Standing Up To Breast Cancer : From Diagnosis to Treatment, New Center Cuts the Waiting and Worrying

When Sophie Shaw’s family doctor informed her that her mammogram showed a suspicious-looking area in her right breast, the retired schoolteacher seemed to take the news in stride.

It was later that the tears came.

“It just struck me: Why me?” said Shaw, a widow who lives in Orange. “I didn’t really know what to expect. I never expected I had anything like that. I don’t smoke, I don’t drink, and I watch what I eat. But then I felt, you never know. . . . That doggone cancer is so prevalent.”

Shaw is one of 1,000 county women the Cancer Surveillance Program of Orange County estimates have been diagnosed with breast cancer this year.

But with delays in lining up appointments with doctors and waiting for mammogram and biopsy results, it may take 6 to 8 weeks from the time a woman discovers a cancerous lump in her breast until she undergoes surgery. Meanwhile, the prolonged waiting only increases her anxiety and compounds the numbing fear that she is going to die of cancer.

That was not the case with Sophie Shaw.

After examining her mammogram, Shaw’s family physician sent her to the Breast Care Center in Orange, an innovative, 5-month-old facility that offers one-stop comprehensive care for all breast problems.

In a single visit to the Breast Care Center, a woman can undergo a complete breast examination, which includes a mammogram with same-day diagnosis. If there is an abnormality, she can be seen that day by a surgeon. If necessary, a needle aspiration--a simple procedure in which cells are withdrawn from the lump--will be performed in the office. If that proves inconclusive, an outpatient biopsy will be conducted that day or the next. All biopsies and surgeries are performed at St. Joseph Hospital across the street.

The majority of breast lumps are benign. But if a positive diagnosis is made, the surgeon then goes over the patient’s options for treatment: whether she is a candidate for a lumpectomy with radiation therapy or a mastectomy, and whether she will have breast reconstruction. The center’s specialists--an oncologist, radiation therapists and plastic surgeons--are available for consultation while the patient decides.

At the Breast Care Center, the time between cancer diagnosis and surgery is usually a week to 10 days. The center not only saves the time, expense and confusion of going from one office to another, it provides an ingredient that usually is missing: emotional support from women who have had breast cancer and survived.

Within minutes of a positive diagnosis, Shirley Gower, director of patient services, steps in and matches the patient by age, marital status and general background with one of 40 support volunteers.

Unlike the American Cancer Society’s Reach to Recovery volunteer program, which generally is not called in until after surgery, Breast Care Center volunteers make their first contact with a patient the day of diagnosis.

“That is so critical because that’s the time the woman is the most devastated, the most traumatized,” Gower said. “And that is where we find she needs the support of someone who has been through it, someone who can virtually say, ‘Yes, I’m a victim of breast cancer, but I’m alive and I recovered and I’m doing beautifully.’ ”

Moreover, during the period in which the patient is weighing her surgical options, she has the opportunity to meet with additional volunteers who have undergone each procedure.

“It’s important to talk to someone because she has been given all these choices,” Gower said. “She can ask, what can I expect? How long will it take for me to recover? How will it affect my sex life?--nitty-gritty issues she will not talk to her physician about.”

The idea of containing everything--from same-day diagnosis to treatment to emotional support--within one unit originated with Dr. John West, who co-founded the Breast Care Center with Dr. David Margileth and Dr. Peter Hinckle.

West, a general surgeon who was instrumental in establishing Orange County’s nationally acclaimed regional trauma care system in the late 1970s, has done more than 1,000 breast cancer surgeries over the past 20 years.

“In the back of my mind, there was the feeling that trauma care was better when we organized a system,” West said. “I thought, why not develop an organized structure for the comprehensive treatment of breast problems?”

Sandy Finestone, coordinator for the Cancer Society’s Reach to Recovery program, praises the Breast Care Center.

“The idea of encompassing it one place and the support of the women is really a good concept,” said Finestone, who helped train the Breast Care Center volunteers. “They are able to eliminate a lot of steps in between.”

Finestone said the Reach to Recovery program would prefer that its volunteers meet patients before surgery, “but we have to be contacted by the doctor in order to know there is even a problem. The Breast Care Center has a wonderful advantage.”

Since opening in August, the Breast Care Center has treated 400 patients, 69 of whom have been diagnosed with cancer.

Orange County Life followed patient Sophie Shaw through the process.

Friday, Nov. 11

Shaw was feeling optimistic when she arrived at the Breast Care Center at noon to learn the results of the biopsy conducted the day before.

