"I Could Go Anywhere for Treatment. I Chose Memorial."
Updated October 2005 — "At my high school reunion in mid-September 2003, my doctor called me on my cell phone, telling me to get a diagnostic mammogram," says Jan. "She said there were microcalcifications on my annual screening mammogram and she wanted a follow-up."
The diagnostic mammogram led to a stereotactic needle biopsy, which confirmed her physician's fears: breast cancer. "I was in shock," says Jan. "I could not believe I had breast cancer. I was only 56. I ate right, exercised and had no direct family history of breast cancer (two paternal aunts had been diagnosed with breast cancer, but I was the first in my immediate family). Although I had been on low-dose estrogen hormone replacement therapy for six years, my sister had been on much higher doses for 25 years without any problems."
From Diagnosis to Treatment
Jan was diagnosed with early-stage ductal carcinoma in situ (DCIS) with .4cm infiltrating ductal carcinoma. There was no lump or visible change to her breast, just the evidence on the mammogram. "Some friends and family suggested that I go elsewhere for care," says Jan, "but I knew that I could get quality care in Broward County."
Jan made an appointment with Phyllis Neimark, MD, surgical oncologist on the medical staff at Memorial Regional Hospital, Memorial Hospital West and Memorial Hospital Miramar and took it upon herself to learn as much as she could about breast cancer and reconstruction issues before her appointment. "My husband, Jim, and I were immediately impressed with Dr. Neimark's knowledge, as well as her caring and professional manner," says Jan. "The best advice she gave me that day was to let her take a conservative approach to surgery with the understanding that she may have to go in again. We agreed."
On December 1, 2003, Jan went to Memorial Regional Hospital, where wire needle localization was performed to confirm the cancer site for the lumpectomy. Once the wire was inserted, the nuclear tracer was injected for a sentinel node biopsy. This procedure identifies which lymph node the cancer is most likely to travel to first.
The pathology report came back with mixed news. The good news was that the lymph nodes were cancer-free; the unfortunate news was that the diagnosis of cancer was confirmed and that the tissue removed did not have clean margins, meaning there was still pre-invasive cancer within the ducts. Because of this, Dr. Neimark recommended a mastectomy of the right breast.
"I was somewhat mentally prepared for this recommendation," says Jan, "but I still cried. Jim said, 'I didn't marry you for your breasts. I love you. I just don't want to lose you.' I decided right then that I never wanted to go through this again and asked her to do a prophylactic mastectomy on the left side, as well, with an immediate reconstruction of both breasts."
Two days later, Jan met with Jonathan R. Weiser, MD, plastic and reconstructive surgeon on the medical staff at Memorial Regional Hospital, Joe DiMaggio Children's Hospital, Memorial Hospital West and Memorial Hospital Pembroke, who was recommended by Dr. Neimark. "Dr. Weiser was engaging, caring, professional and compassionate. He patiently answered my million questions," says Jan. After an exam, he agreed that Jan was a candidate for breast reconstruction using tissue expanders that would be replaced by implants.
"On January 13, 2004, I was amazingly calm," says Jan. "The decision had been made. My family and friends were very supportive, and I was very confident with my choice of doctors and Memorial Breast Cancer Center at Memorial Cancer Institute." Dr. Neimark performed the skin-sparing mastectomies, followed by implantation of the tissue expanders by Dr. Weiser.
Advocating for Awareness
"I am now outspoken about the need for women to get mammograms and to do monthly self-exams," says Jan. "I also want to let women know that with the different reconstruction options available today, they should not fear losing their breasts if diagnosed with breast cancer. They should, however, fear that they will lose their lives if they don't catch this disease early enough."
One in eight women has or will be diagnosed with breast cancer in her lifetime. Jan's advice: "First, realize that everyone's cancer is different. What your friend went through may not be what you will go through. Second, become educated quickly so you can be an active participant in the decisions that are about to be made. Third and most important, make good choices about your physicians and the hospital they work with."
