Breast cancer: Six women, six paths

Breast cancer is no longer considered a single disease. New molecular tools are allowing doctors to see what is going on inside tumors with much greater accuracy, enabling them to tailor their therapeutic approach to fit the traits of each cancer and the needs of each patient, as the women below illustrate.

Sailing through

Name: Caryl Engstrom

Current age: 51


Home: Los Angeles

Diagnosis: Stage 2B breast cancer that was ER-positive

Age at diagnosis: 49

Engstrom had a mastectomy, followed by five months of a combination chemotherapy known as ACT (which includes the drugs Adriamycin, Cytoxan and Taxotere) and 61/2 weeks of radiation. She now takes Tamoxifen, an estrogen-blocking pill, to reduce her risk of recurrence. She is cancer-free.

“My feeling is that the minute I had my surgery, I was cancer-free. The chemo and the radiation are what I call the insurance policy. For me it was about making decisions based on what’s going to give me the best possible chance of having a cancer-free life.

“I know it sounds crazy, but I never felt like, ‘This is gonna kill me.’ It was like, ‘Let’s figure out how to make this work.’ My oncologist told me to have my normal life — every three weeks you’re going to have this treatment, you’re not going to feel well for a few days but you’ll bounce back. It was completely manageable. If you have a healthy diet and a healthy mindset, you exercise, you have a good support system, good friends, you sail through it.”

Gentler choices

Name: Christina Eason

Current age: 37

Home: Thousand Oaks, Calif.

Diagnosis: Stage 1 ductal carcinoma in situ (DCIS) that was ER-positive and PR-positive

Age at diagnosis: 32

Eason’s type of tumor carries an excellent prognosis —96% to 98% of women are alive 10 years after their diagnosis, according to the National Institutes of Health. Eason had a lumpectomy to remove her tumor but, against the advice of her doctor, she did not have a radical mastectomy, radiation or follow-up drug treatments. (Chemotherapy wasn’t recommended because her tumor was localized). Instead, Eason relies on a diet of what she calls “nutrition therapy,” which includes alternating between a vegetarian and vegan diet and doing an annual “detoxification” that involves drinking nothing but specialized juices for three to 10 days. She also takes a combination of vitamin, mineral and herbal supplements to maintain her cancer-free status.

“I didn’t just do chemo and walk away. I have a battle ahead of me for the rest of my life to make choices about what I eat and how I am affecting the estrogen in my body. It’s a daily thing. I want to be around for the next 50 years for my kids, so what am I going to do to make sure that happens?

“I’ve just come out of a season of dealing with paralyzing fear — of learning to cope by controlling where my mind is going. It’s a lot of prayer. My life isn’t guaranteed from this day to the next.”

Tackling high risk

Name: Clare Hobby

Current age: 41

Home: Houston

Diagnosis: Stage 2 ductal carcinoma that was ER-positive and HER2 positive

Age at diagnosis: 38

Hobby was diagnosed in 2008 and then discovered she had a mutation in her BRCA1 gene that increased her risk of developing breast cancer by 55% to 87%. Now that she has had one tumor, she is at greater risk of developing a second primary breast cancer. Hobby had chemotherapy, radiation and a double mastectomy, among other surgeries. As a preventive measure, she had her ovaries and uterus removed last year. She is also taking a drug called Arimidex to kill any stray cells that may have evaded her chemo and radiation treatments and to block her body’s production of estrogen, a hormone that can feed breast cancer tumors.

“I feel fortunate that due to this individualized approach I know more about my cancer and can take more active steps in working preventively with my children, who may have also inherited the gene. Individualized medicine has been a huge gift for us because we can talk to our kids in a completely different way.”

The lonely fight

Name: Faina Sechzer

Current age: 59

Home: Princeton, N.J.

Diagnosis: Stage 2 breast cancer that was ER-positive

Age at diagnosis: 57

Sechzer’s cancer was discovered at an early stage, but a lumpectomy revealed that it had spread to a lymph node, requiring a second surgery. She opted for chemotherapy with the drugs Cytoxan and Taxotere and also received three weeks of radiation treatment. She is cancer-free and is in the midst of a five-year course of Arimidex to suppress her body’s production of estrogen.

“After all this research, I ended up making decisions out of my gut and out of knowing myself. I wanted to live my life knowing that whatever there was to do, I did.

“The biggest difficulty was not physical pain but emotional pain. You find yourself very lonely at that time. I have a loving husband, loving children and a loving support group. But you still find yourself very lonely.”

Hitting on the right drug

Name: Margaret Mauran Zuccotti

Current age: 42

Home: Jenkintown, Pa.

Diagnosis: Stage 4 inflammatory breast cancer that was HER2-positive

Age at diagnosis: 37

Zuccotti’s cancer had spread to her liver and a bone near her right eye socket. She started a tailored treatment plan that included eight months of chemotherapy using a combination of Taxol and Herceptin. She also had a mastectomy. Zuccotti has been cancer-free since July 2007. She continues to be treated with Herceptin every three weeks to keep her cancer from returning.

“I feel very hopeful because my response has been so positive. For someone with my diagnosis and my markers, Herceptin is completely life-changing. I have a cousin who was in her early 30s when she got a similar diagnosis. She was pre-Herceptin. They tried many different medicines. They’re all really hard on the system, on the heart and the spirit. To have something that fixes this particular cancer and seems to be doing it incredibly well is wonderful. It gives you such hope when you’re in this sunny subgroup, where before there was no alternative but to cross your fingers and hope your life expectancy could be extended.”

Blossoming again

Name: Tina Roark

Current age: 49

Home: Eldorado, Ark.

Diagnosis: Stage 3 ductal cell carcinoma that was ER-positive

Age at diagnosis: 37

After getting her diagnosis, Roark found out she had a BRCA1 mutation. She had a bilateral mastectomy, three chemotherapy treatments and took the anti-estrogen drug Tamoxifen for five years to reduce the risk of recurrence. The treatments kept her cancer at bay for several years, but then it spread to her bones, spine, liver, lungs, ribs, hip and sternum. She tried three more chemotherapy treatments that failed. Now she is participating in a clinical trial of a drug called olaparib that appears to have anti-tumor effects in people with BRCA1 and BRCA2 mutations who have advanced-stage breast or ovarian cancer. Her tumors have shrunk dramatically since she began taking olaparib in March.

“I was done. My oncologist had just seen me wither away. It was just time to give up. I had felt so bad. I didn’t have any quality of life. You’re surviving, but is it worth surviving?

“It’s like I’ve blossomed again, from this wilted flower to this big standing up, face-the-world situation now. If it works six months or a year or 10 years — however long it works — it’s a bonus for me.”