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One in three women will develop a form of gender-based cancer in her lifetime. But today, 55 percent will survive their diagnosis and live cancer-free. In 1989, the five-year survival rate for breast cancer was 75 percent. Today the five-year survival rate is 100 percent for women with stage 0 or I cancer, and 93 percent for stage II. Incredibly, breast cancer mortality rates have dropped by about 30 percent since 1990, says Kathryn Moore, oncologist at Park Nicollet Frauenshuh Cancer Center. Right now, there are 4.2 million women with a history of cancer living cancer-free in the United States. This is called survivorship. And, next to eradicating cancer entirely, it’s what the Twin Cities medical community works for. It’s what those diagnosed with cancer live for. What has changed during the past 20 years to make cancer survivorship more than just possible but the norm for so many? Here’s what our hometown medical heroes say.
Research has made a major impact with prevention methods. Now we know that smokers who quit for five years cut their cancer risk in half. There are now better detection methods, like genetic testing—for BRCA1 and BRCA2— that help people make medical decisions to cut or lower their cancer risk before it’s too late.
Researchers are also working on vaccines that prevent cancer. Gardasil, a vaccine that targets strains of HPV known to cause cervical cancer, is now widely available. “[Due to Gardasil] in the past decade, I have definitely seen a decrease in the number of women with abnormal Pap smears who need treatment. There’s now a cancer that can be prevented with a combination of vaccine and regular doctor visits,” says Annelise Swigert, obstetrics and gynecology physician at Southdale OB/GYN Consultants in Edina.
It saves lives. More women are getting their mammograms. In 1994, about 61 percent of women over 40 had a mammogram, now that number is about 67 percent. Today, doctors recommend mammograms sooner in patients with a family history of breast cancer. And genetic testing has become a real and effective tool. Testing helps women know if they have a high risk of developing some cancers, which may lead to the decision for elective mastectomies and hysterectomies as prevention measures. Genetic counselors help people understand their risks based on their genetics. It’s a career, and a prevention approach, that barely existed 20 years ago.
And research on better tests for harder-to-detect cancers, like ovarian cancer, is showing promise. “What research is gearing toward now for ovarian cancer is developing a test like a Pap smear or mammogram that can detect ovarian cancer at very early stages,” says Swigert. “We don’t have that right now.” But with several large studies now in progress, the hope is to have it soon.
During the past 20 years, as researchers have a better understanding of the ways various cancers develop and thrive, drugs have been created to target those causes. “We’re not at the point where we can send someone’s tumor tissue off and give them a drug that targets that mutation, but that’s the direction cancer care is going,” says Moore.
For instance, a major breakthrough in drug treatments occurred in 1998 when the HER2-targeting drug received FDA approval. “This drug reduces the risk of recurrence of this particular type of breast cancer by more than 50 percent in combination with standard chemotherapy drugs,” says Kamran Darabi, medical director at Ridgeview Hematology and Oncology Clinic.
Speaking of chemotherapy, it has also improved. Chemo can now be minutely customized to the type and severity of cancer, which minimizes side effects and maximizes survivorship. This is particularly true for women with ovarian cancer. “There are long-term survivors of ovarian cancer with 10-year survival rates of 40 percent—and those are the patients with really advanced disease,” says Anne Blaes, hematologist and oncologist at the University of Minnesota, Breast Center and Masonic Cancer Clinic.
“Living with it” are words that are often true for women with breast cancer as well. “Breast cancer nowadays, especially stage IV disease, is seen almost as a chronic disease that requires continued treatment but that people can live with, sometimes for many, many years,” says Moore.
A HOLISTIC APPROACH
The shift to treat the whole person, not just the cancer, has been a major transformation in the care plans for women diagnosed. Michaela Tsai, a physician of medical oncology, hematology, and clinical research, says that at Abbott Northwestern and the Piper Breast Center (where she treats patients), women are greeted by a volunteer in street clothes rather than scrubs and offered a cup of tea while they wait. “If you’re diagnosed with cancer, you’re assigned a nurse navigator who is your go-to person to walk you through the entire process. That person is available days, weeks, months, years later,” Tsai says. And that’s just one way cancer patients are seen as people first. Massage, reiki, aromatherapy, music therapy, and meditation instruction are all integrative health treatments that can be available to women with cancer.
Since survivorship is common, starting a family after cancer is common too, so doctors are working with younger patients to protect their fertility. “Young women with breast, ovarian, or cervical cancer have a very high likelihood that their cancer therapy will lead to infertility,” says Tsai. “We can look at ways to harvest eggs and embryos, and hopefully maintain their fertility.”
But the biggest change that has happened since the mid-1990s, says Swigert, “is recognizing that treating cancer isn’t just about surgery and chemo. It’s about helping that patient live her life—helping her understand how important diet, rest, exercise, support groups are.” And it’s the recognition that “once cancer is cured, our job [as doctors] isn’t done.” Medical care teams now know that women need support, not just for the physical effects of treatment, but for the emotional—and well-earned—journey forward as a survivor.
TAMING CHEMO'S SIDE EFFECTS
It’s a treatment that patients sometimes need. Here’s what the past two decades have taught us about chemo:
• Chemo nausea. “Chemotherapy has become a bit more bearable in recent years,” physician and researcher Michaela Tsai says, thanks to improved anti-nausea drugs, which cut down on the extreme persistent sick feelings women had to experience 15 years ago.
