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More choices, difficult options face breast cancer patients today

October 13, 2015
Holly Mason and Gail Shattuck

Looking out into a “sea of pink” each year at the Rays of Hope – Walk and Run Toward the Cure of Breast Cancer, breast cancer surgeon Dr. Holly Mason says she is reminded how each woman’s cancer journey is different, from coping with her cancer diagnosis to making choices about treatment.

“As early as just four decades ago, a diagnosis of breast cancer required that a woman undergo a radical mastectomy, which involves removing the entire breast, chest wall muscle and surrounding lymph nodes,” said Dr. Mason, co-director of the Baystate Breast & Wellness Center. “There were no options.”

As physicians have gotten a better understanding of how breast cancer grows and spreads, they have realized that there can be different ways which can be equally effective in the treatment of breast cancer.

“We look at a patient in terms of overall health, the type and size of tumor, whether the cancer has spread to lymph nodes, the aggressiveness of the cancer and other features. Taking all that information into account, we determine which treatment plan is appropriate,” said Dr. Mason about what they call a “tailored” approach.

The treatment of breast cancer involves a multi-faceted attack, noted the Baystate breast surgeon. Surgery, with or without radiation, removes cancer from the breast and helps to prevent its recurrence in the breast. Medical therapy, whether in the form of anti-hormone therapy or chemotherapy, protects the body from cancer spreading to areas outside of the breast.

“Many patients undergo a combination of these treatments, but the sequence in which the treatments are given can be altered to accomplish certain goals. For example, many patients undergo a treatment plan with surgery first and then chemotherapy, which is followed by radiation therapy. For a patient with a large tumor, chemotherapy can be given first to shrink the tumor to make surgery easier. This may allow a woman to have a breast-sparing lumpectomy, as opposed to a mastectomy. We also now have ways of telling if chemotherapy is needed in addition to anti-hormone therapy by studying the gene profile of the tumor,” said Dr. Mason.

Multiple studies have documented a significant increase in the number of women who choose to have a mastectomy for the breast with cancer or even the non-affected breast. For many of these women, however, there is no evidence that choosing this option will alter long-term survival, noted Dr. Mason. In addition, the risk of a complication following surgery is greater with a mastectomy than it is with a lumpectomy, especially when breast reconstruction is performed.

“That is why it is so important to talk with all of the doctors on your team about the different options available to you and to choose the one that best fits your case,” said Dr. Mason.

But, the fact that there are options can make the decision-making process difficult.

“There needs to be a balance between being able to make a choice and making sure that the choice you make has the best chance at success. Your team of doctors can help you find that balance,” said Dr. Mason.

Michelle Moreau, 53, of Williamsburg, a patient of Dr. Mason, who was diagnosed with invasive ductal cancer in March, is one example of the many women who were able to choose breast-conserving therapy to treat their cancer.

Dr. Mason referred her to Dr. Deborah Katz, a medical oncologist at the Baystate Regional Cancer Program, and together they helped Moreau to make a decision on the treatment plan that was right for her.

“I was told that I could choose a mastectomy if I wanted to, but that I was a good candidate for a lumpectomy because of the location and size of my tumor, and they didn’t believe any lymph nodes were involved. They also explained that having chemotherapy before surgery would be best to shrink the tumor first, then I would have radiation after surgery. Dr. Katz even drew a diagram of a breast depicting what normal and cancerous cells look like, and the aggressive path a cancer cell takes. It was very helpful to me in determining my treatment. I wasn’t ready to have a mastectomy and knew right away when the options were presented to me that a lumpectomy followed by radiation would be my choice,” said Moreau.

At one of her visits, Moreau was given a brochure about donating tissue as part of the Breast Research Registry located at the Rays of Hope Center for Breast Cancer Research.

The Breast Research Registry is where large amounts of information related to the diagnosis and treatment of breast cancer and other breast problems are stored. Availability of human tissues and clinical records provide the best resource to understand breast cancer, but are also the most difficult to obtain. Today, similar to Michelle, over 250 women have donated their leftover tissue after breast surgery for use at the registry, where researchers use information from “the bank” to try to gain knowledge about different aspects of breast health, breast disease and breast cancer.

“Why would I not want to donate my tissue if I can help research and possibly find a cure someday?” said Moreau, who has some advice for other women faced with a breast cancer diagnosis.

“Be sure to get as much information as you can from your doctors….that is really the best way for you to make a decision about what treatment choice is right for you,” she added.

Michelle Shattuck, chair of the Rays of Hope, who had her own choices to make after her diagnoses, said when she looks out into the “sea of pink,” she sees many things.

