“Real Patient Story”
Not a day goes by without seeing at least one pink ribbon. Pink is everywhere! Breast Cancer is openly discussed, highly supported and visibly promoted. Breast Cancer Awareness is so visible, even the NFL players wear pink shoes. The campaign to create Breast Cancer Awareness and encourage woman to get mammograms has been successful! With 1 in 8 (12%) women diagnosed with breast cancer in their lifetime, it is important to get screened.
With the combination of early detection and advances in medicine the probability of surviving breast cancer has increased. 2016 statistics from the American Cancer Society are as follows:
5 Year Relative Survival Rate
- Stage 1: almost 100%
- Stage 2: 93%
- Stage 3: 72%
- Stage 4: 22%
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What about the survivors? What happens to women after chemo, radiation, surgery and prescriptions? What effect does treatment have on survivor’s bodies? How do these side effects impact lives?
Keely is a young breast cancer survivor and this is her story.
What started as pain in her sternum and assumed to be an injury developed into a bump or “lump” within a few months from the initial onset.
As a physically active 29-year old woman pulling a muscle and injuring your sternum would be a logical assumption. However, the fast growing lump was a concern and signal to Keely to see a doctor.
As a new resident in Washington, Keely didn’t have her own physician and was unsure of where to go. She asked a few people she recently met and worked with and thankfully someone recommended Dr. Martha Bennett from Edmonds Family Medicine (part of Swedish). As it turns out, Dr. Bennett was the right doctor at the right time and may have saved Keely’s life.
The Diagnosis
At Keely’s follow up appointment, Dr. Bennett provided her with the results of her initial exam and testing and told her terrible news. Being told that you have breast cancer at age 29 isn’t what you’d expect to hear. At age 30 the number of women diagnosed with breast cancer is .4% (1 in 225) (American Cancer Society Surveillance Research 2015).
Prior to Keely’s follow up appointment, Dr. Bennett, having known her prognosis, had scheduled her to see Dr. Carol Cornejo, a surgical oncologist at Swedish, that same afternoon. The following day she had an appointment with a medical oncologist, Dr. Jeffrey Ward, at Swedish Oncology in Edmonds, WA (a small suburb North of Seattle). Keely expressed her gratitude toward Dr. Bennett. Hearing she had breast cancer was shocking in itself and being new to Seattle presented even more challenges. Having someone take control of arranging all consultations and treatments was a huge relief.
Keely was diagnosed with HER2 breast cancer. HER2 is a type of cancer that tests positive for epidermal growth factor receptor 2, a gene mutation that makes an excess of the HER2 cancer growing protein. HER2 is considered to be an aggressive cancer because of rapid growth and spreading rapidly. Even though her cancer was detected early, Stage 1, HER2 prognosis at a young age has a poor prognosis.
Treatment
Keely’s treatment plan started with a lumpectomy followed by 1 ½ Years of Chemotherapy administered every 3 weeks. Along with the chemo, Keely was treated with Herceptin, a chemical known as Trastuzumad. Herceptin enhances the effects of chemotherapy leading to cellstatis and death of the mutated cells.
After completing chemo Keely had an additional 12 weeks of radiation. Keely spent 2 years of her young life fighting breast cancer. The treatment seemed to be successful but 2 ½ years later the cancer came back – same location but a different type.
Keely’s second diagnosis was treated more aggressively than the first. Her treatment included bilateral mastectomy, which is the removal of breast tissues and frequently the nipple. Dr. Carol Cornejo was her surgeon for the second surgery as well. Keely’s medical insurance had cut ties with Dr. Cornejo’s medical group sometime before the second diagnosis. Regardless, Keely’s oncologist consulted with Dr. Cornejo regarding Keely’s case and she volunteered to do her second surgery. Julie said to me “Dr. Cornejo is one of the greatest people in my life. She’s done pro bono work for my students. She’s simply fantastic on her views of why she’s in medicine and health care.”
Additionally, both ovaries were removed even though she didn’t have the BRCA gene mutation. Women with BRCA have a significant increase in risk of breast and ovarian cancer. BRCA positive women may elect to have a preventive or prophylactic mastectomy as well as ovary removal.
As of May 2016, Keely has been in remission for over 5 years.
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What is life like for young breast cancer survivors after chemo, radiation, mastectomies and ovary removal?
Keely is a happily married elementary school psychologist. She is an intelligent, well-spoken young woman who remains optimistic and hopeful. Having been diagnosed with breast cancer, one of her first concerns was for her doctor having to tell her the bad news. She also said that she couldn’t change the fact that she had cancer, but she could positively affect her health by having a positive attitude and staying physically active.
Life after chemo can have permanent effects on the body. Although Keely is happy and in good health, she is living with the negative side effects of chemo, radiation and surgery. The radiated plane of her chest is tighter and pectoral muscles are tight causing pain. She has scars and has been undergoing fat grafting in order to increase the amount of tissue and increase the stretch and skin elasticity to alleviate pain.
She also has what’s referred to as frozen shoulder or “lymphedema”. One of the most common causes of lymphedema is removal of the breast (mastectomy) and underarm lymph tissue for breast cancer.
Lymphedema is swelling of the arm described as being like an inflated balloon. It can be very painful and last the remainder of her life. Julie has been in physical therapy for 10 years improving her symptoms and physical function. She is physically active and enjoys running and yoga, both of which can help her condition.
