Obstacles persist as breast cancer testing, treatment advance

The MetroWest Daily News

Doctors and breast cancer advocates across Massachusetts are lauding recent advancements in treating the disease - new drugs, new chemotherapy treatments, new screening and biopsy techniques. But even with the large number of advocates and an emphasis on awareness, they say some women are still falling through the cracks.

Whether it’s cultural issues, socioeconomic levels, or plain fear, doctors say they are still puzzled about how to reach certain women about the necessity of screening and showing up for appointments. For many of those women, it’s hard to concentrate on mammograms when worrying about how to put food on the table.

Dr. Jane Mendez, a breast surgeon at Boston Medical Center, said the problem is especially prevalent with her patients. As Michael Stone, the center’s head of surgical oncology, said, paying $15 to park for an appointment is a major obstacle for their patients.

“They’re so worried about surviving that going to get a mammogram is not priority by any stretch of the imagination,” Mendez said.

“We tend to see it at later stages. It might be so advanced that we treat with chemotherapy prior to surgery,” Mendez continued. “In some, it’s already way too late and that’s metastasized.”

Stone said cultural perceptions of cancer arise as well. Many women from Third World countries see cancer as a death sentence, he said.

“I had a patient in my office over a year and half ago. She had been here for quite a few years and her husband was with her,” Stone said. “I told her I thought she had breast cancer. Her husband said to me, ‘Have you ever seen somebody survive breast cancer?”’

Dr. Ann Larkin, associate professor of surgery and co-director of the high-risk program at UMass Memorial in Worcester, had a similar story about a Vietnamese patient. According to the patient’s interpreter, Larkin said, cancer isn’t a word used because of the fear associated with it.

“The challenges are to find ways to communicate with different cultures and get across that this is not a death sentence and we can treat it,” said Larkin, who said she sees many Eastern European, Brazilian, Portuguese and Asian women at her facility. “But how do you talk to a patient about breast cancer treatment if you don’t use the cancer word?”

Statistics from the Centers for Disease Control show survival rates for women diagnosed with breast cancer are continuing to improve. From 1998 to 2005, the number of breast cancer deaths in women fell by 1.8 percent per year. Ronni Cohen-Boyar, executive director of the Massachusetts affiliate of Susan G. Komen for the Cure, said 98 percent of women diagnosed with cancer confined to the breast are alive five years later.

“That’s an amazing statistic,” Cohen-Boyar said. “If we could get people to see, that if you have to have breast cancer, you should be one of 98 percent.”

Doctors and advocates say screening is one of the most important components in catching breast cancer before it spreads. New technology such as digital mammography has emerged, and high-risk patients who have abnormalities in breast tissue can receive a breast MRI.

In addition, new drugs and chemotherapy treatments make treating the disease more targeted, doctors say. For example, a drug approved in 1998 called Herceptin targets a specific strain of breast cancer that was resistant to other medications.

“For a long time, it was slash, burn and poison - surgery, radiation, and chemo,” said Carol Matyka, a Boston advocate with the National Breast Cancer Coalition. “There are drugs that are much more targeted now. What we’re learning now, the key is, how do we understand the right drug for the right cancer?”

Linda Kaiser, a 55-year-old Northborough survivor, said she was diagnosed with stage four breast cancer in July 2007 and a spinal tumor had paralyzed her. Doctors discovered her strain of cancer could be treated with Herceptin, and Kaiser said her tumors are gone. She’s now walking with a walker.

“That was actually the only treatment that I could get,” she said. “Without it, I honestly don’t think I’d be here because the cancer had metastasized so much.”

Developing a new drug can take years, advocates say, because of research, clinical trials, and the approval process. Groups have focused on awareness and large community fundraising efforts, often backed by the 2.5 million breast cancer survivors nationwide.

The American Cancer Society in Massachusetts raised $3.4 million at its 2008 “Making Strides Against Breast Cancer” event, and Cohen-Boyar said Komen’s Massachusetts chapter raised over $2.54 million in the fiscal year ending March 31.

But when it comes to awareness, Larkin said her middle-class and upper middle-class patients in Worcester are the ones paying attention.

“They tend to keep closer track. But frankly, they don’t have as many other incredible stressers in their life,” Larkin said. “A lot of the underserved population in central Massachusetts is not getting in because they fall through the cracks.”

In Boston, Mendez said it’s critical to pay attention to other populations. Black and Hispanic women often have worse outcomes for breast cancer than white women, and Mendez said it’s important to determine whether these statistics come from biological or socioeconomic issues in order to properly treat these women.

Stone said some centers are doing their best to address access to care. Boston Medical Center now has a centralized phone system where workers gather all of a patient’s medical information so only one appointment is necessary.

In Springfield, Dr. Grace Makari-Judson, who directs Baystate Medical Center’s Comprehensive Breast Center, said the center offers mammograms from 4:30 p.m. to 8 p.m. for what she calls the “overcommitted woman” - one with a job, children or other concerns.

Tracy Ibbotson, director of women’s health services at St. Anne’s Hospital in Fall River, said the hospital works with an organization that does outreach to women with substance abuse problems. The hospital also holds a regular “Chocolate and Roses” event, Ibbotson said, where women can receive chair massages, listen to live harp music, and get their mammograms.

When it comes to fear, Dr. Barbara Stewart, an adviser to the Massachusetts chapter of the American Cancer Society, said sometimes the most effective outreach is a relative or friend.

“If they have other people in their lives to help them deal with appropriate visits and screening and really thinking it through and being informed, that’s the best way to make sure if anything’s there, it’s found and found early,” Stewart said.

And some women are sticking to treatment despite the hurdles. Susan Farris, a Canton bookkeeper, was diagnosed last year at age 38. She hadn’t been getting regular mammograms because she hadn’t reached the recommended age of 40, she said, so she didn’t find a lump in her breast until after lap band surgery.

After chemotherapy, radiation, and a mastectomy, Farris said she was out of work for eight months. The costs of treatment have become too much, she said, especially with her husband’s hours being cut. Farris said she’ll have to file for bankruptcy protection.

But, she said, she never thought of forgoing treatments to save money.

“It’s my health,” Farris said. “I want to be around for my kids. I hate to leave them without a mom.”