Photography by Donovan Roberts Witmer
Shirell Chatman & Bridget Montgomery
Shirell Chatman used to wonder just what, exactly, she was looking for in her breast self-exam. In the summer of 2009, she found it.
“I kind of immediately knew,” she says. “This felt like a very hard marble, and I knew this was not supposed to be there.”
Chatman, of Lancaster, is one of nearly 10,000 Pennsylvanians diagnosed annually with breast cancer. She is a branch manager for the staffing company The Performance Group. Bridget Montgomery, of Harrisburg, is an attorney with Eckert Seamans Cherin & Mellott, LLC. Her breast cancer was diagnosed in August 2005.
Both women use humor and friendship to deal with their conditions. And both have benefited from advances in medicine—far from the elusive cure, but targeted treatments that try to attack cancer cells directly and keep the disease from returning.
Screening
Bridget Montgomery doesn’t take no for an answer. As a child, her siblings called her “the investigator,” getting to the bottom of every mystery. When she felt a hard little lump at the spot where breast meets underarm, she underwent a mammogram. Nothing was apparent. She insisted on another. Still nothing.
“There is something there,” she kept insisting.
The third time, “they took it and said, ‘Oh.’” This mammogram, Montgomery says, “had all the markings they don’t like.”
Women know their bodies “better than someone who only sees us once a year,” says Susann E. Schetter, D.O., breast imaging section chief at Penn State Hershey Medical Center’s Breast Center. If there’s a change, get a check. Signals can be “a change of skin color, dimpling, or when you lift your arm to put on deodorant, one breast pulls in a different direction than the other,” she says. “There are lots of signs that we need to be checked.”
Patients with breast cancers detected early—in the duct or “in situ”—have a 98 percent five-year survival rate, reports the Pennsylvania Health Department. Early detection begins with the old-fashioned, regularly scheduled mammogram, says Schetter.
“At some time, we may be able to move away from the mammogram, but until that time, it’s our best defense,” she says. “It’s really important to identify cancer at its earliest.”
A “digital revolution” is overtaking breast imaging, notes Schetter. An American College of Radiology study shows that digital mammography can be more effective among younger women, women before menopause, and women with dense breasts.
“The public perception is that it is better,” says Schetter. “It’s not universally better, but it’s better in some populations.” Besides, as medicine moves to a digital environment, digital mammography “will help with exchanging information and help with patient care.” With its digital capabilities, Penn State Hershey’s Breast Center can easily compare the patient’s results for as many years as the records are stored.
“It’s inevitable that breast imaging would become the standard,” Schetter says.
“I had a Mohawk for one minute of my life.” We just laughed and said, ‘What are you gonna do?’” —Bridget Montgomery
When a mammogram shows “microcalcification,” or tiny crystals like snow, a biopsy is called for, without any further tests. But if the patient felt a lump, “that always requires an ultrasound.” And a breast MRI may be called for—but rarely—after a diagnosis or for women with dense breast tissue.
In today’s medicine, an “incisional,” or surgical, biopsy “is not recommended” because it can disrupt the lymphatic system, says Schetter. There are exceptions, of course, but typically, a minimally invasive biopsy is performed. That’s when a mammogram, ultrasound, or MRI is used to guide a probe in collecting tissue through a tiny incision.
As Ann-Marie Hugh, M.D., notes, “The chances are the biopsy is going to be benign, so why do we have to make a huge cut on the breast to get all that tissue?”
Hugh is a Lancaster-area breast specialist with a rigorous background of fellowship training. She is a board-certified physician at the Breast Health Center, Lancaster.
Treatment
When she first learned her diagnosis, Shirell Chatman screamed and, she says, “kind of lost my mind a little bit.” She had just moved, so she went home to a house full of boxes. She was engaged, but for reasons unrelated to cancer, “slowly, my engagement disintegrated.”
How did she get her mind back?
“That took a while,” she says. “How did I get my mind back? I prayed a lot, and I kept myself busy. I really couldn’t do much else.”
Dr. Hugh’s job, in part, is helping diagnosed patients consider their options. She will get a family history and, if the cancer could be hereditary, suggest genetic studies whose findings could impact treatment. For instance, a woman with a genetic mutation that could signal a greater likelihood of the breast cancer returning, even after a mastectomy, might opt for a prophylactic double mastectomy.
“There’s a lot more awareness of genetic testing, and insurance companies cover it more regularly than in the past,” Hugh says.
In most cases, Hugh’s goal is breast conservation through a lumpectomy that removes only the cancerous tissue.
“We’ve been trying to promote breast conservation because we know there is no difference in survival,” she says. “We try to make that as minimally invasive as we can.”
With most mastectomies—except those in which the cancer was greater than four centimeters, or in which more than four lymph nodes were removed—the course of treatment is over, Hugh says. There’s no radiation.
Lumpectomy followed by radiation to kill any lingering cancer cells prevents the cancer’s return as effectively as mastectomy, Hugh says. Traditionally, whole-breast radiation can take six or seven weeks, killing some good cells along with any diseased tissue. But new, targeted options are emerging. In Europe and at some academic centers, intraoperative radiation is delivered directly to the spot where the tumor was removed, while the patient is still on the operating table.
Breast Health Center in Lancaster offers the targeted partial-breast irradiation, which typically requires twice-daily treatments for about one week, Hugh says.
