Today I Shouted...

This appeared in today's newspaper....


Ann ***** learned she had breast cancer after waking up, after surgery, to a missing breast.
"Back then, there were no choices," the ***** resident said, referring to her radical mastectomy in 1962, in which doctors removed her whole breast, along with all of the lymph nodes and the muscles surrounding it.
Forty years later -- except for sharing many of the same fears -- Hope **** of ***** faced a far different medical landscape when she got her breast cancer diagnosis, and many more choices along the way.
In addition to mammograms for early detection, there were detailed tissue biopsies before surgery to guide physicians' recommendations; and a vast arsenal of cancer-fighting drugs, some able to target a tumor directly, while sparing nearby healthy cells.
And, depending on how far along her cancer had progressed, she could choose the standard treatment for early breast cancer since the 1980s -- a lumpectomy, preserving most of her breast, along with radiation therapy.
"I cried a lot," Hope said, after learning the lump in her breast was cancer. "But I told myself, 'I'm beating this. I'm not letting it take me down.' "
Today, she is a five-year breast cancer survivor, a statistical milestone for surviving any cancer, while the 75-year-old Ann recently celebrated 45 years of being free of this disease.
Although breast cancer remains the second leading cause of cancer death in women behind lung cancer, experts say, mortality rates are declining, most likely the result of finding these cancers earlier, when survival rates are highest -- about 98 percent -- and improved treatments.
In 2007, the American Cancer Society estimates 178,480 women in the U.S. will be newly diagnosed with invasive breast cancer and about 40,460 women are expected to die of the disease.
Hope said she discovered the lump in her breast shortly after the birth of her first son, Nathan, five years ago. But, with no family history of cancer and age 29 at the time, "I was not thinking cancer."
The lump seemed more of an annoyance than a threat, she said, so she contacted a lactation consultant, who recommended putting a cabbage leaf over it to "cool it," which failed to work.
That's when she contacted her doctor. He scheduled a mammogram, then a diagnostic ultrasound and finally a biopsy, which confirmed her worst fears: breast cancer.
But it also laid out a therapeutic path offering the best chance for survival, including aggressive chemotherapy.
For six months, she said, she endured eight cycles of cancer-fighting chemicals every three weeks, losing her hair and her appetite along the way.
At the end, lumpectomy was not an option -- the cancer was too far along -- nor was sentinel node biopsy, a cancer test that tracks potential spread of disease through the "sentinel" or first lymph nodes, mitigating the need for further surgery, if the nodes are cancer-free.
In her case, doctors recommended and she agreed to a mastectomy, which was performed at H. Lee Moffitt Cancer Center in Tampa. Surgeons removed her diseased breast and 17 lymph nodes, all of which proved negative.
"By the time I had the mastectomy, the tumor was totally gone," she said. "I have a picture of me bald at Moffitt afterwards -- smiling," and full of her namesake -- "hope."
Continued battle
But Hope's battle with cancer did not end there.
Several years later, on the birth of a second son, Reese, she developed a sore on her tongue, which turned out to be malignant, requiring still more chemotherapy and the loss of a third of her tongue.
"Radiation for my breast cancer was a cakewalk, compared with the radiation for the tongue," she said.
But the ordeal prompted creation of a cookbook with her husband, Jake, called "Easy Eating," whose proceeds go to the American Cancer Society.
"When you get sick, everybody wants to make you a casserole," Hope said, laughing. "I lost all my taste buds," along with more than 30 pounds.
The second cancer also turned her preventive side into full gear.
In February 2006, she had breast reconstruction, opting to remove her healthy breast to prevent another breast cancer, but not her ovaries, because of negative tests for two inherited breast cancer genes, she said.
"If they had been positive, I would have had my ovaries out, too," she said, "because that increases the risk for recurrence."
Hope conceded that friends often ask if she's afraid of getting another cancer in the future.
"I tell them, every time I go to the doctor, my stomach falls to the ground," she said. "But then I think of something corny, like my kids' wedding, and I am there."
Discovering a lump
Ann *****'s medical battle against breast cancer has been far more straightforward, though not without frustrations, over the years.
What brought her to the operating table, she said, was a pea-sized lump she found, like Hope, through breast self-examination.
"I still remember I went in the hospital on a Friday, with six of us having surgery that day," she said, "and I watched every one of them go home."
Ann spent 10 days in the hospital and, in a separate operation at the behest of "two older surgeons," had her ovaries removed three weeks later.
Because her father had died of cancer several years earlier, she said, she took great pains to hide her cancer from her mother -- no easy feat, given the lack of prostheses at the time.
"We would wear these cotton things for about a year," she said, "and they would suddenly go 'poof,' and we would have to replace them."
Ann never chose to reconstruct her breast.
But once mammography screening became standard in the late 1970s, she said, she began undergoing these tests annually.
The National Cancer Institute and the American Cancer Society recommend women begin getting mammograms every one to two years beginning at age 40, or even earlier, in women considered at higher-than-average risk for the disease.
"Some women say they hurt," Ann said. "But it's an easy thing to do, compared with the alternative."