Since October is Breast Cancer Awareness month, I can think of no better time than to give congratulations to my patient Pearle Mintz. With the intention of bringing hope to anyone diagnosed with this disease, Pearle has given me permission to share her triumph of three decades of surviving -- and thriving -- from breast cancer. Oh, and she says it's okay to publicly reveal her age. That's a double dose of courage for any woman!
Eighty years young, Pearle beautifully illustrates how breast cancer has been transformed from a fatal affliction into a chronic illness whose treatment allows continued life satisfaction and enjoyment. Pearle had breast cancer diagnosed 31 years ago when she was 49. Following her surgery, chemotherapy and tamoxifen hormonal therapy, bone metastases progressed.
She has undergone surgery to remove metastases, radiation, seven types of chemotherapy, bone-protecting bisphosphonate infusions and new hormonal injections. Because her tumor scans have shown nearly complete remission of all her cancer, Pearle has traveled, worked as an interior designer and realtor, helped as an advocate for friends with cancer, and promoted support for cancer research. Having just celebrated her 80th birthday, she continues to bring happiness to her husband, family and friends.
We've come a long way since Pearle's diagnosis. As a result of scientific discoveries, treatments have become more effective. Less-extensive surgery has allowed many women to avoid long-term toxicity such as lymphedema (arm swelling). Some women with gene mutations have elected to reduce their risk of breast cancer by having bilateral mastectomy and immediate plastic surgery reconstruction. Angelina Jolie is a example of this life-saving approach. New hormonal treatment regimens (like everolimus or palbociclib) have made it possible to avoid chemotherapy, and new chemotherapies (like Kadcycla) have improved control of the disease. These have increased a woman's chances of long survival and cure.
One of eight women will get breast cancer, but thankfully, it no longer has to be a death sentence. Use all the recent advances to control this common illness, and be a survivor. Here are my tips, which are passionately endorsed by my patient, Pearle:
• Women should have annual breast cancer screening with mammogram starting at age 40. If a woman's breasts are dense, ultrasound or breast MRI should be performed in addition to mammogram. Discuss all these with your physician. If you are confused by what your physician suggests, get a second opinion (see my book Surviving American Medicine for advice on when and where to get second opinions).
• Check out your own risk using the breast cancer risk tool of the National Cancer Institute (http://www.cancer.gov/bcrisktool/). Then discuss your personal breast cancer risk, and plans for breast cancer prevention and screening with your doctor.
• If a cancer is suspected, get a needle biopsy of the lump to determine if it really is cancer or just benign. Then, if you actually have cancer, get opinions about what treatment would be best from your surgeon and a medical oncologist. Get a second opinion if you want more confidence in your best curative treatment.
• Once you have had treatments, get a complete survivorship plan for the rest of your life from your oncologist. If you need continuing treatments, be sure you discuss all your symptoms with your physician so your quality of life can be as good as possible. If any symptom continues to be troublesome, get a second opinion.
Pearle's life message for us all is that cancer survivorship can be joyful and satisfying, even despite ongoing treatments. And remember, screening saves lives!