — Available for those who

qualify through the St. Vincent Foundation. Call 352-4310. z Breast and cervical cancer program — A state-funded

program for those who meet state financial guidelines. For more information, call 3524310.

Schneck Medical Center ADDRESS: 411 W. Tipton St., Seymour KEY DEPARTMENTS: Cancer Center and Diagnostic Imaging Women’s Center

PHONE: Main, 522-2349; Cancer Center, 522-0480; Diagnostic Imaging Women’s Center, 523-4874.

SERVICES OFFERED

Decatur County Memorial Hospital ADDRESS: 720 N. Lincoln St., Greensburg KEY DEPARTMENT: RadiologyBreast Health Center, PHONE: 663-1156

z Breast ultrasound z Breast ductograms z Breast needle localizations z Breast imaging guidance

SERVICES OFFERED z Digital mammography z Screening mammography z Diagnostic mammography z Computer-aided detection

St. Vincent Jennings Hospital ADDRESS: 301 Henry St., North PHONE: 352-4310 Vernon SERVICES OFFERED z Breast cancer screenings KEY DEPARTMENT: Imaging — Offered through St. Vincent Services

ACTION

FACTS

Continued from Page D1

Continued from Page D1

Donna Christian, Boas’ boss at Edinburgh Premium Outlets, understands what Boas has endured, because she is a breast cancer survivor.

Christian, general manager of the outlet mall, considers Boas an inspiration to his coworkers.

“He continues to work while undergoing surgery, chemotherapy and radiation.

He has kept a positive attitude through the whole process,” she said.

Boas said breast cancer served as a wake-up call.

“You make every day count and not take things for

granted,” Boas said.

Shepherd lived the same philosophy after developing breast cancer. Unfortunately, he never fully defeated the disease and lost his life to it Sept. 24.

Boas will have to take Tamoxifen, a drug that interferes with the activity of es-

B efore Y ou W ere B orn Columbus 812.348.6375

trogen, for five years, to help stave off a recurrence.

That’s fine with him. He’s just doing what needs to be done.

That includes sharing his story with men if he thinks they need to know it.

Just like a man from Hope did.

z The average age of the men who receive breast cancer diagnoses is 68. z Men and women with the same stage of breast cancer have similar outlooks for survival. z A mastectomy, a surgical procedure to remove the breast, is the main treatment for male breast cancer.

— Sources: American Cancer Society, Susan G. Komen for the Cure

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PINK purpose D4

A woman has a 1 in 12 — or 8 percent — chance of developing breast cancer in her lifetime.

The Republic, Columbus, Ind., Friday, October 7, 2011

Tissue samples aid search for cure

BY RYAN TRARES For The Republic Theresa Mathieson slowly opened the cold storage tank and removed a towering stack of glass slides.

Inside the rack were hundreds of tissue samples donated by different types of women, frozen in liquid nitrogen.

Somewhere in that stack, Mathieson and others at the IU Simon Cancer Center hope to find the cure for breast cancer.

The Susan G. Komen for the Cure Tissue Bank is the only facility in the U.S. to collect, catalog and analyze healthy breast tissue for research. By comparing these samples to those from women with breast cancer, scientists hope to find out what exactly goes wrong in the cells to cause tumors.

“You can finally have an idea of exactly what is going wrong in a cell,” Dr. Susan Clare said. “Before, we were kind of guessing. But now we have enough normals that we can figure out what the range of normal is. If we find something outside that range, we know it’s somehow related to cancer.”

Clare is one of the tissue bank’s main investigators, helping lead the research that comes from every donated sample of tissue. Over the course of four years, they have helped provide base samples for cancer researchers all over the world to analyze against cancer cells.

The bank started in 2005 with a mass blood donation at the annual Susan G. Komen Race for the Cure. More than 1,200 samples from healthy women were brought in and stored in the cancer center’s massive bank of freezers.

Researchers wanted to expand their collection to tissue taken directly from the breast. But hospital administrators required convincing before they allowed taking samples from healthy women.

Donation requires women to have a small slice of tissue cut from within their bodies. Though the procedure was simple and took only about 30 minutes, administrators were concerned that women wouldn’t volunteer to go through that.

Tremendous response But the response has been enthusiastic and overwhelming. So far, more than 1,500 women have donated to the bank.

The samples came from women of all races, body types and ages. But all of them share one thing in common: They’ve never exhibited any sign of breast cancer.

Since opening in 2007, the bank has scheduled special donation days to bring in as many women as possible to donate.

Every donor needs to fill out a thorough health evaluation beforehand. The questionnaires ask about their health history, their menstrual cycle, how many children they have, their diet.

“The sample becomes exponentially more valuable as we know more about the lady,” Clare said. “That way, we can deduce what might be causing potential differences between cancerous and healthy tissue.”

Women are then taken to a clinic room, where their breast is sterilized, numbed with a local anesthesia, and slightly nicked with a scalpel.

Using a needle, the surgeon removes a small specimen from within the breast.

Immediately, the tissue is placed on dry ice and taken to Mathieson, who then adds it to the bank’s freezers. Tissue stored in the bank’s liquid nitrogen tanks is kept around minus-292 degrees Fahrenheit.

Flash freezing it, and preventing it from thawing, keeps the tissue from reacting to the outside conditions and changing in any way, Clare said.

“We want these samples to be as close to what they were in the breast as possible,” she said. “We don’t want to introduce anything abnormal.”

Motivated to help Traci Runge, a 43-year-old Carmel resident, had volunteered to donate at one of the bank’s first collection events in 2007. She was motivated to give after watching the mother of one of her cheerleading students struggle with the disease. Both Runge and this mom had young children.

“I was very bothered. Here she was with an infant, and she was sick. And here I was with an infant, and I was fine,” Runge said.

SCOTT ROBERSON | FOR THE REPUBLIC

Bio-specimen manager Theresa Mathieson removes a tower of breast tissue samples from a cold storage tank in the Susan G. Komen for the Cure Tissue Bank at the IU Simon Cancer Center in Indianapolis.

From a research standpoint, Runge might be the most important donor of all, Clare said. In early 2010, Runge was diagnosed with breast cancer herself. She donated the cancerous tissue, as well as additional healthy tissue from her other breast.

Along with the first healthy sample taken in 2007, Runge presents researchers a preserved before-and-after picture of the molecular changes breast cancer can cause.

“The possibilities of what they can learn is amazing,” Runge said. “If I can do this as a way to save someone’s life, especially my three little girls, it’s what I had to do.”

Aids research The tissue bank receives about 15 requests for tissue every year. Research teams have specified what they’re looking for, depending on the types of women or the circumstances in which the tissue has been collected.

After submitting a proposal, each research project is debated by a three-person panel on the validity of the work.

