Whole Again
Local advances in prevention, detection and treatment help women overcome their personal battles with breast cancer
by Bill Donahue


If Sloane Six has one pearl of wisdom for other women, it’s this: Listen to your body. She might not be here today, after all, had she accepted the initial diagnoses of what she describes as “a shooting pain” in her breast.


“It was the result of me being very persistent,” says Six, whose family operates the all-organic Quarry Hill Farm in Harleysville. “I had done all the mammograms, and they all came back negative. The breast surgeon said there were no problems. But I said no, this was not normal.”


An ultrasound and biopsy revealed her worst fears: breast cancer, stage III. “I was shocked out of my mind,” she says. “I spent one day crying and that was it. I said I was not going to sit around and feel sorry for myself. I was going to do what I needed to do.”


Her resulting battle, which began in February 2008, consumed the next year and a half of her life. She and her family made 80 trips to and from the Hospital of the University of Pennsylvania in Philadelphia, for guidance, treatment and recovery, which included the reconstruction of her breast and, in a way, her life.


Recent advances in prevention, detection and treatment in suburban hospitals and medical centers mean that women such as Six have more options for superior treatment. To begin with, the advent of digital mammography at local hospitals has made a great difference in the detection of abnormalities, according to Bruce Weiner, M.D., director of The Breast Health Center at Phoenixville, which is part of Phoenixville Hospital.


“We can detect smaller and smaller tumors, and we can do a lot more with pre-invasive cancer,” he says. “This often results in less disfiguring surgery; breast-cancer surgery has gone from mastectomies in the early ’60s and ’70s to lumpectomies now. We consider breast conservation an important goal. And for those who do need a mastectomy, there have been great strides in reconstruction. We can reconstruct a breast with the patient’s own tissue, and we also can do nipple-sparing mastectomies, which is a nicer cosmetic result.”


Physicians underscore that breast cancer, while terrifying and traumatic, is by no means a death sentence. (See sidebar.) In fact, the overwhelming majority of women who are diagnosed with breast cancer survive the ordeal.


“We’ve seen the survival rate increase for women with breast cancer,” says Dr. Weiner. “The incidence of breast cancer and how we treat it is related partly to society and partly to medical advancements. When mammography became big in the late ’80s and early ’90s, the incidence of breast cancer shot up. Mammography picked up tumors long before they would have normally. … We’ve also seen a great increase in pre-invasive cancer, before the cancer has a chance to spread, and that is also being picked up by mammography; most of those have a chance of cure of 99 percent.”


Detecting any breast abnormalities begins with getting regular mammograms, typically starting at age 40, according to local physicians. Women who have a family history, however, should consider starting mammograms at a younger age.


“Some women worry that mammograms are not safe, but that’s completely unfounded,” says Lisa Pinheiro, director of breast imaging at Chester County Hospital’s Fern Hill Medical Campus in West Chester. “Every day we see women whose lives are saved because of mammograms. … We have plenty of women in their 90s who still get mammograms, and there is some question as to what age you stop getting them. The answer is whatever age you still want to be treated in case there’s a problem. There’s no cutoff age.” 


If and when a malignancy is discovered, local medical centers treat the disease and, at the same time, the patient herself—or himself, considering that 1 percent of breast cancer patients are male—so the patient is mentally prepared for the fight ahead.


“The first mission is to make a diagnosis. The second mission is to educate the patients and their families,” says Thomas Matulewski, M.D., director of The Center for Breast Health at Delaware County Memorial Hospital in Drexel Hill. “Once we make a diagnosis, if it’s benign or malignant, we educate patients as to what the meaning of the disease diagnosis is: where do they go; who do they see; what their options are.


“One of the analogies I like to make is this: Do you remember who was elected president in 1980?” he continues. “First I tell them it was Ronald Reagan. For those who are beyond 50 or 60, they might recall that Nancy Reagan was diagnosed with breast cancer in 1981. Which one of them is still around? … The point is that there are a lot more survivors out there living for a long time with a diagnosis of breast cancer. We get them on solid ground and help them feel comfortable and hopeful.”

Early education as to what a patient with a breast abnormality can expect is critical to enduring the process, because breast cancer tends to carry a very deep emotional weight, even more so than other cancers, according to Mary Lou Patton, M.D., a surgeon at Crozer-Chester Medical Center in Upland.


“It causes so much anxiety because the breast represents so many different things to a woman,” she says. “The breast provides nourishment to a child during breast feeding, it’s a sexual thing, and it’s a body-image thing. So it’s very psychological. That’s why [when a woman is diagnosed with a malignancy] we see them in 24 hours as opposed to ‘See you next week.’”


Tailored Care

Advancements in tumor analysis at local hospitals can now determine how aggressive or nonaggressive a particular malignancy might be, thereby helping physicians prescribe the most accurate course of action. In some cases, a less traumatic route—hormonal treatments vs. chemotherapy, for example—will be prescribed to cure patients of The Breast Health Center at Phoenixville, which opened last November.  


“If a patient needs an ultrasound or there are other diagnostic tests needed, we have a breast navigator to navigate them through the maze of insurance issues; she is not left by herself, which is a great help to the patient,” Dr. Weiner says. “If she needs a biopsy, we perform the biopsy. If she needs surgery, we do the surgery; we tailor care to the patient.”


Dr. Weiner was one of the first surgeons in the greater Philadelphia region to perform a stereotactic biopsy of a breast abnormality. The procedure, while highly accurate, is designed to limit the stress and anxiety to the patient, because the biopsy is done through a small incision using local anesthetic, without the patient having to go to the operating room. As a result, the procedure saves time and money—for the patient and the medical infrastructure alike.


“The old way was with a short-stay unit, where they would put a small localizing needle into the breast, and the patient was made drowsy with anesthesia,” Dr. Weiner says. “They would then make an incision in the breast and remove a larger amount of tissue, and then the patient would go off to the recovery room. Basically it was half a day. Compare that to today: We can now do a biopsy with a smaller incision and take less tissue, with a more accurate result at a reduced cost.”


As for survivor Sloane Six, she has taken several steps to help herself in the aftermath of her fight with breast cancer, beginning with eating right and limiting the amount of stress in her life. Today she eats only organic foods—no preservatives—most of which have been raised on the family farm. Based on the figures she’s seen, 59 percent of people who eat organic foods do so for health reasons, including cancer prevention and recovery.


“I had no family history [of breast cancer], so it came out of the blue for me,” she says. “I’m not a sedentary smoker or anything like that; it probably had a lot to do with stress. You don’t come out of something like this unscathed. I have to be careful with what I lift on the right side of my body, and I have to watch my sun exposure. But those are pretty minor sacrifices compared to still being on this earth.”