In the fall of 2008, Laura Sanders, 50, was looking forward to starting a new life with her fiancé, Randy. Their wedding, set for Jan. 2, 2009, would be a second marriage for both. Laura, director of Goodwill Industries of Southeastern Wisconsin at the Naval Station Great Lakes in Illinois, and Randy, a corporate headhunter, live in Racine.
That September, however, the excitement of their wedding suddenly took a backseat to unexpected news. Laura had recently had her annual mammogram. “I was called back for a biopsy,” she said. “They found small spots in my right breast that looked suspicious.”
|Following the biopsy, Laura was diagnosed with atypical ductal hyperplasia (ADH), a benign (not cancer) condition in which cells appear abnormal (under a microscope) and are increased in number. Having ADH in one breast means a woman has a higher risk of getting cancer in either breast.
“I was told this needed to be taken care of right away,” she said. “An excisional biopsy was recommended, followed by taking Tamoxifen.”
An excisional biopsy is a diagnostic measure involving surgical removal of an area of concern to rule out cancer. (A lumpectomy is performed when a woman has a known cancer and includes removal of the tumor, as well as a small portion of tissue surrounding it.) Tamoxifen is an FDA-approved medication that interferes with the activity of estrogen, a female hormone that can promote the development of cancer in the breast.
Sister Diagnosed EarlierBefore going ahead with treatment, Laura and Randy decided to get more information — with good reason. Earlier that year, Laura’s sister, Therese Quinn, 45, was diagnosed with breast cancer in her right breast (invasive ductal cell carcinoma with lobular features), and genetic testing revealed Therese had a certain breast cancer gene. Therese is a certified oncology nurse at St. Joseph’s Hospital in West Bend.
“Because of my age, my oncologist suggested genetic counseling,” Therese said. “Julie Griffie arranged this for me.” Julie Griffie, RN, MSN, CS, AOCN, is a clinical nurse specialist in the Froedtert & The Medical College of Wisconsin Breast Cancer Program.
Therese met with Sara Svendsen, MS, CGC, a cancer genetic counselor in the Froedtert & The Medical College of Wisconsin Cancer Genetics Screening Program. Svendsen offers genetic counseling and testing for people concerned about their personal and/or family history of cancer. (She provides this service at Froedtert & The Medical College, and in West Bend at the Alyce and Elmore Kraemer Cancer Care Center of St. Joseph’s Hospital.)
“An estimated 5 percent to 10 percent of all breast cancers are inherited,” Svendsen said. “Most inherited cases of breast cancer are associated with two genes — the BRCA1 (BReast CAncer gene 1) and BRCA2 (BReast CAncer gene 2). If a woman inherits one of these genes, there’s a 55 percent to 80 percent chance she will develop breast cancer by age 70. These genes are also associated with a significantly increased risk of developing ovarian cancer.”
“I was with Therese when she learned she was BRCA2 positive,” Laura said. This information would later prove helpful for Laura.
Therese’s gynecologist referred her to Medical College of Wisconsin breast surgeon Alonzo Walker, MD, who specializes in breast surgery. Dr. Walker is the director of the Breast Cancer Program at Froedtert & The Medical College. In March 2008, Therese had her right breast surgically removed, along with 22 lymph nodes. Because two of the nodes were cancerous, Therese also received six cycles of chemotherapy with medical oncologist Ijaz Arshad, MD, at the Alyce and Elmore Kraemer Cancer Care Center.
Because she had the BRCA2 gene, Therese also chose to have her left breast removed as a preventive measure. This surgery, performed by Dr. Walker, took place in October 2008. Medical College of Wisconsin plastic and reconstructive surgeons John LoGiudice, MD, and John Hijjawi, MD, also performed DIEP flap breast reconstruction surgery. (Drs. LoGiudice and Hijjawi practice at Froedtert & The Medical College and Dr. LoGiudice also sees patients at the Froedtert & The Medical College Specialty Clinics in West Bend.)
The BRCA2 gene also greatly increases a woman’s risk for ovarian cancer, so Therese decided to have her ovaries removed (an oophorectomy). This minimally invasive procedure was performed at Froedtert & The Medical College.
Therese said she needs to take the drug Femara for five years. Femara reduces the level of estrogen produced in the body, starving cancer cells by depriving them of estrogen. “I had my follow-up in early August 2009, and I’m all clear,” Therese said.
“We felt very welcomed at Froedtert & The Medical College. From the first phone call, everyone was very supportive and helpful. You walk in and they’re part of your family.”
A “Gift” Guides Laura’s Treatment Decision“When I was diagnosed, I already knew about my sister’s genetic test result,” Laura said. Concerned that she might also have the gene, Laura called Svendsen and got an appointment within a week.
Laura and Randy met Svendsen in late September 2008. “Sara explained my risk of getting breast cancer if I had the gene,” Laura said. “She provided information about my options and arranged for a genetic blood test. She also asked if I wanted a second opinion for my diagnosis. I said ‘yes.’”