So far, the bank has provided samples for close to 60 research projects.

The Mayo Clinic is on the verge of publishing results that compare the typical cells in benign tumors to healthy tissue.

The IU Simon Cancer Center researchers have used healthy samples against those from women with triple negative breast cancer. Triple negative breast cancer doesn’t exhibit the three main indicators found in cancer genes.

Doctors have been clueless as to what sets these women apart from others who have breast cancer.

They found hundreds of genes that differed between normal tissue and the triple negative tissue. One by one, scientists can examine the genes and possibly determine a new indicator for these cancers, Clare said.

None of the work has been published yet, so Clare was hesitant to release any information about the projects.

But she expects the first round of papers to hit medical jour-

How to do

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Minority donors few Currently, the bank is struggling to find minority donors. Only about 3 percent of the collected samples have come from black women. Hispanic women only make up 1 percent.

The solution will hopefully come later this year.

The tissue bank has partnered with Indianapolis’ Super Bowl Host Committee to organize “Indy’s Super Cure.” The hope is that the worldwide attention that will come with the Super Bowl in 2012 will inspire thousands more women to donate.

Several tissue donation events are being planned the week before the game, and organizers are planning additional fundraisers in advance.

“We want to make the bank look like America, and it doesn’t yet,” Clare said. “The Super Bowl committee helps us reach out into those communities.”

Ryan Trares is a staff writer for the Johnson County Daily Journal, a sister paper of The Republic.

Supporting Breast Cancer Awareness Month

White women have a higher incidence rate of breast cancer than African-American women beginning at age 45. African-American women have a higher rate before 45.

PINKpurpose PAGE D5 The Republic, Columbus, Ind., Friday, October 7, 2011

Faith, family, co-workers help teacher survive

BY BRIAN SANDERS bsanders@therepublic.com NORTH VERNON — Having survived a bout with breast cancer, Bev Gibson’s learned to slow down and appreciate the simpler things in life.

“Because I was forced to slow down … for almost a year, I can enjoy sitting in the swing and walking around watching the plants, seeing how much they’ve grown from one day to the other.

I was too busy,” Gibson said of her pre-cancer days, which were little more than a year ago.

In September 2010, Gibson found a lump in one of her breasts.

“I kind of thought the worst because it was an obvious lump … it was pretty apparent that there was something wrong and I don’t know why it took so long to realize it was there,” she said.

The North Vernon native acknowledged that she wasn’t as diligent as she probably should have been about self-examinations.

Gibson’s family had no history of cancer, and the Graham Creek Elementary teacher missed RESIDES: North Vernon her annual mamAGE: 50. mogram last year JOB: Teacher at Graham because it conCreek Elementary School flicted with the in Commiskey start of a new DISCOVERED BREAST CANCER: school year and September 2010. she did not want TREATMENT: Double to miss a day of mastectomy, school.

Upon making chemotherapy and the discovery, radiation Gibson quickly contacted her doctor, who arranged for a biopsy.

On Sept. 24, high school classmate Tammy Creech, who now works for Columbus Regional Hospital’s Breast Health Center as a nurse navigator, delivered the news.

Gibson had Stage 3 breast cancer, meaning the cancer had spread from breast tissue into her lymph nodes.

Gibson informed her principal, Peggy Fear, who referred her to fellow teacher Kim Sullivan, who had survived a similar breast cancer diagnosis six years before.

Aside from the considerable support she got from her co-workers, Gibson credited her faith in God and her family with getting her through a difficult time.

“The support that I get from my husband is unbelievable,” she said of Burt Gibson, to whom she’s been married for 31 years.

Learning of Gibson’s illness brought out a side of Burt she had never seen before.

He intuitively knew when she needed him to take charge and when she needed him to back off, she said.

Bev said working through her disease also strengthened her bond with daughters Ashley Parker and Rylee Goins.

Her faith also was instrumental in getting

Bev Gibson

ANDREW LAKER | THE REPUBLIC

Breast cancer survivor Bev Gibson, of North Vernon, credits support from her friends and family and faith in God with getting her through difficult times. her through that difficult time.

A member of Butlerville Mennonite Church, Gibson recalled praying with her husband and believes God gave her two words: strength and grace.

Leafing through their Bibles, the family found a verse that contained both words, II Timothy 2:1, which reads in part, “... be strong through the grace that is Christ Jesus.”“I was blessed with peace of mind,” Bev said. “I always knew that we and the doctors were doing all we could do.”

Although there were several treatment options available to her, Gibson opted to undergo a double mastectomy.

“It was kind of like ‘OK, this is a no-brainer.

If there’s no breast tissue anywhere in your body, then you’re not going to get breast cancer again,’” Bev said of her decision.

She had the surgery on Oct. 25, 2010, roughly a month after her diagnosis, and a follow-up surgery to remove additional lymph nodes.

Rounds of chemotherapy and radiation treat-

ment caused her to lose her hair.

The fact that their teacher all of a sudden began wearing hats to class did not go unnoticed

by Bev’s students.

“There were some teachable moments because of it and the questions kids asked,” Bev said.

Most of her students had heard of breast cancer, but had never been personally affected by it.

Some students just were envious that Mrs. Gibson was allowed to wear hats in the school building and they were not, she said.

“It’s not that scary to young kids as it is to older people, I don’t think,” she said of her students’ somewhat surprising reaction to her battle with cancer.

The youngsters soon seemed to forget about their teacher’s condition and went about their business, which was refreshing to Bev, because she did not want to be viewed as just a cancer patient.

“I didn’t want to be defined as the person

who needed to be checked on,” she said.

“It’s good to have people who care and are concerned, but sometimes you don’t even want to think about it for a day or two.”

Cancer already has robbed Bev and her family of roughly a year of their lives and she doesn’t want to give it any more time than absolutely necessary.

However, the experience caused her to reevaluate what’s important in life.

“I don’t focus so much on things that didn’t happen and haven’t happened and I thought I wanted to happen. I appreciate things that have happened,” she said.

In a way, she would like to forget the whole ordeal.

“I know I’m fortunate,” she said.

“It’s good to see the people with their pink ribbons on and all that stuff and you’re happy for the support, but sometimes it’s too in-yourface,” she said.

“The world would be better without cancer.”

PINK purpose D6

Cancer begins as one damaged or mutated cell that can grow and spread.

Q A

The Republic, Columbus, Ind., Friday, October 7, 2011

AND

DR. DAVID THOMPSON

KIRK JOHANNESEN |THE REPUBLIC

ANDREW LAKER | THE REPUBLIC

Lynn Alessi, a former nurse, researched reconstruction options and decided to have a double mastectomy after her second breast cancer diagnosis in 2010.

