BRIDGEPORT, W.Va. — As Breast Cancer Awareness Month comes to a close, United Hospital Center officials are hoping to have shed some light on topics that aren’t typically discussed.
“That is the magic of Breast Cancer Awareness Month,” said Linda Carte, director of Cancer Services at United Hospital Center. “It gives us a chance to talk about how to find these things early and how to work with your healthcare provider.
“It’s really important for you to talk to your healthcare provider about your family history of cancer, specifically breast cancer, so that they can come up with the right plan to screen you and find it at it’s earliest stage in order to get the best possible treatment outcome,” Carte said.
Peggy Johnson, a clinical navigator of breast and gynecological health at United Hospital Center, said one hope she had for this year’s awareness month was to increase discussion of breast cancer in men.
“It’s still not widely known that men can get breast cancer. For men, it’s still a taboo,” Johnson said. “They don’t want to know that they have a possibility of having breast cancer because they still think that women get breast cancer and men do not, but they need to realize that men have a certain amount of breast cancer also.”
Just as with women, Johnson advises that men have any abnormalities checked by a physician.
“In the beginning, they thought that men’s breast cancer was more aggressive, and that’s not true,” she said. “They’re finding now that it’s caught at a later stage because men just don’t go have the early warning signs checked.”
Johnson said male patients sometimes feel ashamed to have a breast cancer diagnosis, and Johnson has sensed that with her own patients.
“I am finding that in the experience that I’ve had here, only one of my male patients is really going through this well. The others, they didn’t not do so well,” she said.
As a clinical navigator at UHC, Johnson works closely with patients, both male and female, going through their cancer journey.
“I start with the patient at the abnormal mammogram and make sure they get to the right place, the right doctor the right treatment. I’m there with them throughout the whole process from biopsy and needle localization and whatever their need is to decrease their anxiety going through these treatments and the procedures that they need to have done,” she said.
Johnson has been a clinical navigator for six years, inspired by her own experience with breast cancer to help others.
“It was 16 years ago that I was diagnosed with breast cancer,” she said. “When I heard this job was going to open, I wasn’t really sure, and then I thought, ‘I’ve been through this and if I can help one person, that’s what I’m going to do.”
Since then, Johnson has helped hundreds of women through the fear and stress that comes with battling breast cancer.
“You have to give it to them in small pieces,” she said. “They’re under a lot of stress and anxiety, and they don’t retain a whole lot of what they’re hearing, so they have access to be able to call me. They always have access to me to answer whatever question or concern they might have.”
In her time as a clinical navigator, and more so since her own time as a cancer patient, Johnson said technology in both prevention and treatment has come a significantly far way.
“Technology is a whole lot better and more advanced than it used to be,” Johnson said. “The mammogram that we have now and the technology that we have now have improved the odds of beating the cancer.
“Prevention and early detection, of course, is the key to the breast cancer diagnosis,” she said. “The earlier it’s caught, the better the treatment, the better the outcome, the better percentage of it being caught early. It’s just a better treatment plan.”
One part of prevention is working to spread information of risk factors that can increase one’s likelihood of developing breast cancer.
“As in many cancer, age is a risk factor for many cancers,” Carte said. “As we get older, our risk goes up for developing cancer, and breast cancer is no different.”
Other risk factors include postmenopausal hormone therapy, obesity, having more than one alcoholic drink daily, physical inactivity, a long menstrual history, never having children or having your first live birth after 30, previous chest radiation to treat a different cancer or previous history of breast cancer or certain benign breast conditions.
While the American Cancer Society recommends annual mammograms for all women over the age of 45, several factors can make that an earlier need.
“At age 40 and anytime even prior to that that you feel there’s something not right with your body, please talk with your healthcare provider,” Johnson said. “Then at age 55 you can continue with annual or go to every other year.”
As part of WVU Medicine, United Hospital Center has had numerous opportunities to participate in clinical trials that have worked to advance cancer treatment.
“Clinical trials are really important because what it does is look at what the current standard of care is, what we currently do for breast cancer, and then additionally look at adding something to or subtracting something from care,” Carte said. “Does it make a difference in the longevity of life, curing the cancer or in terms of whether it improves quality of life?”
The first clinical trial that truly changed treatment for breast cancer came over 30 years ago, when doctors at the National Surgical Adjuvant Breast and Bowel project evaluated segmental mastectomy (lumpectomy) in breast cancer patients.
A lumpectomy removes only the cancerous tumor, where breast cancer patients previously all faced mastectomies.
“And in some cases, they said removal of the lump and the radiation can equal the same outcome as mastectomies, and so there was an improvement,” Carte said. “Then you fast forward a couple more years and they said when we’re doing that mastectomy or lumpectomy, do we need to take out all of those lymph nodes.”
Carte said removing a significant amount of lymph nodes can cause long term effects “like susceptibility for infections in that arm, you might have swelling of that arm and shoulder area from removal of the lymph nodes.
“Then another clinical trial happened that looked at taking out just the gatekeeper lymph nodes and not disrupting the lymph node bed as much,” she said. “The result of that study has gone on to show that we can take just that out. So we’ve gone from a very detailed, extreme surgery to less surgery to less disruption of the lymph node beds, and all of these things have happened through clinical trials.”
The possibility of a lumpectomy, as opposed to a mastectomy, was a great advancement not only for medicine, but how a breast cancer patient sees him or herself after the surgery.
“I think it does really help people kind of get back to life sooner,” Carte said. “Yes, it is still a surgery and there are certainly risks with any surgeries, but I think that the long-term once you get over the initial shock of the cancer, when you look in the mirror every day, you’re not reminded when you have a smaller surgery.”
A recent trial that UHC took part in examined women with early stage breast cancer and bone marrow biopsies on the day of their surgeries, Carte said.
“They were trying to look at that bone marrow to see if there’s any common characteristics that they could see of women who have early stage breast cancer to predict whether this cancer is going to be aggressive or not,” she said. “As time goes on, you fast forward a couple more years and they look at treatment, they look at predictive factors, they look at many aspects of breast cancer, and it is through the heroes that signed up for clinical trials that made a difference.”
Some clinical trials even help develop new medications to better treat specific types of breast cancer.
Two new breast cancer chemotherapeutic agents — Nerlynx and Kisqali — that have been released for early-stage HER-2 positive breast cancer and advanced HER-2 negative breast cancer, respectively, Carte said.
Herceptin has been used to treat HER-2 forms of breast cancer for many years. HER-2 is a protein that’s found in specific areas of the body, and when in excess create a cancerous area.
Johnson said hormone therapy has also been a successful clinical trial.
“That trial studies hormone therapy with or without a cancer drug for breast cancer, and it just involves some certain by-mouth medications that they’re trying in different ways to see what the best outcome is going to be,” she said.
Carte said she’s especially grateful for those who volunteer to be a part of such trials.
“When I think back on some of the clinical trials we have been involved in in the past, and I think of the women and sometimes men and women who have participated in these trials,” she said. “I think of them as true heroes because they’re really saying, ‘I want to contribute to the knowledge that we have about breast cancer.'”