“The concept is to try to irradiate the part of the breast at greater risk for recurrence,” she says. A balloon catheter targets radiation directly at the cancerous area.
To qualify, the breast cavity must be able to hold the balloon without it burning the skin, Hugh says. Patients with lymph node involvement aren’t eligible.
Bridget Montgomery’s cancer did involve the lymph nodes, but it was discovered on the operating table through sentinel testing, and not through the traditional procedure of dissecting all the lymph nodes. In sentinel testing, the surgeon injects a dye to find the first lymph node connecting to the breast—the sentinel—cancer.
“If there isn’t cancer in the first lymph node, we really don’t need to do the dissection,” says Hugh. “Our goal is to return the woman back to her normal function if we can.”
When it comes to deciding on the need for chemotherapy and the dosing, oncologists now know to look for the type of cancer cell, because some respond better to chemo than others, Hugh says. For instance, a genetic test called an Oncotype DX can determine if the patient will benefit from chemotherapy—once again, targeting treatment instead of taking a scattershot approach.
Bridget Montgomery’s chemo cocktail included an anti-nausea steroid. Her doctor warned her—correctly—that the steroid would give her false energy. As Montgomery sits on her sun porch, watching birds at the feeder in her lush yard, she describes her reaction.
“I wanted to grow things that lived and to make things live. I went on this planting frenzy that was insane. The yard still shows it because I overplanted. I must have planted 50 or 60 plants. I’m talking big bushes. And then I would start moving things around. I would care for them like it was the last thing on earth I had to do.”
When tests show that the cancer is fueled by hormones, the patient is a candidate for “tamoxifen therapy or similar agent,” says Hugh. The hormones aren’t hormone replacement therapy but a treatment to slow the production of estrogen and progesterone that feeds cancer cells and makes them grow.
In Shirell Chatman’s case, tamoxifen induced early menopause.
“How did I get my mind back? I prayed a lot, and I kept myself busy. I really couldn’t do much else.”
—Shirell Chatman
“Now I’m just hungry, hot, and hostile all the time,” she jokes.
Laughter could be an effective and targeted treatment, too. When Montgomery’s hair started falling out from chemo, she didn’t postpone the inevitable. She and her husband, son, and hairdresser sat in the yard, a bottle of champagne chilled and waiting, as the hairdresser created “all those hairdos you would never allow yourself to have.” Flock of Seagulls hair falling over her face. A Mohawk.
“I had a Mohawk for one minute of my life,” Montgomery says. “We just laughed and said, ‘What are you gonna do?’ What are you gonna do? We popped the bottle of champagne and toasted, ‘To your health. To each other.’”
Paying it forward
Post-surgery, Chatman enrolled in a boxing class. “I guess I have a little repressed aggression. My engagement went down the tubes, and I had cancer.” Boxing didn’t just provide an outlet. It also did a better job than physical therapy at restoring the range of motion in her arm, the one limited by lymph node removal.
Working out remains a passion.
“I’m working out five days a week because I want to be in the best health I can be,” Chatman says. “I was in great health, or so I thought. I never had surgery before.” After a pre-op EKG, a nurse said, “Wow, you’re in such great shape.”
“Yeah, I’m in great shape,” Chatman responded, “but I have cancer.’”
Surgery remains a key step in removing the known cancer and testing the margins for cancer cells, says Hugh. But the focus then shifts to preventing its return.
Both Chatman and Montgomery are grateful to family, friends, and employers who have supported them. Both discovered friends they didn’t even realize they had—co-workers and others who stepped up to help in simple ways like cooking meals or sharing a funny movie. Both are now paying it forward.
Chatman shares the message of breast health among African-American women, who are less prone to developing breast cancer but likelier to die because it’s detected later. Maybe it’s because more are uninsured, and women who don’t get regular check-ups don’t hear from their doctors about the importance of self-exams, Chatman says.
“You’re not gonna start glowing in the dark,” she continues. “And there’s always [been] a stigma. When I was a kid, African-Americans didn’t really talk about anyone who had cancer. It was kind of like something to be ashamed of, but it’s not.”
Montgomery, a 2010 YWCA of Greater Harrisburg Women of Excellence honoree, raised $15,000 by forming a team and walking the Susan G. Komen for the Cure’s 3-Day for the Cure 60-mile walk (in freezing rain, she adds). Her problem-solving nature sees money as the key to progress. “The cure and the treatment take a lot of money. Let’s get real about that.”
Montgomery also has found that the “most beneficial” thing she can offer is lending an ear. People hear through friends about her cancer, and they’ll reach out “because they want to talk to somebody and have a lot of questions.”
“I truly feel for whatever fears or concerns that any woman would have when she gets that diagnosis,” she says. “Some women get mad. Some women don’t want to deal with it. I have a very clear perception in my mind that each woman needs to deal with it in terms of her own personality. The friends around us should let us deal with it in their own way. There’s no, ‘You should be doing anything about it.’ It’s really, ‘What can I do to help you?’”
Chatman believes she has become more patient and appreciates her health “a little more.” Montgomery says she has been given “a real gift”—the ability to see everyday problems as surmountable.
“Cancer gave me this great appreciation for every day. Really, every day. I feel that every single day is a gift.” She looks outside her sunroom to the garden she planted in the throes of treatment. “My phlox—they just bloomed in the last couple days, and I get to see it. That’s really cool.”
