Mammograms were never something Karin Diamond tried to avoid. She got one every year without fail and planned her annual wellness appointments to fall between six months. As she puts it, “there was someone squeezing my breasts every six months.”
Karin has big breasts, they are dense, and her great-aunt died of breast cancer pretty young. She also has other high-risk markers: She is light-skinned, Ashkenazi-Jewish and menstruated at the age of 11. “All my life I assumed it would happen at some point in the future,” she explains.
The future turned out earlier than expected. On February 1, 2018, a routine mammogram returned with an abnormality. “I was like that, really? I’m 50! Am I not getting a few more years? Says Karin. “But that’s what it is, I was not shocked or hysterical or any of that.”
First 3D mammography
This visit happened to be the first time she was given a 3D mammogram, a new type of imaging that captures the breast at all different angles and circulates around the breast tissue to create a full 3D image. Traditional 2D mammography produces only two images: side-to-side and top-to-bottom. Several studies have found that 3D mammograms find more cancers than traditional 2D and reduce the number of false positives.
Just 20 minutes after Karin left the office, her phone rang. “They told me to come back. I went the same day and they did a lot more tests: ultrasound, mammography, it all works, ”says Karin. “After that, things went very fast.”
A tumor no larger than 2 cm had formed in her right breast stage 1 breast cancer. Early capture of cancer had enormous benefits. Karin had opportunities available. She quickly planned an appointment with Roshni Rao, MD, head of breast surgery at Columbia University Irving Medical Center / New York Presbyterian, and on the advice of her longtime gynecologist, also made an appointment for a second opinion outside Columbia.
“First of all, we were superduper impressed with Dr. Rao. She drew pictures, she explained things, ”says Karin. “She told us what all the different options were: lumpectomy, full mastectomy, she was talking about intraoperative radiation versus standard radiation.”
Radiation lowers the risk of breast cancer recurrence, but intraoperative radiation (often abbreviated as IORT) is a relatively new method. With IORT, targeted radiation is given during the operation in a single dose directly to the area where the cancer used to be. Traditional methods use postoperative radiation therapy cycles to radiate all or part of the breast.
“When we went to the other doctor, she did not offer intraoperative radiation. It’s not something they have, and it was in a huge institution, ”says Karin. “She only talked about lumpectomy versus full breast removal and radiation. She did not think I needed chemo, but did not rule it out. ”
Fantastic candidate for intraoperative radiation
The tumor was small, which meant that Rao thought Karin was a good candidate for intraoperative radiation therapy. That left the possibility of full breast standard radiation open in the future. “My husband and I both agreed: We should go with Dr. Rao for so many reasons. Number one was intraoperative radiation; it was really important for me to try to save my breast if I could. Number two, just the whole picture she drew, the explanations she gave, ”says Karin. “We planned the operation in the third week of March.”
“My husband and I both agreed: We should go with Dr. Rao for so many reasons. Number one was intraoperative radiation; it was really important for me to try to save my breast if I could. Number two, just the whole picture she drew, the explanations she gave, ”says Karin.
The operation went well and the cancer had not spread to the lymph nodes. “I was very, very happy. I have a slightly larger scar because the meat was cooked, so to speak, but the scar is not even visible anymore, ”says Karin. “That was it. They told me to be back in six months for my mammogram. I went on holiday 10 days later.”
Six months later, the mammogram revealed ductal carcinoma in situ, or DCIS, on the opposite side of the same breast. DCIS is the presence of abnormal cells inside a milk duct that is considered the earliest form of breast cancer. “How it happened when it had only been six months and I had started Tamoxifen, who knows, but it was tiny, tiny,” says Karin.
Doctors often prescribe chemotherapy medication to treat or prevent cancer after successful surgery. Tamoxifen is a selective estrogen receptor modulator (SERM) that works by attaching estrogen receptors to the breast so that the hormone can not bind to them. One pill every day for five years reduces the risk of breast cancer by 50%.
If this was Karin’s first cancer, Rao explained, they would not have needed radiation at all. “They would have gone in, removed the tiny little DCIS and been done with it,” Karin says. “But another cancer, the same breast, six months apart? I had to have full chest radiation. ”
Karin felt no reaction to the radiation until the day after her last session. “Suddenly it looked like the one breast I had been lying in the sun for months and the other was normal color. Then it faded and the skin peeled off, ”says Karin. “And I was like, oh, that’s what they meant!”
Since then, Karin has been cancer-free.
“For me, intraoperative was really the right choice, because I did not know that six months later I would go through this again,” says Karin. “If I had gone to another doctor and had full chest radiation, I think I would have had no choice. Six months later they would have said ‘Even if it’s just DCIS, you need a full mastectomy.’
For now, Karin takes one mammogram at a time and enjoys life with her husband and three children. When friends ask her about her experience, her most important piece of advice is always: “Find a hospital that offers intraoperative radiation.”