This story is being shared for Breast Cancer Awareness Month.

Ashley was the receptionist at a breast cancer office. She was the “voice of the office” and grew to know patients and comfort them through their journey. There were patients who feared they might have cancer, some coming in for a confirmed cancer consultation and others returning for a post-op visit. Some patients were coming in to discuss genetic testing or talk about prophylactic mastectomies to prevent a cancer. Over her years at the front desk, Ashley learned quite a bit about breast cancer risks, screening and treatment. 

I mention this background because Ashley had access to breast cancer surgeons and anything she needed to keep her as safe as possible. The American Society of Breast Surgeons and American College of Radiology recommend annual mammography beginning at the age of 40 for the average woman or 10 years prior to a cancer diagnosis in the family. She knew screening guidelines and followed what she thought was right for her — believing she was not at increased risk. Had Ashley known she was at increased risk, she would have done something about it. She was unaware. 

Ashley felt a lump when she was 40 years old. She went to get her first-ever mammogram which resulted in a subsequent biopsy and diagnosis of a triple-negative breast cancer (negative for estrogen, progesterone and Her2). When a patient is diagnosed with an aggressive breast cancer of a certain size, chemotherapy precedes surgery. Days after diagnosis, her paternal cousin informed her that she was BRCA-gene positive. “I probably should have told you earlier.” 

Ashley inherited the gene from her father’s side of the family. Her father was diagnosed and died of pancreatic cancer within months of Ashley’s diagnosis. Remember that the history from the paternal side of the family is equally important and perhaps needs even more attention as it is sometimes a more distant relative like a paternal aunt or cousin with breast/ovarian cancer history rather than the dad. 

If Ashley had known that BRCA ran in her family, she would have been tested. If she knew she carried a gene, she would have started high-risk screening which involves breast MRI starting at the age of 25 and then MRI alternating with mammography every six months by age 30. She could have opted for a prophylactic mastectomy to prevent cancer before she ever needed chemotherapy and had to lose her hair and deal with all the other side effects/consequences of chemo.  

Ashley is now on the other side of her cancer treatment. She has completed her chemotherapy. She has healed from bilateral mastectomy and reconstruction. Her hair has grown back in. I would like to thank Ashley for being willing to share her story. The American Society of Breast Surgeons recommends that ALL women with breast cancer undergo genetic testing. If someone learns he/she carries a gene, it is very important that they share this information with relatives. It can be lifesaving and empowering. 

Key points for breast cancer awareness/screening:

1. Start annual mammography at the age of 40 or 10 years prior to a cancer diagnosis in the family.
2. Patients qualify for high-risk screening such as MRI or contrast-enhanced mammography if lifetime risk is 20% or higher.
3. Mammogram reports now discuss breast density. Women with dense breasts could consider high-risk screening (although insurance will not always cover unless 20% lifetime risk).
4. Mammograms are recommended for all women who have an estimated five-year life expectancy (good luck with that accuracy!).

Therese Cusick, M.D.
Clinical Professor
KU School of Medicine-Wichita Department of Surgery