"My experience with treatment, including reconstruction, was made so much better because of my physicians. When I talk to other women about what they might experience with breast cancer treatment, they want to know how much pain they should expect. I tell them that I was uncomfortable at times, but with support from my physicians, I wasn't in pain," says Jan.
"Dr. Neimark and Dr. Weiser are my superheroes," adds Jan. "Though the mammogram diagnosis saved my life by catching the cancer early, these two physicians, with their expertise and compassion, made me whole again - both emotionally and physically. I am alive and well and happy because of them. And my thanks also goes to the rest of the staff at Memorial Regional Hospital. They were truly wonderful."
If you are concerned about your risk for breast cancer and would like a referral to a physician, call Memorial Physician Referral Service toll-free at (800) 944-DOCS. We're available 24 hours a day, 7 days a week.
- Essential Breast Cancer Information and Support
- Memorial Breast Cancer Center at Memorial Cancer Institute
Breast reconstruction — An important topic for women to discuss with their doctors before cancer treatment begins. The standard options for breast reconstruction include skin expansion followed by the use of implants, or flap reconstruction.
- Skin expansion involves the insertion of a balloon expander beneath the skin and chest muscles following mastectomy (removal of the breast). The surgeon will periodically inject a salt-water solution into the balloon to fill the expander for several months. After the breast skin has been sufficiently stretched, the balloon expander is removed and replaced by a permanent implant. Today, some initial expanders serve as final implants.
- TRAM flap breast reconstruction is also common after a mastectomy. A flap of the lower abdominal wall fat, with its own blood supply, is transferred to the intended breast area. Normally, the blood supply comes from the rectus muscle(s) attached at the lower edge of the rib cage. Reconstruction also can be performed using other tissue from the body, such as the latissimus dorsi muscle.
Diagnostic mammogram — May be required if abnormalities are seen or suspected in a prior screening mammogram; if there is a lump, pain, thickening, nipple discharge or a inexplicable change in breast size or shape; or if it is difficult to obtain a clear X-ray by a screening mammogram because of special circumstances, such as breast implants.
Ductal carcinoma in situ — Also called DCIS or intraductal carcinoma, it is the most common type of non-invasive breast cancer in women, accounting for nearly 25 percent of all breast cancer diagnoses. In situ describes a cancer that has not moved out of the area of the body where it originally developed. With DCIS, the cancer cells are confined to milk ducts in the breast and have not spread into the fatty breast tissue or to any other part of the body (such as the lymph nodes). DCIS may appear on a mammogram as tiny specks of calcium, or microcalcifications, generally too small to notice by physical examination.
Sentinel node biopsy — A new procedure that involves removing only the first one to three lymph nodes in the lymphatic chain. The lymph ducts of the breast usually drain to one lymph node first, before draining through the rest of the lymph nodes underneath the arm. That first lymph node is called the sentinel lymph node and helps sound the warning that the cancer has spread. Dye is injected to identify the first few nodes in the lymphatic chain for removal. By removing fewer lymph nodes, the chances of pain and lymphedema (chronic swelling) of the arm are reduced.
Stereotactic needle biopsy — A method used to obtain tissue samples of an abnormality seen on a mammogram. The spot to be biopsied is located via mammography. Two mammographic (stereotactic) images are obtained and 3-D coordinates are calculated from these computerized digital images. This information is used to accurately position a needle. A vacuum-assisted needle is then used to remove a biopsy sample from the breast, and the tissue is examined under a microscope. Often, this microscopic examination confirms a suspected diagnosis of DCIS.
Tamoxifen — Used to treat early-stage breast cancer after primary treatment (lumpectomy or mastectomy). Tamoxifen is an "anti-estrogen" and works by competing with estrogen, which is needed for breast cancer cells to grow. By blocking estrogen in the breast, Tamoxifen helps slow the growth and reproduction of breast cancer cells.