40,000 deaths from breast cancer in 2012

Here are the statistics on breast cancer and biopsy in 2012, as found in BasicMedicalKey.com by Darryl Carter, 5th ed.:

In 2012 in the United States, there were 230,000 new cases of breast cancer, 99% of them in women, with nearly 40,000 disease-specific deaths (1). A much larger number of lesions were detected on clinical and radiographic breast examinations, and many of these were sufficiently suspicious of cancer to result in a biopsy. Ultimately, it is the responsibility of the pathologist to distinguish those of the biopsied lesions, which require additional attention or treatment from those which do not. In addition, the pathologist must integrate and disseminate an increasingly complex set of pathology-derived data to radiologists, surgeons, and medical and radiation oncologists to achieve optimal clinical results.

Apparently, calcifications are often seen in mammograms and are often an indicator of cancer cells. This paragraph describes core needle biopsy and fine needle biopsy.

  NEEDLE BIOPSY

Core needle biopsy (CNB) has the advantage over fine-needle aspiration (FNA) of allowing identification of benign entities and localization of calcium deposits with the result that the proportion of indeterminate and inadequate specimens is far less. Distinction between in situ and invasive carcinoma may also be more readily accomplished, and predictive markers (estrogen receptor [ER], progesterone receptor [PR], HER2/neu, etc.) can be better evaluated. However, FNA may be done more quickly with a diagnosis of malignancy at the time of outpatient visit. In the evaluation of CNB, problems are encountered because of the limited size of the specimens and, not infrequently, the presence of crush artifact. Other problems include potential destruction of lesional tissue by hemorrhage or infarction and displacement of benign epithelium to simulate invasive carcinoma (3), although displacement of epithelium has also been reported following localization by guide-wire for excision of a mammographic abnormality (4). CNB of nonpalpable lesions requires radiographic guidance by either ultrasonography or stereotactic mammography. In CNB performed to evaluate microcalcification, it is important that the calcifications be identified on specimen radiographs (5) and confirmed in the histologic sections, even though calcifications imaged on radiographs are often larger than those seen histologically. Calcification is rarely seen in FNA. Uncertainty in the interpretation of a CNB or the finding of significant atypia should lead to open biopsy. In patients receiving neoadjuvant therapy, CNB specimens may be the only histologic evidence of cancer if there is a complete response.

And much more... to keep reading, go to the site: http://basicmedicalkey.com/breast-4/

My Stereotactic Needle Biopsy

I walked out of the medical office and into the bright sunlight under a blue sky, glad to escape from the radiology equipment, computer screens, and radiologic technicians that had surrounded me for the previous two hours.  

I walked self-consciously, grateful for mobility and my strong legs.  Eighteen days earlier I'd been sitting by the bedside of Kathleen Mirante, no longer able to walk, dying of uterine cancer that had moved to her lungs.  

She has passed on to another state of being.  I am still here, emerging into the bright sunlight after a stereotactic needle biopsy with post clip.  Grateful.  

In my mammograms last Friday, three years after cancer was discovered in my left breast, there were spots of calcium in my right breast.  They are very small, seven specks in a cluster, looking like the Pleiades, fleeing Orion in the night sky. 

"These could be the sign of a tumor," Dr. Geeta Iyengar told me last Friday, recommending a biopsy.

Three years ago I lay on a table as she found the right spot, numbed the area, and shot the thin needle in, sucking out a bit of tissue from the tumor.

This time I was sitting up with my right breast squeezed flat by a mammogram machine that enabled her to pinpoint the spot on a computer screen before a needle stabbed in and sucked.  Above me hung one of the crystal chandeliers that give patients something to see while looking up.  There's one in every room. 

Actually the name of the machine is Selenia Dimensions, and it is accredited by a college:

This equipment has been accredited by the

American College of Radiology

while in service at

Medical Imaging Center of Southern California

As my breast was being pushed into place and my arm lifted away, I realized, "I'm being woman-handled."  The doctor and her two radiologic techs are women.  I felt safe and secure during it all, grateful that no men were involved.

This procedure costs $2,200 -- but I think Medicare will pay for it.

Dr. Iyengar told me to return Friday for the report after the tissue is analyzed.  I wonder why she didn't just handle it by a phone call.  Does the appointment mean that there's at least a 50% chance that it is another cancer?