High risk pushes some women to remove healthy breasts

BY BRENDA SHOWALTER bshowalter@therepublic.com When Lynn Alessi was diagnosed with breast cancer for a second time in 2010, she looked very matter-of-factly at her options and decided to have both breasts removed — even though only one had cancer.

“I didn’t want to worry about it anymore,” said Alessi, 54, of Columbus.

“I’m not really a big worrier, but I was already going to do one, so why not go ahead and do both?”

Alessi, wife of a family practice physician and a former nurse, researched reconstruction options and decided within a few weeks to have the double mastectomy.

“The things they can do with reconstruction are truly amazing,” she said.

“I thought while I’m having one I might as well have them match.”

Alessi laughs, but turns serious when thinking of her experience and a family history of breast cancer that included a grandmother dying of the disease in her early 50s.

“I make jokes, but I really didn’t want to worry anymore,” she said.

Proactive measure The procedure Alessi had on her healthy breast is known as a prophylactic mastectomy, surgery to remove a breast to prevent the development of cancer.

Dr. Frederick Shedd, a surgeon with Southern Indiana Surgery in Columbus, said Alessi’s decision is one that is becoming more common with medical science advances that can more accurately determine a person’s chances of developing breast cancer.

Those who opt for the surgery often are patients who have tested positive for the BRCA1 or BRCA2 gene with genetic testing.

“If you test positive for one of the two of those, your risk may be 80 percent or higher that you will develop breast cancer in your lifetime,” Shedd said.

Genetic testing will never provide 100 percent proof that someone will develop

Lynn Alessi AGE: 54.

FAMILY: Husband, Dr. John Alessi; daughter, Erica; son, Jonathan.

PROFESSION: Trained as a nurse. Currently works as an AmeriCorps staff member at the Volunteer Action Center in the Doug Otto Center.

BREAST CANCER JOURNEY: First diagnosed with breast cancer in one breast in January 2005. Had a lumpectomy, six weeks of radiation and took the cancer drug Tamoxifen for five years. Diagnosed again in the same breast in May 2010. She decided to have both breasts removed.

breast cancer, he added, so other factors are considered.

If someone has had other family members with breast cancer, their chances of developing the disease are greater.

In other circumstances, women might have had past experiences with suspicious mammograms and biopsies even though they never were diagnosed with breast cancer.

And, computer modeling, which involves various risk factors, can place patients in high-risk categories even though they tested negative in genetic testing.

Peace of mind Shedd said having a prophylactic mastectomy can seem radical, but when all these factors are taken into account, some patients think it’s the best move for their health and peace of mind.

“If you’ve got a family history and someone tells you that you have an 80 percent risk of getting breast cancer, it’s not a hard sell for some women,” Shedd said.

He also understands what a personal and difficult decision it can be for others.

A number of personal factors also are taken into account.

These can include a patient’s age, whether they have had children and if they are in a long-term, stable relationship.

Another, less radical option would be having ovaries removed and going through a course of chemotherapy to reduce risks of getting breast cancer.

Beth Staker, a nurse navigator with Columbus Regional Hospital’s Breast

Center, said how difficult the decision is depends on the woman. “(Nurse navigators) don’t make decisions on the types of surgeries, but I’m available to talk about the process and what are the normal things to expect,” Staker said.

One of the reasons Shedd believes prophylactic mastectomies are becoming more common is the advances made in reconstructive surgery.

One procedure includes incisions being made under the breasts along the skin fold so much of the skin and nipples can be saved.

“It’s the same skin, so it looks like a breast that has had augmentation,” Shedd said. He added that for some women, the surgery might even improve the look of their breasts.

The thought of going through a mastectomy and reconstruction surgery can be daunting, but Shedd said it has the potential to prevent many anxious years if women are in a high-risk category for developing breast cancer.

Women diagnosed with breast cancer who decide against mastectomies often live with the worry that the breast cancer could come back, Shedd said.

“They end up having lots of mammograms and ultrasounds and MRIs and biopsies and procedures,” he said. “It’s like they relive and go through that again.”

The final decision on whether to have a prophylactic mastectomy is up to the patient after receiving all the information.

For Alessi, the decision was best for her. “You do what you have to do,” she said.

“I make jokes, but I really didn’t want to worry anymore.” — LYNN ALESSI

The Republic’s Kirk Johannesen sat down with Dr. David Thompson, a Columbus surgeon whose patients include those with breast cancer, to discuss the disease. Thompson graduated from Indiana University’s medical school in 1991, received his surgical training at the University of Kentucky from 1991-96 and came to Columbus in 1997.

Q: The term breast cancer evokes fear and concern, but what about breast cancer should make men and women optimistic? And why?

A: Any time you hear the word cancer, everybody gets concerned, and sometimes they think it’s a death sentence. But, clearly, the majority of breast cancer is very treatable. Obviously, the earlier we catch it and the sooner we know about it, and the sooner we start treatment, the better the prognosis and the better chance of curing it. … The optimism lies in the fact that it’s very treatable when caught early, and I would say far and away the majority of the people we can treat and cure.

Q: What are the most common misperceptions people have about breast cancer, and why?

A: I think one of them is that it’s not treatable, or incurable and a death sentence. The majority of them are very curable.

The second thing, I would say, is there is still that misconception that if you have to have surgery for breast cancer that it involves a radical surgery — what we used to term a radical mastectomy, which means taking all the breast tissue off, taking all the lymph nodes out of the arm, which with it has potential side effects and complications. But now, it’s to the point that it’s very treatable just taking the cancer out and sampling just a few lymph nodes under the armpit as opposed to the old radical surgery that used to be done.

Q: When you are meeting with a person who has been diagnosed with breast cancer, what is the most important thing you want that person to understand?

A: I would say No. 1, that we’re going to be able to treat their cancer. And then, No. 2, here at Columbus Regional (Hospital) we have a multidisciplinary team. In other words, there’s the nurse navigator who helps them get through the process and helps them with questions and provides information for them. We have the surgeon who does the surgical aspect of the care. We have the medical oncologist, the radiation oncologist available if they’re needed to help with their portion of the overall treatment of the cancer. It’s a multidisciplinary approach, so the patient can rest assured that all aspects of their cancer treatment are going to be taken care of, and can be taken care of well here at the hospital.

Q: What do you tell someone who asks you, “What can I do to prevent breast cancer?”

A: I think the most important thing that has been shown to prevent breast cancer is routine, annual mammograms; breast self-exams on a monthly basis; and a breast exam by a physician at least once a year.

Q: In the fight against breast cancer, in what ways are people, science and medicine winning, and in what ways do they still have obstacles to overcome?