But when West told her the test was positive, she was stunned.

“It is? “ she said, her eyes widening as she looked first at West and then across the table at her daughter, Margie Dickason, who had come along for moral support.

Shaw sat quietly as West explained that the cancer was probably diagnosed early because, although it showed up on the mammogram, it could barely be felt on a careful breast examination. To find out whether the cancer had spread to other areas, he said, Shaw’s lymph nodes would have to be examined.

In discussing Shaw’s surgical options--a mastectomy, a lumpectomy with radiation and breast reconstruction--West noted that not everyone is a candidate for a lumpectomy. The procedure, in which only 10% to 20% of the breast is removed, is followed by six weeks of radiation therapy. “We don’t know for sure right now whether you’ll be a candidate or not because we’ll have to examine the tumor in more detail,” he said. “But all the information so far suggests that that is an option that you could at least seriously consider.”

After talking and answering questions for half an hour, West said he would like Shaw to make her decision by the next Friday at the latest.

“You’re not expected to remember everything,” he told her. “We’ll go over all these things over and over. You’ll walk away from this and say, ‘What the heck did he say?’ You’ll go home and write down questions . . . and don’t feel in any way foolish about asking the same question over and over.”

Shaw would be meeting with the center’s oncologist, Dr. David Margileth, and one of the radiation therapists. But first, Gower introduced her to Mary-Grace Guerin, one of the support volunteers.

“Cancer’s tough, but we do live through it. That’s the best thing to remember,” said the soft-spoken Guerin, who had a modified radical mastectomy 2 1/2 years ago. “I was so overwhelmed in the beginning. All I did was cry. . . . Also, it’s all right to be angry. You’re going to go through mountains of different emotions. . . .”

The two women chatted for nearly 15 minutes, their talk ending with Guerin giving Shaw her phone number and saying, “I’m going to be as close as your telephone.” Then Guerin handed Shaw a beautiful purple quartz.

“I always give a piece of rock--because we can be strong as rocks,” Guerin said.

Guerin rose and the two women hugged.

“I wish you God’s strength,” Guerin said. “Things will be good. You’ll make them good.”

“Thank you,” Shaw said. “Thank you very much for sharing.”

Monday, Nov. 14

After spending the weekend thinking about her options, Shaw still was undecided about which was best for her. “I feel like I was bombarded” with information, she said. “I just can’t decide myself.” She made an appointment to see Dr. Hal Shimazu, her family physician, to talk it over with him.

Although the visit to Shimazu helped reassure her that she was in good hands at the Breast Care Center, it did not help her make up her mind. “I knew when I saw him it was up to me to decide,” she said later.

Shaw received calls from two Breast Care Center volunteers--one who had undergone a lumpectomy with radiation therapy and another who had had a double mastectomy with breast reconstruction. They would meet with Shaw separately at her home Tuesday. Meantime, she went to her yoga class, which, she said, “helped clear my head.” Still, she added, “after a couple of days, it’s getting to me what a big decision it is to make.”

Wednesday, Nov. 16

Shaw met with a third Breast Care Center volunteer.

On Tuesday, she had met with two volunteers and, although she was impressed with the results of the breast reconstruction on the woman who had undergone a mastectomy, a lumpectomy was sounding more appealing to her.

Because the cosmetic results of a lumpectomy vary from patient to patient, however, Shaw wanted to talk with another volunteer who had undergone the procedure.

After seeing the woman’s breast, Shaw was impressed. “You could hardly tell: She was perfect,” she said.

Although a lumpectomy sometimes causes the breast to darken in color or change in texture or even in size, Shaw said she liked the idea that the procedure not only saves the breast but retains the sensitivity of the tissue because the nerves are not damaged. She also was impressed by the volunteer’s description of the radiation therapy as being “almost like a lunch-hour treatment.”

Thursday, Nov. 17

Shaw had a busy day ahead. At 1 p.m. she was to see a radiation therapist at the Breast Care Center. At 4, West would remove the biopsy stitches, and at 4:30 one of the center’s four plastic surgeons would discuss reconstructive surgery with her.

Shaw had just about made up her mind to have a lumpectomy with radiation therapy, but that changed when she met with the radiation therapist.

Shaw was informed that the final pathology report showed that the type of tumor in her breast had a higher-than-average chance of recurring. Although she was still a candidate for a lumpectomy with radiation therapy, she was no longer an “ideal” candidate for the procedure. In Shaw’s case, the chance of her tumor recurring would be less if she had a mastectomy.