Another permanent side effect of breast cancer is early menopause caused by a decrease in estrogen. Ovary removal, chemotherapy and radiation are all causes of decreased estrogen. The other reason is the effect of antiestrogen medication taken to keep the breast cancer at bay as a preventative.
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What happens to a young women’s body when she goes into permanent early menopause?
When there isn’t enough hormone production to support a women’s body the effects can be unpleasant and life changing.
A decrease in estrogen can affect tissues including the vagina, vulva, uterus, breasts, bones, brain, skin, hair, heart, blood vessels, bladder, urethra and mucous membranes. Menopause symptoms are:
- hot flashes
- night sweats
- insomnia
- mood swings/irritability
- memory or concentration problems
- vaginal dryness or vaginal atrophy
- itching and burning
- heavy bleeding
- fatigue
- depression
- hair changes
- headaches
- heart palpitations
- sexual disinterest
- urinary changes
- weight gain
- dyspareunia (painful sex)
The menopause symptoms that specifically impact sexual relationships are:
- vaginal dryness (vaginal atrophy)
- itching and burning
- urinary changes
- dyspareunia (painful sex)
Vaginal dryness and painful sex are more common conditions resulting from early menopause caused by breast cancer treatments. As a young, married breast cancer survivor the negative side effects of vaginal dryness and painful sex were a source of discomfort affecting her relationship. Keely wanted to live life as normal as possible, have a good relationship with her husband and restore sexual function. Vaginal dryness and painful sex are awkward, difficult and private topics which hinder asking for relief from symptoms. Although medical oncologists are knowledgeable about side effects they may not have a solution.
Once a patient has completed all treatments, what do they do about their sex life?
Treating Early Menopause Symptoms
Keely initially spoke to her Medical Oncologist, Dr. Ward about her symptoms. Although common among breast cancer survivors vaginal dryness and painful intercourse aren’t treated by a Medical Oncologist. Dr. Ward referred Keely to women’s healthcare specialist,Tami Corbett, ARNP at Sound Women’s Care which is now part of Swedish.
Under Tami’s care Keely used topical treatments but didn’t consider them successful. Julie turned to the breast cancer organizations and other survivors for more treatment options and information. She belongs to:
- Align
- Young Cancer Survivors
- Athletes for a Cure
During her research, Keely discovered the MonaLisa Touch laser. There were a couple of young women like herself that had been treated with the MonaLisa Touch and Keely was able to connect with them and find out more. She also researched it heavily on REALSELF, breast cancer websites and social media. With this newfound knowledge, Julie decided this might be the solution for her. One year since the FDA approved the MonaLisa Touch laser, the only doctor in WA offering this NEW treatment was Dr. Karny Jacoby of Washington Urology.
Julie saw her Women’s Healthcare specialist Tami Corbett. Initially Tami was against the MLT as it was new and she didn’t know the long-term effects. When Keely told her that that it was Dr. Jacoby that was doing the treatment her opinion changed. Tami said something like Dr. Jacoby was a credible and forward thinking physician with lots of experience with women’s issues. Since Jacoby was the doctor Tami would support the MonaLisa Touch laser treatment.
Before proceeding with any treatments, Julie consulted with her Medical Oncologist, Dr. Ward who told her he was familiar with the procedure, as Dr. Jacoby had come to one of his meetings and presented the MonaLisa Touch. Even though Dr. Ward has 2 patients that elected to be treated with the laser they hadn’t completed their series of 3 treatments so he didn’t have any solid results to share with her. He also didn’t know what the long-term results would be specifically for breast cancer survivors, but felt that the procedure itself was safe. He gave her the approval to seek treatment.
Keely had a consultation with Dr. Karny Jacoby and was comfortable with her experience and chose to have the MonaLisa Touch laser treatment.
The MonaLisa Touch has proven efficacy having been on the Italian market for over 10 years. It is an outpatient procedure, takes less than 5 minutes, is much like your annual exam, and is virtually pain free with no downtime.
The MonaLisa Touch has been shown to have optimal results when applied 3 times, with each procedure 6-weeks apart. As patients continue to age symptoms will gradually return requiring a MonaLisa Touch UP on an annual basis.
Keely’s results were as follows:
Treatment 1: Noticeable improvement
Treatment 2: 4 weeks after there was a significant improvement which gave her hope
Treatment 3: Some improvement
It has been approximately 3 months (when initially published) since Keely completed all 3 treatments. She says she definitely has improvement but it was better earlier in the cycle. Over time the improvements have decreased. Although she doesn’t have 100% relief from symptoms it is helping. It’s possible that breast cancer survivors present a special more difficult to treat subset of patients who may need more frequent treatment. For example, every six months rather than yearly. More research needs to be done to see.
About Dr. Karny Jacoby
When talking to me about Dr. Karny Jacoby, Keely shared that normally she is very uncomfortable with any doctor when it comes to women’s health. She doesn’t like to take her clothes off for exams. However, Dr. Jacoby’s manner put her at ease so Julie was comfortable and had a positive experience. Keely described Dr. Jacoby as being calm and kind, chill and down to earth, unpretentious, real and personable. She is a great person and Julie supports what Dr. Jacoby is doing for breast cancer survivors.