A: I think there hasn’t been big changes in the surgical treatment of breast cancer for probably 25 years, so the surgical treatment of breast cancer has been pretty standard. There’s been subtle changes, like changes in the way radiation therapy is done. But as far as surgery goes, it’s stayed pretty stable.

I think the big advances have been in the way we do radiation therapy for breast cancer, and certainly the way chemotherapy is done. There have been big advancements in the last 10 years in terms of chemotherapy.

Q: What is breast magnetic resonance imaging and why is it important?

What prompted a change in guidelines for those who should have a breast MRI? A: Breast MRI is a little more sensitive type of X-ray of the breast. I think that the guidelines that we typically use for breast MRI is somebody who has a type of breast cancer that may occur on both sides, which is a lobular carcinoma — that’s a type of carcinoma that has a tendency to occur in both breasts at the same time. Another indication is anybody who has had previous radiation to the chest for maybe another diagnosis, like Hodgkin’s disease. That’s an indication for breast MRI. Somebody who has very dense breasts, and mammogram is not as sensitive in detection of cancer in them because their breast tissue is very dense, so then an MRI may be indicated. I think the most important thing is that the MRI be ordered after a detailed discussion with the patient, a detailed review of their medical See THOMPSON on Page D11

PINKpurpose

Monthly self-exams and annual mammograms and breast exams by doctors are important forms of early detection.

PAGE D7

Getting it all down

The Republic, Columbus, Ind., Friday, October 7, 2011

Husband becomes detailed note-taker, keeper of information during wife’s treatment

BY BRIAN BLAIR bblair@therepublic.com PETERSVILLE — Getting hit by a river of emotions when facing breast cancer in November 2008 was one thing for Sally and Gary Gant. Facing a flood of technical information and options was quite another for the two.

“So I took notes at every doctor’s appointment,” said Gary. “Then, I could always go back and look over what the doctors had said.

“It helped me check my own memory and make sure I had things right.

“That really helped me. Did it help you, dear?”

He looked across the kitchen table at Sally.

Her eyes grew wide at the memory.

“Oh, gosh, yes,” said Sally.

Especially since much of her recall went blank early in the chemotherapy portion of the nearly yearlong treatment that included a lumpectomy.

“I remember only needing to sleep a lot,” said Sally. “I would wake from a nap feeling like I still needed a nap.”

So Gary, accustomed to fine detail as a result of a 37-year career as a engineer, became a little more wide-eyed.

“I really tried to be the conscience,” said Gary. “I was checking to make sure we were touching all the right bases and asking all the right questions.

“I tried to write down as much as I could.”

Breast Health Center nurse navigator Beth Staker, whom the Gants see as an emotional lifesaver during their experience, figures at least half her patients take fairly detailed notes during appointments.

“And we always encourage

Gary & Sally Gant RESIDE: Petersville.

AGES: Both 66.

JOBS: Sally recently retired as a teacher at Richards Elementary School. Gary recently retired as an engineer at Cummins Inc. DISCOVERED BREAST CANCER: In Sally November 2008.

TREATMENT: Lumpectomy, followed by chemotherapy and radiation in a nearly year-long treatment. them to bring their questions,” said Staker.

Sally herself kept a journal during the early stages of treatment. She wanted to find patterns of her reactions to the drugs “so I could plan for those days.”

Her notation from Feb. 17, 2009, includes a mention of three pills to fight nausea while also battling mental fog and extreme thirst.

“Lost lots of hair in shower,” she also noted.

After she had a son shave her head, she wore baseball caps. She understands that some women stress over such a loss.

Not her.

“It’s just hair,” she said.

Some of Gary’s handwritten notes — records he since has discarded — took the form of pointed questions for doctors: How can we know this procedure will work? How will we know the cancer is gone? What test clearly will show us that it’s gone?

He discovered that answers were less pointed.

But at least he got information and insight to help see the full picture.

JOE HARPRING | THE REPUBLIC

Above: Sally Gant has her husband, Gary, as a partner on her journey with breast cancer. Sally credits her husband’s steadfast support and her own positive outlook as prime factors in her progress.

“He’s a smart cookie — a really bright guy,” said Sally.

As a retired Richards Elementary School teacher, she seems pretty savvy herself.

She offered a stunned expression when asked what she would have done without her spouse’s thoroughness through her 16 rounds of chemotherapy

and 32 rounds of radiation.

“I do not have any idea,” she said. “And I do not want to ever find out.”

It took her a full year after treatment ended to regain strength and energy. Gratitude fills nearly every comment for both of them now when they look back at their journey

through cancer.

That time remains evident in the T-shirt she sports with the breast cancer ribbon, through pink shoelaces that hang from a rack in the next room, through the pink Race for the Cure cap that sits atop a nearby lampshade.

Bright color for a bright

outlook.

If such items hang around a while longer at their southeast Bartholomew County home, so be it. Besides, how can she forget a life-changing experience?

“Gary and I kind of interpreted all this as a path we had to walk down,” she said.

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PINK purpose D8

Researchers have detected 15 types of breast cancers, named for the part of the breast in which they develop.

The Republic, Columbus, Ind., Friday, October 7, 2011

Group effort by doctors benefits patients During a recent session, Miller explained why she was an advocate for breast conservation in a patient. She noted on the scan how the margins around the cancerous tumor were large enough to take the tissue out and leave the rest of the breast.

Other doctors raised concerns that the margins were too close. After discussing the problem, and Miller stating her case, it was determined that saving the breast was the best option.

BY RYAN TRARES For The Republic Within minutes of being diagnosed with breast cancer, Heidi Anderson felt buried by the decisions that faced her.

The southside Indianapolis resident would need to make an appointment with an oncologist to discuss how much radiation would work best. At a separate time, she would need to have surgically implanted a port for the chemotherapy to be administered.

Over the coming weeks, Anderson would have to meet with surgeons, nurses, social workers and financial advocates.

“The process started going so quick. Shockingly so,” she said.

Being diagnosed with breast cancer is a devastating development in a woman’s life.

But on top of the disease itself, patients often find themselves overwhelmed by the amount of information and scheduling they need to process.

To ease patients through, doctors at Franciscan St. Francis Health’s breast care clinic have altered the way they work with patients. Instead of asking women to come to three or four different physicians individually, health officials have banded together to meet as one with the patient, explaining everything from diagnosis to surgery to post-treatment recovery.

For Dr. Denise Johnson Miller, director of breast surgery at St. Francis, the sessions provide a stabilizing influence at a tumultuous time.

“Having to juggle everything to try to get to each different appointment, to every different doctor and make sure they’re there on time, it’s very, very challenging,” she said. “Coordinating this care is the biggest factor in a cancer program.”

The multi-doctor approach started in 2010 at the breast care center, but St. Francis has been doing a similar program with its lung and colorectal cancer patients for more than four years.

