Breast-cancer battle gains ground

Kelly Mull, 39, knows she's lucky to be alive.

In 1996, the Whitefish woman felt sore as she put on the snug vest she wears for kayaking.

Upon examining her breasts, Mull felt a lump on the right side. She immediately went to her doctor, who told her it was most likely nothing, citing her age and no history of breast cancer in her family.

She took off on a trip with the decision about pursuing more tests left up to her. When she returned, Mull went directly back to her physician's office.

"I said my gut tells me this is not something to blow off," she recalled.

That saved her life.

Due to her dense breasts, a mammogram failed to delineate the lump. An ultrasound imaged the area for a subsequent needle biopsy.

A few days later, her test was back with the diagnosis of breast cancer. Mull scheduled surgery the next day, followed by chemotherapy and radiation.

Because she knew her body, listened to her intuition and took quick action, her tumor was found at Stage 2, early enough for medical science to offer the best hope for a cure.

"Women need to become comfortable with their own bodies," Mull advised.

Because more women like Mull now pay attention to their breasts and get mammograms, breast cancer's grim statistics have begun to brighten, according to Kalispell surgeon Dr. Jim Bonnet.

"Since 2001, we're beginning to see a decline in the mortality of this disease," Bonnet told a gathering organized for breast cancer month.

Bonnet joined Drs. Karen Hunt, Patrick McDonnell and Gordon Stillie in the session sponsored by Kalispell Regional Medical Center and HealthCenter Northwest.

The team represents the specialties all too familiar to the many breast cancer survivors : surgery, radiology (imaging), oncology (chemotherapy) and radiation oncology.

Providing an overview, Bonnet said more than 200,000 women will receive the dreaded diagnosis this year. About 40,000 of those will die.

He emphasized that a yearly mammogram and physician exam, coupled with monthly self exams, remain a woman's best course for surviving.

"The only way we will make a dent in this disease is through early detection," he said.

Bonnet stressed that all women should have a baseline mammogram at 35, then begin annual mammograms at 40. A woman needs to start 10 years earlier if she has a mother or sister who has had breast cancer.

With all the publicity and education about the disease in recent years, he said doctors still hear patients say they don't need a mammogram since they have no family history.

"Most women with breast cancer have no history of breast cancer in their family," Bonnet said.

Although science has found a genetic link to some types of breast cancer, Bonnet said those account for a very small percentage of the women with the disease.

He said the greatest risk for breast cancer remains being born a woman. The risk jumps up with obesity, inactivity and aging.

Perhaps due to those factors, the number of women diagnosed with breast cancer continues to increase. But Bonnet said radiologists such as McDonnell bring good news for women who follow recommendations for mammograms.

"In 2005, a woman diagnosed with early-stage breast cancer, less than a centimeter, and treated properly, has a 90 percent chance of living out her life," Bonnet said.

McDonnell said new technologies promise even better detection just around the corner. He said mammograms now miss about 15 percent of masses in dense breasts.

He said a technology called tomosynthesis appears to provide better imaging while reducing radiation and discomfort from breast compression.

Tomosynthesis takes angled pictures of the breast along an arc. It provides images of slices of the breast, giving radiologists a three-dimensional image rather than a two-dimensional view.

A new use of magnetic resonance imaging also has promising applications for breast cancer.

"Its role is evolving as we speak," McDonnell told the gathering.

The cost of MRIs, at over $1,000, cause insurance companies to balk at this application.

While breast MRIs remain controversial in the medical community, McDonnell said they have proven useful for determining the stage of cancer development. The images also show enhancements within a breast, such as increased vascularity, that help a diagnosis.

McDonnell said the health center has ordered the equipment necessary for breast MRIs.

"We'll be offering it soon," he said.

Hunt, an oncologist, followed McDonnell, explaining her specialty's role in the treatment process.

"What we do is we take care of the total body problems that breast cancer patients have," she said.

Oncologists treat patients with chemotherapy to kill microscopic bits of cancer which sometime slip past the lymph node filters into the blood stream.

"Breast cancer is very sneaky," Hunt said.

She said even women with early stage breast cancer may have microscopic cancer cells hiding in other parts of their bodies. Several factors play into the chemotherapy decision, including age, type of breast cancer and lymph-node involvement.

Hunt said some situations indicate that chemotherapy will increase survival after surgery from 37 to 66 people out of 100. Others only change the odds by 2 more people out of 100 surviving with chemotherapy.

But some women weather the side effects of chemo even with the low chance of a benefit.

"What we really don't know is which 2 percent is it that chemo is going to make a difference for," Hunt said.

She described a new diagnostic test called Oncotype DX which uses the unique gene profile of a patient's tumor to predict the likelihood of a recurrence.

Again, the cost makes this test problematic.

"It's new," she said. "I don't know if insurance companies will pay for it."

Stillie, a radiation oncologist, described a top technology now available at the Kalispell Regional's cancer center which insurance companies cover.

He said intensity modulated radiation therapy applies to breast cancer as well as many other cancers.

He described the technology as a way of distorting the radiation beam to create and place hot spots to destroy cancer and cold spots to preserve healthy tissue.

Stillie pointed out that many larger cities have yet to offer this technology.

"IMRT is state of the art," he said. "There's nothing newer and nothing better."

But to take advantage of these treatments, a woman needs to take the threat of breast cancer seriously enough to perform monthly self exams and schedule annual physician exams and mammograms.

Cancer survivor Mull knows that fear and expense can throw up barriers that cause women to risk their lives. She learned that a woman needs to become her own medical advocate.

"If you think you need more tests, don't take no for an answer," Mull said. "A woman's intuition is as strong as a steel structure."

Reporter Candace Chase may be reached at 758-4436 or by e-mail at cchase@dailyinterlake.com.