“As chair, when I’m at our annual walk and run surrounded by fellow survivors and so many selfless people giving of their time for a variety of reasons, whether it is walking in memory or honor of someone, I feel as if I’m in the middle of a big pink hug. These women, men and even children are so very loving and giving of their time. And, it is just so empowering for me as a survivor and as chair of this wonderful organization, which means so much to so many people, to experience it all,” said Shattuck.

The South Deerfield woman’s cancer journey began in 2008 at the age of 38.

The following year a second diagnosis revealed that the cancer had metastasized to her lymph nodes.

“The first time I had cancer, my husband and I made sure we gathered all the information we could before making an informed decision. For me, that was to have a mastectomy with immediate reconstructive surgery. After a few more tests were completed on the breast cancer tissue, we decided along with my oncologist, Dr. Grace Makari-Judson, who is chair of the Baystate Health Breast Network, that anti-hormone therapy would be the best course of action,” said Shattuck.

The following year, when the cancer reappeared in her lymph nodes, Shattuck said they made the decision to be more aggressive with her treatment, which included two additional surgeries, 16 weeks of two different types of chemotherapy, and 25 sessions of radiation.

“There are a variety of choices and options for people diagnosed with breast cancer. It’s imperative to do all of the research you can prior to making an informed, well-thought-out decision,” said Shattuck.

In relation to the removal of Shattuck’s lymph nodes, today Baystate Medical Center is involved in a multi-center clinical trial to determine if all patients who have cancer in their lymph nodes need them all removed or just need radiation.

“It is through research that we will be able to learn more about breast cancer and become better able to tailor different options to women and their unique cancers,” said Dr. Mason.

Also, since Shattuck had her breast reconstruction surgery in 2009, there have been further advances, including a procedure called DIEP, which is only available in western Massachusetts at Baystate Medical Center.

Deep inferior epigastric perforator (DIEP) artery flap is a muscle-sparing procedure that allows women to recover more quickly from breast surgery, as well as lowering their risk of losing abdominal muscle strength compared to other flap procedures.

During DIEP flap surgery, an incision is made along the bikini line and a portion of skin, fat, and blood vessels are taken from the lower half of the abdomen, moved up to the chest, and formed into a new breast. The tiny blood vessels in the flap of the new breast are then carefully reattached.

By not cutting any abdominal muscles, this procedure helps preserve the strength of the abdominal wall. Plus, no mesh material is required to support the abdomen, minimizing the long-term effects on the patient’s ability to get back to normal activities.

In addition, since most patients’ excess body fat is around their waistline, this procedure helps reduce the abdomen much like having a tummy tuck does. For patients with little to no belly fat, the back or buttocks tissue can be used.

Since 1994, Rays of Hope has raised over $12.4 million, with all monies remaining in the area and administered by the Baystate Health Foundation to assist patients and their families affected by breast cancer.

Those who want to support the Rays of Hope, but are unable to due to other commitments, can make a personal donation in honor or memory of someone by visiting baystatehealth.org/raysofhope. There is also an opportunity to sign up as a “virtual” participant, choosing your own method of participation – walk, run, bowl, swim and more – anytime during the month of October to get in five miles, while raising donations similar to other Rays of Hope participants.

This year, Greenfield-area residents who wish to participate in the Rays of Hope – Walk and Run Toward the Cure of Breast Cancer in Springfield, can board the “Pink Party Bus” offering a complimentary ride to Springfield and back on Sunday, Oct. 25. Advance registration is required for the bus in order to ensure there are enough to accommodate those traveling to Springfield. Call 413-794-8001 or email raysofhope@baystatehealth.org to register today.

“I hope over the past two years as Rays of Hope chair that sharing my breast cancer journey has helped those currently on their own journeys, as well as others yet to be diagnosed, to know they are not alone, that they do not need to be afraid because there are ‘Rays of Hope’ surrounding them,” said Shattuck.

“It’s so very empowering for survivors, who can say to themselves: ‘That’s right, I’m alive and walking and we are raising money and funding research right here in Springfield for a cure,’” she added.

IF YOU GO

What: “Rays of Hope - Walk and Run Toward the Cure of Breast Cancer”

When: Sunday, Oct. 25

Where: Temple Beth El, 979 Dickinson St., Springfield; Registration for the timed 8K run begins 7:30 a.m., start time is 8:30 a.m.; Registration for the Walk (2- or 5-mile route) begins 9 a.m., start time is 10:30 a.m.

For more info: baystatehealth.org/raysofhope