The doctors meet with pa-

SCOTT ROBERSON | FOR THE REPUBLIC

Radiologist Dr. Michael Fisher, left, and pathologist Steven Clark are silhouetted by an image of a woman’s breast with a cancerous tumor during a tumor board meeting at St. Francis Hospital in Indianapolis. tients every Wednesday, gathering in a large conference room together with family members, nurse navigators and others to ease the process.

Each doctor presents information on the breast cancer. The radiologist shows the scans and X-rays that first identified the tumor. The surgeon explains whether a lumpectomy is the best course or if a mastectomy would be safer.

Appointments for starting chemotherapy, or the amount of radiation that will be needed, are all reviewed by the oncologist.

“I like that they’re all right

here. It makes it a lot easier and less stressful. It’s easy to get answers. You don’t get the runaround; they’ll give you the straight answer,” Anderson said.

She was diagnosed with Stage 3 ductal carcinoma in July.

Her physician had noticed a small indentation on her breast, and sent her to see a radiologist for a mammogram and biopsy.

Within a week of the diagnosis, Anderson had an appointment with Miller about surgery. Two weeks after that, she had her first meeting with a plastic surgeon about reconstruction.

By all of the major physicians involved at the same time, a clear timeline can be set up for treatment, radiologist Dr. Michael Fisher said.

Instead of waiting nearly a month to get all of the necessary tests and appointments, the process can start in a week.

“There’s something to be said for just getting it over with. Once they find out, they want us to hurry up, get it taken care of and be done with it. The waiting part stresses patients out,” said Fisher, a radiologist with Radiology Associates of Indianapolis.

Before ever meeting with the patient, the breast cancer

physicians gather for a premeeting, which they call the tumor board. Each specialist can explain what they saw in the particular diagnosis and course of treatment.

The opportunity to have all of the main doctors in the same room, looking at the same data, helps to mark a clear treatment path for the patient, Miller said.

“Patient care is not stagnant — people change, situations change, you get lab results back where you thought the patient would be fine and it turned out that they’re not,” she said. “We try to collaborate all of the time, but it helps to be at one place at one time.”

“That’s an important discourse to have, whether you like it or not,” she said. “You need to have a place where people are looking at things with different eyeballs and different perspective, so that you can make the best decision possible.”

Family members are asked to come in, as the amount of information can be overwhelming for a patient by themselves.

Getting the entire family in the room at one time helps everyone hear the information at the same time, eliminating confusion.

“Sometimes, these things can be like a game of ‘Telephone.’ One sibling hears it and passes it on to another, then another, and it gets all jumbled. This way, it’s a little more understandable and unified overall,” Miller said.

The multi-doctor clinic is offered as a choice for patients.

If they find it simpler to meet separately, to process each doctor’s information on its own, they can do that.

Anderson has appreciated the fact that all of her doctors are centrally located in one place.

Doing so not only makes it easier for her and her husband Ron, but eliminates any doubts that she may be getting counter-productive advice.

“We can see that the doctors are all in here working together. That they’re communicating and not having one say something while another says something different,” she said.

Ryan Trares is a staff writer for the Johnson County Daily Journal, a sister paper of The Republic.

Options available for those with insurance concerns

BY BRIAN SANDERS bsanders@therepublic.com A breast cancer diagnosis is scary enough without worrying about how you will pay for tests and treatments.

Area hospitals understand the predicament and often are able to help patients with insufficient health care coverage or none at all.

Columbus Regional Columbus Regional Hospital’s Mammography Assistance Program offers deeply discounted mammograms to those who qualify.

However, the program doesn’t cover patients who already have been diagnosed, according to Deana Tuell, a breast health navigator at the hospital’s Breast Health Center.

A mammogram normally costs $200 or more, but with the

discount, they can be had for just $5.

Options also are available to patients who already have been diagnosed with breast cancer.

Columbus Regional has financial counselors who help patients get the treatment they need at a price they can afford or, if necessary, at no cost.

“Even if people can’t pay, we don’t turn them away, never,” Tuell said.

“We always have things we can check on … the main thing we tell women is just because you have financial problems, it isn’t the end of the road, we can help you.”

St. Vincent Jennings St. Vincent Jennings Hospital offers free breast cancer screenings to qualified patients in its service area.

Discounted mammograms are offered to the community every May and October for

those ineligible for the free screenings, said Terri Everage, a breast cancer survivor and the hospital’s manager of imaging services.

The discounts are provided through support from the Breast Cancer Cervical Cancer Program, which also provides patients with continued assistance with chemotherapy and radiation treatment after they are diagnosed with breast cancer.

St. Vincent Jennings also tracks women in the county who are due for their mammograms.

Patients are reminded via phone calls and letters to get their annual test and those who feel they cannot afford it are offered financial assistance, Everage said.

“We have a very extensive tracking method,” she said.

The system aims to prevent

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Jennings County residents from falling through cracks and helps keep treatment costs down by catching cancer early.

Decatur County Decatur County Memorial Hospital also offers breast cancer screenings at discounted rates for those who qualify.

Cindy Daihl, manager of the hospital’s oncology department, stressed there are plenty of options available to breast cancer patients who have no health insurance.

The hospital staff works with pharmaceutical companies, which have their own patient assistance programs, to get medicine at low or no cost for those who do not have insurance to help pay the full price.

“We’re fairly resourceful at finding financial assistance for treatment,” Daihl said.

Most county hospitals in Indiana also offer charity care to those who have no other means of getting treatment, Daihl said.

“It’s not unusual,” she said of breast cancer patients needing financial assistance.

“Cancer’s a very expensive disease to have.”

Daihl said just diagnosing which type of cancer a person has can cost thousands of dollars and treatment costs vary widely from patient to patient.

She urged those who fear they have breast cancer and cannot afford it to contact their hospital and get help.

“We deal with this every day … it’s not uncommon for people to say ‘I don’t know what to do’,” Daihl said.

Schneck Schneck Medical Center in Seymour currently offers free mammograms to financially

eligible women.

Sally Acton, director of the hospital’s cancer services, anticipates the free tests will become a regular offering at Schneck.

The hospital’s program also pays for further testing when breast cancer is found.

Beyond that, Schneck has a contractor who specializes in helping patients find financial assistance, Acton said.

One such source of assistance is Medicare and Medicaid. Most women are surprised that they can temporarily qualify for those programs to help pay for their cancer treatments, Acton said.

Schneck’s staff also strives to make sure cancer patients get their medications at the lowest possible prices.

“We work with people to get that treatment done … we don’t turn people away,” she said.

