Kelly Fleming, 43, of Brookfield, knew the importance of getting regular mammograms — an X-ray image of the breast. Breast cancer had been diagnosed in two of Kelly’s blood relatives, which meant she had a higher risk of getting the disease as well.
|The goal of a screening mammogram is to find cancer before it starts to cause symptoms. Kelly had her first screening mammogram at age 38. (Current American Cancer Society guidelines recommend the first screening mammogram at age 40 and yearly thereafter.) During a routine screening mammogram in March 2008, she was shocked to learn she had a mass in her left breast. “It was very unexpected,” Kelly said. “The mass was low and deep; I was told a physician wouldn’t have found it during a physical exam.”
Kelly and Brooks thank their dear neighbor for letting them borrow her beautiful yard as background to their family photos.
A biopsy of the mass showed that Kelly had breast cancer. “I immediately thought, ‘what do I do, where do I go?’”
Where to GoKelly and her husband, Brooks, worked together to develop a plan. “From day one, my husband said my breast cancer was our winning fight,” she said. “He researched everything for me, and we called friends and people we know who have gone through this experience. The Froedtert & The Medical College of Wisconsin Breast Cancer Program kept coming up.
Kelly chose Froedtert & The Medical College for her care. In the coming weeks, she would meet with Medical College of Wisconsin physicians who specialize in every type of care she needed — breast cancer surgery, breast reconstruction, chemotherapy and radiation therapy.
Meeting the TeamKelly first met with Medical College of Wisconsin surgeon Alonzo Walker, MD, who specializes in breast cancer surgery. After Kelly had imaging scans and other tests, Dr. Walker discussed treatment options with her.
Kelly also met with Medical College of Wisconsin plastic surgeon John Hijjawi, MD, to discuss breast reconstruction and her options.
A number of options are available today, including breast implants and the DIEP Flap procedure, which uses excess abdominal skin and fat to reconstruct the breasts.
Lymph Node BiopsyBreast cancer can spread to the lymph nodes under a woman’s arm. Knowing if the cancer cells have spread to lymph nodes is important. If it has, there is a higher chance that the cells can enter the bloodstream and spread to other areas in the body. Kelly had a biopsy of her lymph nodes in May 2008.
“The biopsy showed cancer in my lymph nodes,” she said. “My doctors knew they would need to remove my lymph nodes during surgery.”
Dual SurgeriesOn June 11, 2008, Kelly had surgery and the first stage of breast reconstruction — performed by Dr. Walker and Dr. Hijjawi, respectively. During the surgery, Dr. Walker also removed 19 lymph nodes. Eight of them were cancerous.
An advantage of having breast reconstruction at the time of a mastectomy (versus later) is that the chest tissues are undamaged by radiation therapy or scarring. This often means the final result looks better. Also, immediate reconstruction means one less surgery, although some woman may still require a few surgeries after the first surgery to complete the process.
After Dr. Walker removed Kelly’s breast tissue, Dr. Hijjawi placed a tissue expander (like a balloon) beneath Kelly’s skin and chest muscle.
A tissue expander is used to stretch a patient’s skin to allow room for an implant. Through a tiny valve beneath the skin, a saline (salt water) solution is injected to fill the expander. This solution is injected at regular intervals until a patient’s skin reaches the desired size. Then the expander is removed and replaced with an implant.
“What they did on that day was pretty incredible,” Kelly said. After surgery, she spent two nights in the hospital and returned to work two weeks later.
Kelly and Brooks’ son, Ben, 5½, visited Kelly in the hospital, where Ben met Dr. Walker. “Ben still talks about him; Dr. Walker was so nice to him,” Kelly said.
ChemotherapyUnder the care of Medical College of Wisconsin medical oncologist John A. Charlson, MD, Kelly received 15 weeks of chemotherapy beginning in July 2008. The goal of chemotherapy is to prevent or postpone cancer from coming back after the initial surgery and radiation. Even if the cancer appears to be confined to the breast and lymph glands, there is a chance cells have spread to other areas that cannot be seen. Chemotherapy is given to try to kill these cells.
Kelly received the chemotherapy at the Day Hospital in the Clinical Cancer Center at Froedtert & The Medical College. The Day Hospital is specially designed for patients who need chemotherapy, other types of infusions or advanced services which might otherwise require hospitalization.
Targeted TherapyIn September 2008, Kelly began taking Herceptin, a medication approved for treating HER2-positive breast cancer. This type of breast cancer involves a protein (human epidermal growth factor receptor-2) that promotes the growth of cancer cells. In about one of every three breast cancers, the cancer cells make an excess of HER2 due to a gene mutation. HER2-positive breast cancers tend to be more aggressive than other types of breast cancer. Herceptin targets HER2, kills these cancer cells and decreases the risk of recurrence. Kelly continued taking the medication for 12 months.
Radiation TherapyIn March 2009, Kelly received 28 days of external beam radiation, under the care of Medical College of Wisconsin radiation oncologist J. Frank Wilson, MD, FACR, FASTRO. The radiation treatment was directed at her left breast and lymph nodes, where cancer had been found. Radiation therapy is usually delayed until chemotherapy is complete.
Team Support“I knew Froedtert & The Medical College would have the doctors I needed,” Kelly said. “The team of physicians is just wonderful. They do what they do so well! The woman who does the pre-op evaluations calls them the ‘dream team.’”
Julie Griffie, RN, MSN, CS, AOCN, a clinical nurse specialist in the Breast Cancer Program, coordinated all of Kelly’s care. “I could always contact Julie if I needed anything or had questions,” Kelly said. “She set up my appointments and provided test results. All the nurses were great.”
Kelly also visited the Small Stones Wellness Center, located in the Clinical Cancer Center. The Wellness Center is designed to support the healing process by helping men and women enhance their appearance, promote relaxation and boost self-esteem. All products and services are integrated with patients’ medical care at the Clinical Cancer Center. “The woman there was very helpful,” she said. “It’s so nice that everything’s in one building.
“Froedtert & The Medical College is wonderful. I’ve told everyone. By the second day, the women at the front desk in Radiology knew my name. They cared and were welcoming. If I need to recommend anyone for breast cancer care, I will recommend Froedtert without hesitation. I can’t imagine going anywhere else. The staff was wonderful at every level.”
Kelly also received tremendous support from many people in her life. “My boss and coworkers have been very supportive,” she said. “I’ve worked for my boss for 10 years, and he was so sad when I told him about diagnosis last year. He said he was just happy to see me at work when I could be there! I can't thank him and my coworkers enough for the support they continue to give me. They, along with my husband, son and other family have kept me going. My husband and son have been great through it all.”
When Kelly began her breast cancer journey, a friend suggested she organize her medical appointments, caregiver phone numbers and other important information in a binder. Kelly took her friend’s advice and created a resource that helped her throughout her care. It now serves as her resource for referring others to specialists at Froedtert & The Medical College.
After all of her treatments, tests show no signs of cancer. Kelly will continue to have regular follow-up visits at Froedtert & The Medical College.
Last Review Date: Jan. 14, 2010