Shaw was more confused than ever when she met with West, the surgeon, at 4 p.m.

“We felt she could still go either way and the overall survival probably wouldn’t change,” West explained later. “But because of the type of the tumor, the chance of local recurrence within the breast would be higher than for the average patient we deal with who undergoes a lumpectomy with radiation.”

Although West now thought a mastectomy was the best way to go, he recommended that Shaw still consider her options.

“I told her to go home that night and think about it,” he said. “Sophie was unsettled and expressed some of that to Shirley Gower. I called her back that night and she clearly had a lot of questions. It really wasn’t clear to her where she stood with these things. All this information was jumbling around and hadn’t crystallized.”

West suggested that Shaw and her daughter come to his office Friday to go over her questions with him.

Friday, Nov. 18

Shaw and Dickason met with West in the morning to discuss why a lumpectomy with radiation therapy was not as good an option as before.

“She had a whole list of questions,” West said. “She was still feeling overwhelmed.”

But after considering the increased chance of recurrence if she went ahead with a lumpectomy, Shaw made up her mind: She would undergo a modified radical mastectomy, the most common breast cancer procedure in which the entire breast is removed, along with most of the underarm lymph nodes.

That decided, she also chose to have immediate breast reconstruction rather than doing it 6 months or more down the line. “I think, why get yourself cut up twice? It’s bad enough once,” she said. As for her choice to have breast reconstruction, she said, “I don’t think I could live with some empty space there--something to remind you of it all the time.”

After talking with West, Shaw underwent a chest X-ray and other routine pre-operative laboratory work.

She said she wasn’t feeling too anxious about her upcoming surgery.

“No, I’m kind of relieved I don’t have to think about what to do about it anymore,” she said.

Surgery was scheduled for 6 p.m. Monday at St. Joseph Hospital.

Monday, Nov. 21

Shaw spent the morning taking care of a few business matters and getting her nails done and her hair cut. “I thought I wouldn’t feel like getting a haircut afterward,” she said. One of Shaw’s three daughters, who lives in Virginia, called to say she wished she was there to give her mother support.

Shaw also made a phone call of her own--to volunteer Guerin to thank her for the crystal. “I wanted to tell her that she had given me a lot of support,” she said. “It helped a lot to ease my mind.”

As the time to go to the hospital drew closer, Shaw began feeling more anxious and apprehensive. “I’ve talked to those ladies that had breast surgery and (each case) is a little different. I got to worrying: How far has it (her cancer) gone?”

Dickason drove her mother to the hospital about 2:45 p.m. to be admitted.

Shaw was in her hospital gown standing next to a hospital bed in the surgical admit unit talking with her daughter when West walked in at 4:30.

“How’re you doing, Sophie? All set?” West asked.

Although a bit more quiet than usual, Shaw seemed confident and prepared for her surgery.

“Well, basically, this is kind of a formality,” West said. “I just wanted to answer any of your questions.”

“Well,” Shaw said with a smile, “I won’t be awake, will I? I won’t be able to tell you what to do.”

West laughed.

“I read the book last night,” he joked.

West told Shaw that she would wake up with a numbness in the inner part of her arm. But because he would be using a laser to cut the breast tissue, which causes less trauma to the nerves than an electrocautery unit, she would have less pain.

“Hopefully,” West said, “we’ll have you home for Thanksgiving.”

Shaw next met with the anesthesiologist, who gave her a mild sedative.

At 5:45, she was wheeled into the operating room where West and Shimazu, who would be assisting West, were waiting for her.

While the nurses got their equipment into place, Shaw was further sedated and then gently put to sleep.

As a nurse began prepping Shaw--scrubbing her with a reddish-brown, iodine-containing soap and then painting her with a stronger iodine solution--West explained that because he would be using a laser everyone in the room must wear green-lensed goggles to prevent eye injury from reflected laser beams.

At 6 p.m., as the three masked, gowned and goggled figures of West, Shimazu and a scrub nurse huddled over the operating table, West marked out the incision with a sterile marking pen. Then, with a scalpel, he made an elliptical incision through the center of Shaw’s breast, going around the nipple and biopsy sight.

With Shimazu carefully elevating the flaps of skin with retractors, West began separating the skin from the underlying breast tissue with the laser. Using the instrument like a calligraphy pen, West coagulated the blood vessels before cutting them. Because of that, the entire procedure is almost bloodless.