Supporting Breast Cancer Awareness Month

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PINKpurpose PAGE D9 The Republic, Columbus, Ind., Friday, October 7, 2011

Spread the message Family tragedies prompt woman to encourage early detection

BY TOM LANGE For The Republic Cheryle Anderson didn’t know that her mother was dying when she saw her in July 1980, but she and her siblings knew something was wrong.

The family was gathered for the funeral of Anderson’s sister Sandie Willey, who had died of complications from bronchitis at age 31. At the funeral her mother, Margaret Willey, had worn a long-sleeve turtleneck despite the heat.

Four months later, 58-yearold Willey died from breast cancer. She was the first relative Anderson would see killed by the disease, but she wouldn’t be the last.

Anderson, now 65, is the third oldest of 13 children that included 10 girls. Between 1980 and 2003, she saw breast cancer kill her mother and two of her sisters. Another of Anderson’s sisters is a breast cancer survivor.

Three cancer-related deaths in 23 years scared the Columbus resident into making sure she was taking care of herself.

Since her mother’s death, she’s regularly done self-exams, she receives annual mammograms and she is considering having testing for the breast cancer gene done.

“I worry. How can you not when you’ve got that many in your family that’s had it?” she said.

Family’s battle Anderson was born and raised in Franklin. Margaret and Kenneth Willey worked hard to provide for their large family. Margaret also came from a large family so she knew what was needed to keep everyone happy and healthy.

Anderson’s older sister, Diana Keller, was the first of her immediate family to be diagnosed with breast cancer, but she beat it and is still alive at 72.

Nearly a decade later at

Cheryle Anderson AGE: 65 RESIDES: Columbus FAMILY BREAST CANCER HISTORY: Mother Margaret Willey and sisters Brenda Burton and Prudence Blessing developed breast cancer; died of stroke.

Sister Diana Keller beat it.

Sandie Willey’s funeral, Anderson and her sisters suspected their mom was sick. The only explanation the family could think of for Willey’s long sleeves in the summer was to cover up cancerous sores. But she wouldn’t go to a doctor.

Willey was taken to the hospital in November after the pain became too much to bear, and she died Nov. 6, 1980.

“I guess it’s just because she was scared. I … she just didn’t. She didn’t seek help of any kind,” Anderson said.

No one is sure when Anderson’s sister, Brenda Burton, first discovered her tumor. Anderson doesn’t think she waited as long as their mother to seek treatment, but Burton’s daughter, Grace Norton, 49, remembers her mother waiting years for treatment before dying.

Burton avoided seeing a doctor about the lump in her breast until the cancer spread and tumors began appearing around her neck. Norton remembers her father, Wayne Durbin, telling her that Burton didn’t want doctors experimenting on her.

“It was horrifying because she had let it go,” Norton said.

Burton was beyond surgery when she was diagnosed. Her doctors put her on chemotherapy and radiation, but she died Oct. 22, 1984.

Norton learned to expect the worst. Her father was later diagnosed and died of cancer, and during that time Norton didn’t let herself believe there was hope.

The cancer-related deaths scared Anderson, Norton and

the other women of the family into action, getting annual mammograms after 40 and performing self-exams. Mammograms are nerve-wracking experiences — with every appointment comes the fear that the doctor will find something suspicious, Norton said.

Anderson’s other sister, Prudence Blessing, also was vigilant about mammograms and self- exams, and in 2001 she found a lump in her right breast.

Blessing was living in Virginia with her husband, Craig, and the couple’s two kids when she was diagnosed. She underwent chemo followed by a double mastectomy and then more chemo.

The family was hopeful the cancer had been caught in time, but it reappeared a year later.

Blessing underwent additional chemo but continued to get worse and was eventually diagnosed with leukemia. To survive she would need a bone marrow transplant. Anderson was tested and matched the bone marrow her sister would need for a transplant, but two weeks before she was to go to Virginia for the procedure Blessing died of a stroke.

Pushing prevention Anderson doesn’t know how other families would deal with the deaths of numerous siblings, but the tragedies brought hers together. She and her siblings would get together or make phone calls to talk about what had happened.

“Thank goodness for Facebook, email and stuff like that,” she said.

Anderson was diagnosed last year with cervical cancer, which was detected early, and after surgery she required no radiation or chemo. She’s continuing her self-exams and mammograms.

Anderson doesn’t like to make speeches but she tries to share her family’s history with

See MESSAGE on Page D11

Breast simulator test designed for future docs

BY CARLA K. JOHNSON Associated Press CHICAGO — Women often find it somewhat mysterious to do a breast exam. It also can be mysterious to medical students, said a Chicago researcher who has a $1.8 million federal grant to design the first physical test to measure how well future doctors examine breasts by touch and find possible cancers.

Using plastic models of breasts embedded with datacapturing sensors and simulated tumors, Dr. Carla Pugh of Northwestern University Feinberg School of Medicine is zeroing in on how to measure a medical student’s ability to tell the difference between a cancerous lump and a benign cyst.

Medical students’ hands-on skills in breast palpation aren’t

tested in their licensing exam.

Pugh hopes her research will change that.

She says doctors don’t want to talk about it, but they all know a colleague who’s missed a cancer during a breast exam, or they’ve missed one themselves. Pugh, 45, is a surgeon with a doctorate in education and a patent in sensor technology.

“What if there were a test and you had to meet a minimum level of proficiency before you could do breast exams and say you’re competent?” she asks. That might lead to better exams and more accurate diagnoses, she says.

Breast exam skills aren’t tested in the current U.S. medical licensing exam, says Dr. Stephen Clyman of the National Board of Medical Examiners, a co-sponsor of the

test that’s the entryway to the medical profession.

Clyman directs the board’s Center for Innovation, which investigates how new technology might be used in future licensing exams. He is a consultant on Pugh’s breast exam simulator research.

Pugh’s project will attempt to answer those questions by recording the movements, pressure and patterns of experienced doctors as they palpate simulator breasts with various masses and cysts hidden inside.

The mock tumors must feel authentic to a physician’s fingers. Pugh has built tumors from beans glued together, glass beads and hardened clay.

Lentils embedded in rubber mimic the feel of fibrocystic breast changes, a noncancerous condition.

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ANDREW LAKER | THE REPUBLIC

Cheryle Anderson lost her mother, Margaret Willey, lower left, and sister, Brenda Burton, to cancer.

Another sister, Prudence Blessing, also developed cancer and later died of a stroke.

PINK D10

Other risk factors include radiation exposure, age, starting menopause after 55, childbirth after 35, prior history of breast cancer, dense breast tissue, breast conditions, postmenopausal hormone use, birth control pill use, alcoholism and obesity.

purpose

The Republic, Columbus, Ind., Friday, October 7, 2011

‘Joy and gratitude’ Friend thankful for Zehr’s help

BY BORIS LADWIG bladwig@therepublic.com

ANDREW LAKER | THE REPUBLIC

Lynn Zhao, left, laughs with friend Cathy Zehr during a visit. Zhao said her friend’s help provided comfort and reassurance during her breast cancer scare. After Zehr’s breast cancer diagnosis, she asked God to use her illness to help others.