Waiting to see... like three years ago.    

[Note on Friday: I received a call from Dr. Iyengar at 9:30 am telling me that the biopsy was negative for cancer.  So now I know: 
1) She tells patients to make an appointment to hear the results if there's a reasonable chance it's cancer. 
2) She calls before the appointment if the result is no cancer.]

X-ray of fluid removed from my breast today including this little patch of 7 specks of calcium

I'm very grateful for all this loving attention.  These women made me feel important.  Karen, one of the radiologic techs, showed me the removed tissue on a screen, including the seven specks of calcium.  

I think of all the women in the world who are 40 years old but don't have the opportunity to get mammograms every year and who won't receive the lumpectomies they may need.  

I think of my three paternal aunts who had breast cancer in the 1930s, 1940s, and early 1950s.  Aunt Mildred died because her cancer metastasized to her neck and the rest of her body.  Her two sisters survived into old age after surgery, but one died of ovarian cancer.

My husband's Aunt Con had the best medical care then available in New York City for her breast cancer, but it metastacized to her bones and she died in 1984.  http://www.nytimes.com/1984/07/24/obituaries/constance-hoguet-president-of-the-philharmonic-society.html

Thanks to Dr. Geeta, Karen, and Donna, aided by Selenia, I'm confident that the worst possible outcome is another lumpectomy, not a terminal illness.

That scary door...

As I rushed to my doctor's appointment today, I wasn't thinking about exactly which doctor I was going to see: internist, cardiologist, dermatologist...

The sign on the door was a shock as I arrived:  UCLA Oncology.

Yes, I regularly visit an oncologist.  Ugly and scary word.

But I am a three-year survivor of breast cancer, so that's good.

In Memory of Melinda Sue Casey

Melinda Sue Casey survived for 16 years after she was diagnosed with metastatic breast cancer.

Born in 1955, she died on February 20, 2017.

For many years she taught the children of migrant workers in Oxnard, California.  She retired for health reasons at age 45 and took up volunteer work.

She was a member of St. Aidan's Episcopal Church in Malibu.

Her survival for 16 years rather than the predicted 4 years was the result of "one-part medicine, but the lion's share was heart and spirit," her obituary reports.

http://www.legacy.com/obituaries/name/melinda-casey-obituary?pid=1000000184443335

My heart aches for her, just 61 years old at her passing, because I too received the CA diagnosis.

Mine was stage 2, not stage 3 or 4.

Mine was three years ago this coming April.  

We cannot know the length of our days, but we can remember that "Dust we are, and to dust we shall return" (Genesis 3:19).

I also like this verse:

"Remember now your Creator in the days of your youth, before the days of trouble come, and the years draw near when you will say, 'I have no pleasure in them"... before the silver cord is snapped, and the golden bowl is broken, and the wheel broken at the cistern, and the dust returns to the earth as it was, and the breath returns to God who gave it" (Ecclesiastes 12:1-8).

In memory of Lily Meza

Lily Meza, a classmate of my daughter Ellen since their days at Edison Language Academy, died on January 14, 2016, at age 30.

http://smdp.com/santa-monica-high-alumni-support-ailing-cancer-patient/153016

She graduated from Santa Monica High School in 2003 and worked as a nanny and freelance photographer, traveling to China and Greece.

In 2013 she was diagnosed with angiosarcoma.  She would have turned 31 on February 12.

Angiosarcoma is a cancer of the inner lining of blood vessels.  8% of these cancers occur in the breast.

http://sarcomahelp.org/angiosarcoma.html

http://www.breastlink.com/breast-cancer-101/rare-breast-cancer-types/angiosarcomas/

"Primary breast angiosarcomas occur most commonly in women between the ages of 20-40 years, and typically present as an ill-defined breast mass.  Secondary angiosarcomas usually occur in older women years following the treatment of breast cancer."

Born in Mexico, she was brought to California as a child.  Her lack of papers complicated her efforts to get health care.

My deepest sympathy to Lily's parents and wider family.

BRCA 1 & 2 Testing

A new test for the BRCA 1 and 2 genes that is easier and cheaper--and more accurate--was announced this week.

http://www.nytimes.com/2015/04/21/business/more-accurate-affordable-tests-for-detecting-breast-cancer-genes.html?smid=nytcore-ipad-share&smprod=nytcore-ipad&_r=0

I'm glad to hear this.  I tested negative for the genes, as did my sister, but we were worried because three paternal aunts had breast cancer, and one died of ovarian cancer.