As West dissected the skin flaps with the laser, the pungent smell of vaporizing tissue filled the room. A plume of white smoke rose from the vaporized tissue, but was minimized by the constant repositioning of a suction tube kept within inches of the laser tip.

At 7:10, a little more than an hour after he made his incision, West had finished removing the breast from the underlying chest wall muscles.

“I’d call Turpin now and tell him I’ll need him in about half an hour,” he said to a circulating nurse as he began to remove the area of the lymph nodes under Shaw’s arm.

At 7:45, West was finished and Dr. Ivan Turpin, the plastic surgeon, took over.

Turpin lifted the large pectoral muscle and made a pocket underneath to make room for the tissue expander, the first stage of breast reconstruction. He slipped the pancake-sized, empty silicone sack into the pocket and sewed the muscle over it. A thin tube connected the expander to an almond-sized, one-way valve. The valve was placed under the skin so that in the future, saline could be injected through it to fill the expander. Six to 8 weeks later, after the expander had been stretched to the appropriate size, it would be removed in outpatient surgery and replaced with a permanent silicone prosthesis.

By 9 p.m. the surgery was over and Shaw, still sedated, was wheeled back to the recovery room.

Tuesday, Nov. 22

Shaw’s daughter dropped by to see her mother at 8:45 a.m., followed by West.

“She was in a real good mood, real happy,” he said later in the morning. “The surgery went very well. There were basically no surprises. I couldn’t tell her what the lymph nodes’ status was. That requires looking under the microscope. It was submitted (to the lab) late last night so we won’t get the results until tomorrow.

“I try to be positive without providing unrealistic hope. She didn’t ask me, but there are 50-50 odds the lymph nodes are not involved.”

Although Shaw was experiencing stiffness and numbness in her arm, West said she looked good and was not feeling too much discomfort. “The dressing is still on and she hasn’t looked at it yet,” he said.

One of the Breast Care Center volunteers Shaw had spoken with the previous week stopped by later to see how Shaw was doing.

Sitting up in bed that afternoon, Shaw said her most vivid memory of the night before was being wheeled into surgery and “being able to see and hear everything” before being put to sleep. She also remembered having tears in her eyes.

Recalling the wait before she went into the operating room, Shaw smiled and said: “Do you know what foolish question I asked my daughter? ‘Was I a good mother?’ I don’t know what I expected--(that) I wasn’t going to come back?” She laughed. “Of all the questions to ask her. Isn’t that weird?”

Shaw said she woke up about 2:30 in the morning. Wide awake, she turned on the TV set mounted on the wall. Because her arm started aching, she called a nurse, who gave her a shot to ease the pain.

While she waited for a visit from her daughter Dickason and two of her grandchildren, Shaw was asked if she was concerned about the outcome of her lymph nodes test.

“Not really,” she said. Then she smiled: “I think the reason for it is I’m under sedation. I’m resting and I’m at ease. I feel like I’m taken care of.”

Wednesday, Nov. 23

Shaw was in good spirits, chatting with visitors while waiting for West to arrive with results of the lab report on her lymph nodes. With visits from Dickason, her grandchildren and another daughter who lives in Long Beach, Shaw said she’d had enough company to keep her mind off worrying about whether the cancer had spread.

At 4:30 p.m. West entered the room and stood beside Shaw’s bed.

“Well, I gave you some bad news last week,” he said.

“Good news this week?” Shaw asked expectantly.

“Are you ready for some good news?”

“Yeah.”

“The lymph nodes are OK.”

“Ohhh. . . , “ Shaw sighed.

“Isn’t that nice?” said West, leaning over and giving her a hug.

“Oh, I love you,” Shaw said, hugging him back.

“OK, that’s the best news,” West said. “That’s no chemo(therapy). That means that you’re in a wonderful prognosis. . . .”

After examining Shaw, West said she had a slight temperature and her lungs sounded a bit congested. He ordered a chest X-ray. Her release from the hospital was delayed until Saturday. Looking ahead, West told Shaw she would be followed “indefinitely.” She would have a yearly mammogram and he would see her twice a year for 3 years to examine her left breast.

“To be totally honest, you’re in the best prognostic category, but cancer has an unpredictable nature to it,” he said. “And I think it’s important to remember that everything looks optimistic, it looks good. We will follow you carefully and we’d love to be able to say, here’s your 5,000-mile guarantee. . . .

“But it sure is nice to give you good news,” he said. “I wish I could do that all the time.”