STORY BYOctober 2003 was a busy time for Juliana Brixey, a registered nurse pursuing her doctorate at the University of Texas Health Information Sciences at Houston. But the 50-year-old wife and mother of 2 teenage girls knew getting a mammogram was important, so she made the appointment and got it over with, not giving the routine test another thought.
On a Saturday 2 weeks later, Brixey's doctor called her to discuss the results. He detected an area of microcalcifications in her right breast and wanted to see her in his office on Monday. Brixey was stunned.
"I hadn't even felt a lump," she says.
Nor had there been a "lump" on her mammogram.
Like Brixey, many women think they are in the clear if they perform routine self-breast exams and don't find lumps. However not all women who have breast cancer will ever notice or feel a suspicious mass. And, not all cancer appears as a mass.
"Because more women are having routine mammograms, most patients we see these days present with microcalcifications," says Dr. Christine Cocanour, an associate professor of surgery with UT Medical School. "Doctors want them presenting before they can feel anything, because then we will be able to offer patients more treatment choices."
Early detection offers women the best chance of survival, Cocanour says. When breast cancer is detected before it spreads to the lymph nodes, the 5-year survival rate is 97 percent, according to the American Cancer Society. The rate drops to 79 percent if the cancer spreads to lymph nodes under the arm, and 23 percent if it spreads to distant organs such as the lungs, bone marrow, liver or brain.
Microcalcifications, specks of calcium found in an area of rapidly dividing cells, are the first sign of breast cancer in more than half of all cases. Regular mammograms are the best way to detect this early sign of breast cancer.
More than one microcalcification may be a sign of cancer, and is a common sign of ductal carcinoma insitu (DCIS). DCIS is a pre-cancerous condition in which the abnormal cells stay in the breast ducts. In some cases, DCIS may become invasive cancer and spread to other tissues. Catching the abnormal cells before they grow out of control is key to treating it, says Cocanour.
"If you can find something before it becomes large, then your options and your ability to do breast conservation increase," she says.
Women age 40 and older should have a screening mammogram every year, and should continue to do so for as long as they are in good health.
From the American Cancer Society www.cancer.org
When mammograms pick up small clusters of microcalcifications, doctors often recommend following up with either a stereotactic core needle biopsy or surgical biopsy. Stereotactic core needle biopsies use a computer to map the location of the calcifications and guide the placement of the needle, which takes a core sample of the breast tissue.
Doctors recommend a surgical procedure called a needle or wire localized breast biopsy when a large amount of breast tissue needs to be removed. A surgical biopsy is also the best option when the suspicious tissue is in a difficult-to-reach area, for example, too close to the chest wall or near a breast implant.
The biopsy is usually performed as an outpatient procedure in the mammogram suite of a hospital. A radiologist numbs the area of the patient's breast to be biopsied with local anesthetic, and then places a thin hollow needle into the breast.
The patient then goes to the operating room, where the surgeon removes the tissue around the wire and sends the sample back to the radiologist to perform a mammogram on it. Once the mammogram confirms the presence of microcalcifications, the sample is sent to a pathologist for evaluation.
The pathologist will look at the tissue sample under a microscope to determine what kind of cancer the cells are, how fast they are growing and changing and whether the cancer could spread. Based on the results, the patient and her doctor can use the information to choose the best treatment.
If the tissue is not cancerous, the patient's doctor may recommend frequent follow up exams to watch the suspicious area. Cancerous tissue will need to be surgically removed. The extent the cancer has spread will determine whether only the cancerous tissue needs to be taken out, or if one or both breasts needs to be surgically removed.
Brixey's doctors diagnosed her with invasive ductal carcinoma, which had the potential to spread. She chose to have her right breast removed, a surgery called a simple mastectomy, and opted for immediate reconstructive surgery. One year later, Brixey is again busying herself with her studies and trying to live her best life.
"It is so important to get a mammogram even if you don't have a lump, so you can get the right treatment," Brixey says. "You can live a long successful life after diagnosis. It is the beginning of a new chapter of life for me."
UPDATED: 10-07-2004
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Dr. Christine Cocanour is an associate professor of surgery with the UT Medical School.
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