Dr. Carolyn Kaelin had treated hundreds of women with breast cancer. But she changed roles when she found her own breast cancer during a monthly self-exam. There was a small area where the skin had pulled inward ever so slightly, forming a tiny dimple.
As many as 15 percent of breast cancers in the early stage don't show up on mammogram, although that remains the best tool for identifying and treating breast cancer at an early and treatable stage. That's why doing a self-exam is also important, said Kaelin, director of the Comprehensive Breast Health Center at Brigham and Women's Hospital at Harvard Medical School in Massachusetts.
Kaelin, the author of "Living Through Breast Cancer," will be featured Oct. 11, 7 p.m., at the Huntsman Cancer Institute's 2000 Circle of Hope in the sixth-floor auditorium. In her talk (admission is free, but reservations are required because of limited seating) she'll tell what she learned on her journey from physician to patient. Much of that centers on preserving your self-image while you're making sure you get the best care possible.
Even young women should be performing breast self-exams, ideally one week after the onset of menses when the hormones are lowest. At age 40, a mammogram should become an annual event. And Kaelin tells her patients that self-exam involves not only feeling for lumps and changes but observing, looking closely at the breasts, first with the arms at rest, then overhead, then on the waist and squeezing.
Women also can help themselves by paying attention to the lifestyle factors that seem to increase the risk of developing breast cancer, Kaelin said. Alcohol is one. The more one drinks the greater the risk.
Research also hints, though it's not yet conclusive, that people who maintain a healthy weight and who are physically active have a smaller chance of developing a first breast cancer than people who struggle with weight or are sedentary. It is clear that after treatment for breast cancer, those who are active and keep their weight down have a "markedly decreased chance" of developing a second breast cancer, she said.
"Physical activity doesn't require running a marathon or biking a century," Kaelin said. Walking three to five hours a week will do. "It's very attainable."
As for weight, those who gain 12 or fewer pounds during chemotherapy have fewer relapses than those who gain 13 or more pounds. "Those who are able to maintain a healthy body-mass index are less at risk for a relapse than those who continue to gain weight," she said.
Diagnosis and treatment of breast cancer can "provide a window of opportunity whereby women consider and are successful in changing long-standing lifestyle patterns," she said.
Benefits of healthy weight and exercise extend into other areas, including improved heart health, fewer cases of diabetes, strong bones — very important for women who've had breast cancer because chemotherapy can be devastating on bone mass — and more.
"We are in a fortunate time in medical history. The vast majority of women diagnosed and treated for breast cancer go on to live a full life expectancy. This part of their journey is a bump in the road. We have had advances in screening and now are able to diagnose breast cancer at smaller, more curable stages," Kaelin said.
She predicts even more exciting developments in breast cancer treatment down the road. Already there are adjuvant therapies that help kill stray cancer cells that might otherwise survive treatment.
She expects in the not-too-distant future cancer experts will be able to tailor treatment to individual women based on their genetic characteristics and that of their cancers. Right now, researchers know that some women respond to certain treatments and others don't. Kaelin believes doctors soon will be able to determine much better who fits in which category, which will make treatment more effective and spare women treatment that wouldn't work.
For instance, with estrogen-receptor-positive tumors, there seem to be at least two subgroups of women. One subgroup gets very little benefit from chemotherapy and does well with hormonal therapy. Another group seems to benefit from both. And there's the "triple negative" group that is more difficult to treat because they lack certain receptors. "So we need to be very exacting what chemo regiments we may choose to treat that group."
The ability to more closely tailor care to match the specific characteristics of the tumor and the woman herself bode well for treatment, she said.
You can register online at www.huntsmancancer.org/breastcancer or by calling 801-587-4241.