Cancer diagnoses move woman to help others

BY BORIS LADWIG bladwig@therepublic.com When Cathy Zehr was told at age 37 that she had breast cancer, she fainted in the doctor’s office.

It didn’t matter that the doctor told her the cancer was Stage 0 or that the 10-year survivability rate of women with her condition was about 97 percent.

“All you hear is breast cancer,” Zehr said, who lived in northwestern Indiana at the time.

“My hearing started fading. (I felt) this rush of emotion.”

Morbid thoughts flashed through her brain: about mortality, an uncertain future, the impact on friends and family.

Zehr said she heard the diagnosis, but could not believe it.

“What do you mean I have cancer?” she thought.

Later, sitting in her car, in the parking lot, her body started to shake. Her emotions kept intensifying, and she began to cry.

“I should have had someone there with me,” Zehr said.

Her anxiety and confusion passed within minutes, however.

“I just felt overwhelmed to pray and thank God for this diagnosis,” Zehr said.

She said she accepted her new reality and asked God to use her illness for a greater purpose: to help others.

Her cancer was ductal carcinoma in situ, which meant cancer cells were only in the lining of the milk ducts, and had not spread to other tissues in the breast.

After 33 radiation treatments, which she typically received on her lunch break from her corporate communications job, she was cleared.

She got married and moved to Columbus in 2000,

four years after her initial diagnosis. During her first mammogram after moving to Columbus, doctors thought they saw something. Zehr had gone to the screening by herself, and immediately her emotions came flooding back.

She turned out to be fine, but from that day forward, her husband, Randy, promised to take time off every six months to go with her.

Going together For five years, the couple went to the screenings in Indianapolis together. The mammograms were always AGE: 53. clear. The couple always turned the day JOB: Substitute teacher into a date, going out at Columbus East High to eat wherever Cathy School. wished.

HUSBAND: Randy.

In 2005, Randy had DISCOVERED BREAST to attend a work meetCANCER: Three times, ing and could not go Stage 0 each time. First with Cathy. She said diagnosed in 1996 at the mammogram day age 37. had become routine by TREATMENT: Radiation, then. She went by hertwice. Double self, for the first time mastectomy after third in about five years. diagnosis.

And doctors found something.

“I thought, ‘You’ve got to be kidding me,’” Cathy said.

She had flashbacks to her first diagnosis.

Doctors told her they had to do some tests and that she should go to lunch and come back in two hours.

The longest two hours of her life, Cathy said.

She didn’t want to call Randy, because he could not do anything anyway. She tried to call a friend

Cathy Zehr

but could not reach her.

She could not focus on lunch and returned to the doctor’s office. The diagnosis: cancer. Again, Stage 0. This time in the other breast.

Cathy said she struggled more with the second diagnosis than the first, because she felt bad about how her disease would affect her husband.

“Why did she bring that into his life?” she remembers asking herself.

This time on the drive back home she wept for her husband.

Randy, meanwhile, said he worried solely about her and felt horrible that she had to battle cancer again.

He said that he suspected something was wrong because he tried to call her but could not get an answer.

Cathy worked the radiation treatments into her substitute teaching schedule at East High School.

She jokes that it took longer to find a parking spot than to receive the radiation treatments.

She also said that waiting in the doctor’s office and seeing other patients with more severe cases of cancer strengthened her resolve to help others with the disease.

In early 2007, she was diagnosed with cancer for the third time.

She knew she could not have more radiation treatments, but she said for the first time in 11 years, she did not shake when she received the bad news.

“Actually I was fine with this,” she said.

She always knew in the back of her mind that she would have a double mastectomy if the cancer returned again.

Whenever her emotions threatened to slip into self-pity, Cathy said she told herself to snap out of it and to be grateful to receive three Stage 0 diagnoses.

“She’s the eternal optimist,” Randy said.

Cathy Zehr’s experiences with breast cancer, including three Stage 0 diagnoses, have prompted her to talk openly and often about breast health issues, encouraging people to get mammograms and working with the Susan G. Komen for the Cure foundation.

She has had a tremendous impact on lots of women, her husband, Randy, said.

She has taken them to doctors to deal with the diagnosis, brought goody bags for people who have recently received a diagnosis, made sure they know they are supported and loved.

For example, in early 2009, Cathy helped Lynn Zhao, a Chinese-born Canadian citizen who had moved to Columbus from Canada four years earlier.

Zhao sat in a medical office in early 2009 after a mammogram, while a doctor looked at X-rays on the wall.

Something did not look right.

Zhao’s fear was heightened because she struggled to understand the medical jargon.

When nurses and doctors tried to comfort her, even offering to drive her home, it scared her even more, because she thought her condition was serious.

At home, Zhao called Cathy, a friend whom she had met in Community Church of Columbus Bible study meetings. In one of the meetings, Zhao remembered Cathy saying that she hoped God would use her experience with breast cancer to help others.

Zhao said she does not accept help from others easily, but that Cathy made it easy because she immediately said she would come over to talk about the mammogram’s results, counsel her on her next steps and drive her to the doctor’s office for a biopsy.

Zhao also was dealing with hypothyroidism and visa problems, including a four-day deportation back to Canada between the mammogram and the biopsy.

The doctor in Greenwood even allowed Cathy to come into the consultation with Zhao.

“I remember it was a long day,” Zhao said.

A few days later, Zhao called Cathy with the happy news: She did not have breast cancer.

The two friends chatted recently at Cathy’s home, both ebullient, even laughing now about some of their experiences.

Zhao said that Cathy’s help provided comfort and reassurance.

“My heart (is) filled with joy and gratitude,” Zhao said.

Help from Cathy and people in the community also gave her a deep sense of Columbus being home.

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Surgery, chemotherapy and radiation are the common treatments for breast cancer.

PAGE D11 The Republic, Columbus, Ind., Friday, October 7, 2011

Genome project striving for patient-specific treatments

BY ANNIE GOELLER For The Republic Breast cancer patients treated at two southside hospitals could be helping to find treatments for women across the country with the same type of cancer.

Tumors removed during a mastectomy or lumpectomy can be shipped to a center in Arizona, where they are studied for how they respond to certain drugs and treatments.

With enough testing, researchers could find that a specific treatment can be extremely beneficial for a certain type of cancer, said Dr. Jeffrey Mossler, pathologist at Community Health Network.

Community Health Network, which includes Community Hospital South on County Line Road, and Franciscan St. Francis Health in Indianapolis have been sending tissue samples to be studied for years.

