STEADY PROGRESS IN CARE FOR CANCER: Two Cases, 25 Years Apart, Reveal What Has Changed in Medical Treatments and Public Perceptions

By The Akron Beacon Journal, Ohio, The Akron Beacon Journal, Ohio

Dec. 28–hile much remains the same about the disease that showed up in Amy Wilson this year and in her grandmother 25 years ago, a lot of other things have changed in the years between.

Grace Dutton, Wilson’s grandmother, was 58 when she was diagnosed with breast cancer in 1980.

Like Wilson, she found her own lump. Unlike Wilson, she didn’t know whether she would wake up with both of her breasts as she fell asleep for surgery to have her cancer removed.

“This is the way I do it,” her surgeon told her. If the lump were cancerous, he would take the whole breast. If not, “that would be it,” he said.

And what about breast reconstruction?

“I didn’t have a choice,” Dutton said. “They didn’t even mention it.”

She has been using a prosthesis.

Still, whatever her surgeon did worked. Now 83 years old, Dutton, who lives in Sioux City, Iowa, did not have chemotherapy, but her cancer has not returned.

“I was just thankful that they got it all,” Dutton said of her cancer.”I thought, `If I ever found a lump in the left breast, I’d say, “Take it. Take the whole thing.” ‘ “

Her story shares some similarities to that of 78-year-old Sara Jane Cullison of Kenmore, who had breast cancer 30 years ago — or, as she says, in “the primitive days.”

Her choice then, too, was “mastectomy or die,” she said.

As Wilson’s oncologist at Akron General Medical Center, Esther Rehmus, says, then “the idea was, the bigger surgery you did, the more cancer you would cure.”

But five years later, Cullison’s cancer returned. She underwent radiation treatment that caused burns.

After Cullison was diagnosed with skin cancer in 1981, she began chemotherapy with one drug — 5-Fluorouracil — and she picked it up herself from a pharmacy.

Her oncologist kept the drug vials marked with her name in a refrigerator.

The first time Cullison was asked what stage her breast cancer had been — a now universal way of identifying the seriousness of the disease — she responded, “What’s that?”

Cullison’s doctor told her only that her tumor was cancerous.

And people had more misconceptions about cancer back then.

“When I first had it, if I told somebody I had cancer, they backed away from me like it was contagious,” Cullison said.

Rehmus, Wilson’s oncologist, credits the White House’s first ladies, particularly Betty Ford, with spreading awareness on breast cancer and mammograms after being diagnosed with the disease.

Mammograms were just starting to be recognized as an important screening tool in the mid-1970s, Rehmus said. Self-exams did not become more commonly done until the 1980s and ’90s, Rehmus said.

Now there’s more openness toward breast cancer, too.

“I think one of the biggest things is that people talk about it,” said Linda Parenti, an obstetrician-gynecologist with Ob/Gyn Associates of Akron who has been practicing in the field for 30 years.

“It used to be a big secret. Nobody talked about breast cancer, because it was your breast.”

One of the most obvious examples of this openness is with the emergence of more resources for people with cancer.

For Dana Castle, 74, of Akron, who was diagnosed with several different cancers in the past 10 years, her battles would have been easier if she could have turned to others who had cancer.

Now she participates in a support group at Stewart’s Caring Place, a nonprofit in Akron that opened its doors about a year ago and provides free services to those touched by cancer.

Sheryl Pflueger, program director for the organization, said the facility is among only a small number like it in the state, although she said she has seen resources for cancer patients become more well-rounded, addressing the burdens of cancer from a variety of angles.

Douglas Trochelman, director of oncology services for Summa Health System, said the disease itself has changed, too. There are more young women getting breast cancer. Also, since the mid-1990s, incidence of the disease, or its rate of occurrence, has increased, but deaths from breast cancer have been dropping, he said.

The reasons for the bad news are unclear, Trochelman said, but the good news probably is due to earlier detection.

About 200,000 women are diagnosed with the disease each year, and about 20 percent die of it. But breast cancer keeps getting closer to becoming a chronic condition that people can live with, rather than being a life-threatening problem, Trochelman said.

Those lifesaving advances in technology also make treatment decisions more difficult for doctors now, Trochelman said, but it’s a welcome problem.

There are more options available to treat each type of breast cancer, he said, and patients come to him with much more information. That’s helpful, too.

“I think they have a more optimistic outlook and a much more reality-based kind of outlook,” he said of his patients.

Harriet Savage, 65, of Akron is one example of an informed patient who is benefiting from some of the latest advances.

Savage was diagnosed with breast cancer seven years ago. It returned late last year.

Her doctor caught the recurrence through a PET scan that she asked the doctor to perform because she had heard from others that they had detected their cancers with the scan.

Savage has continued her treatment with the relatively new drug Femara. If her cancer returns, her oncologist expects that another drug, Herceptin, could be the tool powerful enough to kill it.

Symptom management for chemotherapy has become an art in itself, said Cathy Farmer, coordinator of cancer research at Akron General. Now, Farmer says, most chemotherapy patients, like Cheryl Seeley, don’t become sick or nauseated from treatment, thanks to effective new medications for side effects.

Seeley, 48, of Akron, said she “flew right through” her chemo treatments.

It’s exciting to see treatment for breast cancer becoming more customized and user-friendly, Farmer said.

“It’s almost like it’s going to become designer therapy,” she said.

Elizabeth Suh can be reached at 330-996-3748 or esuh@thebeaconjournal.com.

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