• “Chemo brain.” “Chemotherapy can have cognitive effects and decrease a woman’s ability to concentrate. It can affect short-term memory,” Tsai explains. This can limit a woman’s ability to go back to work, or affect her relationships. Now an acknowledged side effect, “chemo brain” is being studied in the hopes that it doesn’t have to debilitate.
• Chemo’s risks. Chemo can open the door for other diseases. “There are higher rates of cardiovascular disease, diabetes, and obesity. A lot of patients end up with sarcopenia, where they lose muscle mass and gain fat mass,” says hematologist and oncologist Anne Blaes. Methods to deal with this are being developed, such as better tools to show cardiac imaging at the same time as breast imaging so doctors can keep tabs on both.
SURVIVOR SUPPORT SUCCESS
Support is now a part of many post-treatment plans. “There’s a comfort when patients are actively doing something for their cancer. When treatment stops, it’s one of the most stress-inducing times for a patient,” says oncologist Kathryn Moore. How can you support a cancer survivor you love, or yourself?
• Know that life will not be the same as before and that survivorship is an ongoing adjustment for everyone.
• Expect changes in sexual health. “A woman who’s had a mastectomy or gone through cervical cancer will not have the same sex life,” says hematologist and oncologist Anne Blaes. Support groups, therapists, counselors, and past survivors can help facilitate conversations about sexual health for a survivor and her partner.
• Keep the evidence of survivorship. “Many hospitals and clinics have developed survivorship programs,” says Moore. “Patients receive a treatment summary: specifics on what stage their cancer was, what treatments they received, the names of the drugs they received, and what the game plan is going forward.” It’s proof of how far the person—and health care—has come.
TWO SURVIVORS, MORE THAN 20 YEARS RACING
Twin Cities women Susan Sheridan and Judy Smith have been cancer-free for more than 15 years each. And they’ve participated in nearly every Race for the Cure to celebrate it.
Photos courtesy of Judy Smith and Susan Sheridan
Survivor for 15 Years
Age Diagnosed: 29, with stage II breast cancer, in 1996
Race participant Susan Sheridan was an active mom living in Rochester with two young kids when she was diagnosed with stage II breast cancer at age 29. “When I was diagnosed, they told me I wasn’t going to live more than five years, which meant my baby would just be getting on the bus for kindergarten. That was not enough time,” Sheridan says. “My goal was to fight as hard as I could and do whatever I needed to do to live longer than that.”
She feels fortunate to have stayed home with her sons Phil and Nick—who are now both in college—as they grew up. “I was always very active in their lives because at one point I thought I wouldn’t even get to be a part of their lives,” says Sheridan, who wasn’t just their mom, but also their soccer coach, field trip volunteer, and assistant at school functions.
“Before I was diagnosed, I didn’t have the Internet to look up my symptoms. I couldn’t research my breast cancer on WebMD. Those things didn’t exist back then,” she says. “Now, you can go online and read people’s blogs about their experience [with cancer] and you can really relate to those stories, and it helps.” After undergoing seemingly every treatment available during her two bouts with cancer (she had a recurrence in 1997), Sheridan completed her last treatment in 2000 and has been cancer-free ever since.
Today, Sheridan lives in Cottage Grove with her husband, Phil, and since 2008 has been an active member of the Dragon Divas boat team. The Divas, which consists of paddlers who’ve overcome or are battling cancer and is the only group of its kind in the metro, is a way for Sheridan to connect with other survivors, stay active, and have fun. The team competes in races in Minnesota, and even went to last year’s Dragon Boat Festival in Sarasota, Florida, to compete with other breast cancer survivor teams from around the world.
She’s also attending this year’s Race for the Cure walk with her family, a Mother’s Day tradition they’ve continued since their first race 20 years ago.
Survivor for 33 Years
Age Diagnosed: 33, with breast cancer, in 1981
In the 1980s, late-stage cancer at age 33 was all but a death sentence for Eden Prairie resident Judy Smith. Staging breast cancer wasn’t even a thing back then—it was just considered really bad news. “My cancer was rather large and it had spread, so I wasn’t given a lot of hope. They gave me three months,” she recalls. “I was operated on the day before Thanksgiving, 1981, and here I am 33 years later.”
At the time of her diagnosis, Smith, a receptionist at European Health Spa, and her husband, Ed, a truck driver, were newlyweds with hopes of starting their own family. “The doctors told me I couldn’t have children because the pregnancy hormone elevations would make my cancer come back,” says Smith. “So, we didn’t have children. I did exactly what the doctors told me to do—I didn’t eat chocolate for 20 years, and I love chocolate!”
A long-time participant in Race for the Cure, Smith, who spends her days with her 5-pound black toy poodle named Blackberry Brandy, says the encouragement from other survivors and their families and seeing the same faces each year have been her motivation to keep fighting for herself and for others. “My husband and I worked with cancer patients for 26 years, helping them, talking to them, holding their hands, crying with them. He would work with the husbands and I would work with the wives,” she says. “It’s something that I pretty much devoted my life to because someone saved me. I survived because of my chemo doctor and my surgeon.”
And she survived with humor. “I was bald for two and a half years—they didn’t think my hair would ever come back. It’s white, but it’s back!”
And she did it with strength. “I took everything they told me to do to heart; I had a will to live. I laughed a lot and I never asked, ‘Why me?’ You’ll get depressed but then you have to kick yourself in the rear and move it,” she says.