Geneticist Mary-Claire King of the University of Washington has called for this test to be available to all US women over 30 yrs. of age.

Rest in Peace: Laurie Becklund

After the lumpectomy, after the radiation, we are told to take an anti-estrogen pill daily for five years, and then we are pronounced "five-year survivors."

"Have a nice life," Laurie Becklund's doctors told her at that point.

The part they don't stress is that one in ten of us still has micro-metastases after our treatment and will develop problems with cancer later.

Laurie died of metastasized breast cancer on Sunday, Feb. 8, 2015, exactly two weeks ago.  Her breast cancer had returned 13 years after her first diagnosis in 1996, and she lived almost six years after it returned.  

Today her family and friends put on a five-star memorial service, which my husband attended.  (I choose to attend my usual monthly Women-Church liturgy.)  She was an award-winning reporter for the Los Angeles Times and had written several books.

Here's the final piece Laurie wrote, "As I Lay Dying," which appeared on a full page of the op-ed pages today in the Los Angeles Times.

http://www.latimes.com/opinion/op-ed/la-oe-becklund-breast-cancer-komen-20150222-story.html

William Faulkner never imagined that his novel, As I Lay Dying, would bear such strange fruit.

Laurie was born in 1948, as was I.  

She applied to be part of Stanford University's freshman class of 1966, but she was turned down.  The foolish selection committee still goes for students who have 1) achieved in sports, 2) held offices in high school government or edited high school newspapers or yearbooks, 3) achieved in music or the arts --in addition to having 4.0 grades.  

Instead of Laurie, the committee chose me and my neighbor Shelley Surpin, now an entertainment lawyer; neither of us did anything particularly noticeable with our talents, unlike Laurie.  Perhaps they chose me because they needed a few from Bakersfield and the San Joaquin Valley.  Laurie came from the San Diego area, where there were many qualified applicants.  

Note about The Ratio: one-third of the entering students were female.  Two-thirds of the seats in the class went to males.  If Stanford had not been such a sexist place, as well as sports-ist, Laurie would have entered the class.

Instead Laurie earned her BA from Immaculate Heart College in Los Angeles, run by a group of nuns who took the Vatican II direction to heart and soon shed their habits and their subservience.  Cardinal McIntyre tried to squelch them by shutting down donations to the college, which had to close.   

 http://en.wikipedia.org/wiki/Sisters_of_the_Immaculate_Heart_of_Mary

Pat Reif was among them, an activist for civil rights, against nuclear weapons, and for peace.  She later founded a master's degree program in feminist spirituality at Immaculate Heart College.

http://articles.latimes.com/2002/mar/28/local/me-reif28

In this environment, Laurie flourished.  She learned activism and advocacy for women.  It's not surprising that she went much further than the sweetie-pies who went to Stanford in 1966 and married a classmate, as did I.

Laurie went to Columbia School of Journalism and did important work for the LA Times.  She didn't marry until age 32.  

Her reporting exposed the government death squads in El Salvador in the 1980s.  

http://www.latimes.com/local/obituaries/la-me-laurie-becklund-20150210-story.html

Laurie, the trajectory of your life and that of mine crossed in several ways.  Our husbands both worked at the LA Times--and you too were among those talented journalists.   

Our lives both were touched by the Immaculate Heart sisters.

You had one daughter (wise in just one), while I had three.

Breast cancer entered your life in 1996 but waited until 2014 to enter mine.

You wrote several books as I edited just one (the reverse of our daughter totals).  You were a much better reporter than I.

You died this month from metastasized breast cancer; I still live.

Cancer may get me in a few years, or maybe my end will be with Alzheimer's disease.

The important thing is that we were each created and loved by God and did our best to serve our Maker.

We both strove to answer the question posed by Evelyn Underhill in her book The Spiritual Life:

...what function must this life fulfill in the great and secret economy of God?

Day 19 of Radiation

Sheesh!  Enough already.

I still have four more days of radiation to go... 

At this point my left breast is a sad puppy: bright pink and droopy and tender.  When I brush against or bump into something, it reminds me of being  a nursing mother and having to drive home from a days's work with tender cement blocks on my front, overfilled with milk.