On Oct. 14, Laura and Randy met with Sara for the blood test results. “It was a beautiful fall morning,” Laura said. “I thought, ‘this is the calm before the storm.’
“Sara gave us the news that I was also BRCA2 positive. She arranged for us to meet Dr. Amanda Kong for a second opinion, and informed Dr. Kong about my genetic test result.” Amanda Kong, MD, is a Medical College of Wisconsin breast surgeon.
After Laura had tests, including MRI and ultrasound imaging of her breast, Dr. Kong informed her that she had ductal carcinoma in situ (DCIS), a condition in which cancer cells exist inside the lining of a breast duct, but have not spread outside the duct to the surrounding breast tissue. If not treated, the cancer can spread to other parts of the breast.
The cancer diagnosis was different from the one Laura had received earlier.
“Dr. Kong discussed all my options with me,” Laura said. Laura chose to have a double mastectomy (surgical removal of both breasts).
“Knowing I had cancer and that it had a high risk of occurring in the other breast, I decided I didn’t want to keep looking over my shoulder and worrying about it,” she said.
Laura credits her sister’s breast cancer experience with helping her make her decision. “In a way, my sister gave me a gift by having genetic testing first,” Laura said. “After I had the test, I knew where I stood.”
Laura and Therese later traced the BRCA2 gene to their father’s side of the family. Before their own diagnoses, they didn’t know the gene was in their family.
Laura met with Medical College of Wisconsin gynecologic oncologist William Bradley, MD. After discussing her options, she also decided to have an oophorectomy because of the high risk for ovarian cancer. She also met with Dr. Hijjawi to discuss options for breast reconstruction.
Laura and Randy informed all of the physicians about their impending wedding. “Dr. Kong said it was possible to get all of my treatment done in time for the wedding,” Laura said.
“Laura also told them that she had a strapless wedding gown she wanted to wear,’” Randy said.
Laura managed to keep her spirits up during this time. In fact, a week before surgery, she held a “Goodbye to the Girls” party, attended by dozens of loving friends and family members.
Three SurgeriesOn Nov. 12, Laura underwent three surgeries at Froedtert & The Medical College.
First, Dr. Bradley removed Laura’s ovaries, using a minimally invasive (laparoscopic) technique. Next, Dr. Kong performed the double mastectomy and a sentinel lymph node biopsy. A sentinel lymph node is the first lymph node to which cancer cells are likely to spread from the primary site. The sentinel node cells showed no signs of cancer.
The third procedure, performed by Dr. Hijjawi, involved placing tissue expanders beneath Laura’s skin and chest muscle. Through a tiny valve beneath the skin, Dr. Hijjawi injected a saline solution to fill the expander and expand the skin. The solution was injected at regular intervals through December to gradually expand the skin to the desired size.
Laura spent two nights in the hospital and recovered at home in plenty of time for the wedding. She was able to wear her strapless gown — with minor alterations. “I filled it out a little more at the top after my surgery,” she said, laughing.
Team SupportIn addition to the physicians, the Sanders also appreciated other caregivers they met at Froedtert & The Medical College.
“Mary Jo Burgoyne was a calm person who helped us cope with our stress, anxiety and fears,” Laura said. Mary Jo Burgoyne, CNS-C, APNP, is a psych-oncology clinical nurse specialist for the Froedtert & The Medical College of Wisconsin Clinical Cancer Center.
“She was a great help for me, too,” Randy said. “Everyone provided really good care and worked so well together.”
A couple weeks after surgery, Laura had therapy with Chris Walczak, a hand therapist at Froedtert & The Medical College. “Chris helped me regain range of motion in my arms. She was wonderful,” she said.
Moving On“Randy and I are more than happy to share our story so other women facing breast cancer know they have a wonderful resource in the doctors, nurses and staff at Froedtert & The Medical College,” Laura said. “They are the best at what they do, and they are the people you want at your side through it all. They have a team, a network and support in place. That was the best choice I made — getting connected here.
“The staff is very compassionate in how they relate to each patient. Everyone we met along the way was so caring.”
“You feel very welcomed,” Randy said.
In June 2009, the expanders in Laura’s chest were removed in an outpatient procedure, and silicone implants were placed under the expanded skin. Because her cancer was found early, was surgically removed and had not spread, Laura did not need chemotherapy, radiation therapy or drug therapy. “I was so thrilled about that,” she said.
“I had the gift of knowledge and early detection. I feel such a sense of relief having made this choice. I don’t worry about breast or ovarian cancer now. I’m healthy and happy.”
For any woman, a prophylactic (preventative) mastectomy reduces the chance of developing breast cancer by 90 percent to 95 percent.
“Having each other made a difference. We faced this together. And friends and family rallied around me. My sister, with what she went through, was a really big support.”
Randy is also very happy with the outcome. “I get Laura for every day,” he said.