The International Genomics Consortium in Arizona recent-

ly received a grant to expand and extend that research, and both Community Hospitals and St. Francis agreed to continue sending samples there, he said.

The research project helps doctors and hospitals move toward the goal of individualized treatments for patients, Mossler said.

“For about the last eight to 10 years, we’ve been moving into an era of personalized medicine. Prior to that time, patients would all be treated the same,” Mossler said.

Drugs and treatment plans are all a part of that new movement, he said.

In recent years, doctors and researchers have found that hundreds of cancer medications are effective in only 5 to 10 percent of patients. So they often don’t get used, he said.

But with more testing, researchers could figure out what cancers are best treated by certain drugs and then use that information to treat cancer pa-

tients, Mossler said.

“If you actually knew the group who would respond, you might see significant responses,” he said.

The research isn’t only for breast cancer patients and is used for multiple types of cancer, including lung, colon and pancreatic cancers — anything the hospital had enough tissue to send for research, he said.

The tissue is collected by surgeons. Research coordinators look at the hospitals’ surgery schedules daily, seeing if any of the surgeries they have scheduled are cancer-related.

A pathologist then will examine the tissue once it is removed to make sure it is not damaged and is a large enough sample that it can be used for research, Mossler said.

If the piece is large enough, it is immediately frozen and will be sent to the lab in Arizona, marked with general information about the patient, such as sex and age, for research.

The sample has to be flash frozen within 30 minutes of being removed, in order to prevent some of the genetic material of the cells from breaking down, said Dr. Stephen Clark, a pathologist for Franciscan St. Francis.

Before any tissue is sent, the research coordinator will get the patient’s consent, which commonly is given, Mossler said.

At the lab in Arizona, the tissue samples go through a full genetic sequencing, breaking down the specific information about the genetic code of that specific type of cancer.

The cancerous tissue also can be compared to normal tissue, looking for mutations, he said.

That information all goes into a database, which is used by researchers across the country.

“The whole project is trying to develop a dictionary of genetic abnormalities of tumors, and make that available to customize a treatment,” Clark said.

he said.

Now, doctors regularly test for that information, but only since that gene was identified.

With further research, more genes and mutations like that can be found, he said.

“Every six months or so, there is something new we learn about the genetic makeup,” he said.

Clark has seen the progress in mapping the genetic makeup of tumors. When researchers understand how separate cancers are formed at the molecular level, they can begin to develop ways to treat them.

That process is still years away.

“I think we’re in the early steps of the next phase of oncology and tumor treatment. It’s not quite ready for primetime, but we’re approaching that,” Clark said.

Annie Goeller is a staff writer for the Johnson County Daily Journal, a sister paper of The Republic.

COSTS

THOMPSON

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history, a detailed review of any mammograms done. It’s an expensive test, but I think when used in the right context, it can be very advantageous in the treatment of breast cancer.

Q: What is genetic high-risk testing, and why should people consider it? What do people learn from it?

A: The genetic testing is the BRCA testing, which is a genetic marker which predisposes people to breast cancer. Normally, we’ll test that in somebody who has a family member with a history of breast cancer, especially a family member who had premenopausal breast cancer.

What it helps us determine is their risk of developing cancer in the future, both breast cancer and ovarian cancer. If we know someone whose mother developed breast cancer in their 40s, then

Between St. Francis and Community Health, the hospitals have sent close to 1,000 tissue samples to Arizona for study. But how that information is used varies based on what a researcher is studying, Mossler said.

“It is there for people to access that information, to ask and answer any questions. What they want to know depends on the research interest of that person,” he said.

For example, a drug company might have a medication that treats a certain mutation. So the company might want to see how often that mutation occurs in a certain type of cancer to see how many patients could benefit from that drug, Mossler said.

Doctors already have seen certain drugs be beneficial in breast cancer patients. For example, about 15 years ago, doctors identified the gene called HER-2 and found that when those women were given Herceptin they had a dramatically better response to treatment,

we will recommend that the daughters undergo genetic testing to determine their risk of developing breast cancer.

If they are found to have an increased risk for developing breast cancer based on their genes, then we may recommend proceeding with doing some type of surgical procedure, even before they develop a sign of cancer — before they develop an abnormal mammogram or an abnormal MRI. Q: Are people who are at greater risk of developing breast cancer becoming more proactive in their fight against it? If so, why and how?

A: We see a lot more women who want to have mastectomies or even bilateral mastectomies, even in younger women, because they don’t want to have to worry about the future risk of developing breast cancer. They would

rather just have surgery now and have reconstruction, and decrease or eliminate their risk for developing breast cancer down the road.

Q: What are the most important strides made in the fight against breast cancer in the last 10 years? The last 20?

A: From a surgical standpoint, I would say sentinel lymph node biopsy, which again is us just going in and sampling just one or two lymph nodes as opposed to clearing out all the lymph nodes in the armpit. …I think just all the awareness.

There seems to be a lot more awareness in the public about breast cancer. Certainly, Susan G. Komen Foundation has had a huge impact on that. I think Lance Armstrong and the Live Strong Foundation have had a huge impact on cancer awareness.

And, I think in general, women are much more proactive in their health, getting screening mammograms, getting yearly mammograms and the types of things it takes to detect breast cancer earlier.

Q: What advances in breast cancer detection and treatment could happen within the next 10 to 20 years, and what impact could they have?

A: I don’t see the surgery for breast cancer changing much over the next 10 to 20 years. I think the majority of advances will be made in radiation oncology and medical oncology, possibly changes in chemotherapy, possibly types of radiation therapy for breast cancer. And then, earlier detection of breast cancer, with the areas that would be beneficial, and there may be advances.

director for Anthem Blue Cross and Blue Shield, the largest insurance provider in the area, said it’s hard to provide precise answers about coverage because Anthem offers so many different plans with different benefits, co-pays and cost shares.

“So it’s almost impossible to give an estimate that would have any relevance,” Felts said.

But, he said, Anthem’s over-

all philosophy is to help members prevent breast cancer, detect it early and get treatment.

Anthem’s preventive health guidelines include recommendations that women over the age of 40 receive a clinical breast exam by their health care provider and a mammogram every year.

“The majority of our health plans include this as a preventive care benefit,” he said.

MESSAGE

Continued from Page D9 people. If breast cancer comes up as a topic of conversation she talks with women about the importance of early detection.

Her hope is that at least one woman who isn’t thinking about the disease or is afraid to will start thinking proactively.

“So many women die a year of breast cancer. But also, so many women survive breast cancer by early detection,” she said.

Tom Lange is a staff writer for the Johnson County Daily Journal, a sister paper of The Republic.

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The Republic, Columbus, Ind., Friday, October 7, 2011