I want to tell the radiation folks, "Thanks---this will be enough for me." 

Oh well, I guess dropping out is not allowed.

My energy level is low but I keep bumbling around trying to do things instead of just resting.  As a result, things take longer and the choices I make are not as good.  Short circuits in the frontal temporal lobe.

The good news: I hope to start the drive to Colorado on Aug. 1.

Also on that day I start taking Arimidex, one a day for the next five years.

Yippee, I'm on The Pill again.  Not.

At least I don't have to do chemo therapy. 

Oncocyte Score...

The word oncocyte still feels very awkward on my tongue, but I have good news to report:

My oncocyte score is 17 (out of 50).  The lower the better on this evaluation of the exact type of cancer cell I have.

Under 20 is considered low risk.  That is, I have a risk of about 10% of recurrence of the cancer--after completing radiation and after taking an Aromatase inhibitor for five years.

One in ten--that seems pretty scary to me, but I am grateful that my particular type of cell is not the very aggressive type with a 1/3 or 1/4 risk factor.

What random factors go into having cancer--when you discover it, what type you have, whether it's caused by genetic predisposition, by environmental conditions, or by sheer chance.

l'm becoming more grateful by the day for each aspect of my health that goes well.

Saving Money, Not Lives

Insurance companies don't want to pay for mammograms for women ages 40-49.

Neither does the federal government--we have to reduce the national debt, right?

Never mind that 100,000 women who could get regular mammograms during that decade of their lives "would eventually die from breast cancer as a result of waiting until 50," according to computer models of the US Preventive Services Task Force, as reported by Dr. Daniel B. Kopans in last Friday's Wall Street Journal.

In spite of these statistics, the Task Force in 2009 changed its recommendation to screening only at age 50 and older.

Fortunately, the Obama administration did not support the Task Force's recommendation, and when the Affordable Care Act was signed into law in 2010, insurance coverage for mammograms for women in their 40s was mandated.

You can find more details in Dr. Kopans' article.  Here's a link that leads to the WSJ but there's a pay wall between you and "Mammograms Save Lives."  If you have access to a school or college, you can get the article through ProQuest Newsstand.

http://online.wsj.com/news/articles/SB10001424052702304547704579564440536353948?KEYWORDS=daniel+b+kopans

Both the American Cancer Society and the US Preventive Services Task Force are currently reviewing their guidelines on this issue, according to Dr. Kopans.  Insurance companies base their coverage decisions on these guidelines.

It behooves all of us who care about this issue to call, write, email and otherwise lobby to make sure the screening guidelines return to coverage for women ages 40-49.

Thank you to my husband, John Arthur, for telling me about the article by Dr. Kopans.

Below is the letter to the editor I sent today to the Wall Street Journal:

To the editors:

As a woman whose breast cancer was detected by ultrasound screening recommended after a mammogram, I want to thank Dr. Daniel Kopans and the WSJ for his opinion piece "Mammograms Save Lives" (May 23, 2014).

Actually, the article has more facts than opinion but its message is loud and clear: "Criticism of breast-cancer screenings is more about rationing than rationality."

My mammogram in March was "normal" but because of dense breast tissue, a follow-up ultrasound was recommended.  It clearly showed the mass, which after biopsy was confirmed as stage 1 cancer.  If an ultrasound had not been recommended, my cancer would not have been detected until a year later.

I have learned that 40% of women have dense breast tissue, which makes not only a mammogram but follow-up screening critical.  Many times I've been informed about the density of my tissue, but only once in the past has follow-up screening been suggested (in that case, an MRI which my health insurance did not want to pay for).  

I am so grateful that mammograms for women 40-and-older and follow-up screening in about 10% of mammograms are paid for by health insurance.

I will begin working to make sure the US Preventive Services Task Force restores its screening guidelines to cover women ages 40-49.  I have a blog on breast cancer (http://doingthecancerdance.blogspot.com/) and can use media such as Twitter and YouTube.

I am currently 65 years old but care deeply about the 100,000 women whose lives could be saved by screening at 40 but "would eventually die from breast cancer as a result of waiting until 50" (according to the Task Force's own computer models.

My daughters could be among those whose lives would be lost by a lack of insurance-covered screening.

Anne Eggebroten

Santa Monica CA 

"The important thing is that when you come to understand something you act on it, no matter how small that act is." --Sr. Helen Prejean