HEALTHYU

The deciding factor

ANNE CUMMING RICE, FOR UCHEALTH
Allison Hines and her son, 3-year-old Aiden Cole Hines, pick strawberries at Garden Sweet Farm in Fort Collins. Spending time gardening is one of their favorite things to do together. Allison lost her own mother to
breast cancer in 2008 and was determined that her son would not have to go through the same pain when she was diagnosed with breast cancer five years later.

She was young and healthy, but after losing her mother to breast cancer, Allison Hines knew she had to be vigilant. That may have saved her life.

The wake-up call came for Allison Hines 15 years ago, when her mother was diagnosed with stage 3 breast cancer that had spread to her lymph nodes.

For a while, her mother knew she had a lump in her breast. Because of past experiences with doctors due to her multiple sclerosis, she was reluctant to get it checked out. She also had a history of cysts, which made her optimistic it wasn't a cause for concern.

So she waited. When she finally went in, the doctor told her it was nothing to worry about. But her husband, Hines' dad, encouraged her to get a second opinion.

At the time, Hines hadn't yet finished her college degree.

"My mom's diagnosis was a huge wakeup call for me," said Hines, 39, mom of a 3-year-old boy and vice president of resource development for the United Way of Larimer County. "It made me get my life together."

Her mom went through treatment, but cancer eventually took her life in 2008.

"She got to see me graduate from college, get married and buy a house," Hines said. "When my son was born in 2012, it was a painful reliving of my mother's death for me. Her story could have been so much different."

What happened to her mother woke Hines up in more than one way. At the encouragement of her OB/GYN, she started getting mammograms several years before the recommended age of 40. She agreed to undergo genetic testing for breast cancer in the fall of 2013. Even when it came back negative, she continued to go in for regular mammograms.

A year after the genetic testing, a routine mammogram revealed a small spot that turned out to be stage 1A breast cancer.

"Maybe in the back of my mind, I knew," Hines recalled. "I didn't want my story to end up like my mother's."

Early detection

Dr. Bev Donnelley, an OB-GYN at the Women's Clinic of Northern Colorado, encouraged Hines to get early mammograms and do the genetic testing. She also was the one who called Hines to tell her she had cancer.

"As an OB/GYN, you see patients age and have families," Donnelley said. "It's difficult to deliver news like cancer, but it's part of being compassionate and caring for people."

Of the women diagnosed with breast cancer, 80 percent don't have a genetic predisposition to it, Donnelley said.

While Hines' genetic testing came back negative, Donnelley said she believes there's a possibility Hines has a genetic variance or mutation that science hasn't yet discovered.

"Genetic testing isn't fool-proof," she said. "There are still things we don't understand."

But Hines' experience shows vigilance is what makes the difference in the long run.

Donnelley is a proponent of yearly mammograms, in spite of recent trends toward mammograms less often.

"I've known a lot of patients diagnosed with breast cancer in their 30s and 40s," she said. "And our risk in the United States appears to be much greater than anywhere else in the world."

Mammograms are now digital, making it much easier for radiologists to read the results. As mammography rates have increased over the past several decades, more cases of breast cancer have been detected early, when chances of survival are the highest. Since 1990, the breast cancer mortality rate has decreased 34 percent – a direct result of early detection and improved treatment.

Community of treatment

After her diagnosis, Hines' case was scheduled to come before a weekly conference of UCHealth medical professionals who meet together to determine the best course of treatment for cancer patients.

The week before that conference, though, Hines was at a community event where she saw Dr. Josh Petit, medical director of the radiation oncology department at UCHealth in northern Colorado.

"I went up and introduced myself to him and told him I was scheduled to come before the conference the next week," Hines said. "I wanted him to know who I was, that I wasn't just a name on a file."

Petit said he remembers that initial meeting.

"It was a first," he said. "But it was nice when I was in that conference to have some context for who we were talking about."

The conferences involve professionals from radiation oncology, pathology, general surgery, nurse practitioners, plastic surgery, research and genetic counseling, among others. It's an academic model of doing things usually done at large teaching facilities.

"Everyone gets to see the same information, but you get a different perspective from each physician," Petit said. "Essentially, you get a built-in second, third, fourth opinion."

Over the course of her treatment, Hines relied a lot on her team's expertise. She elected to do a lumpectomy rather than a mastectomy. She then underwent about six and a half weeks of radiation. An avid marathon runner, Hines said the radiation took more out of her than she anticipated.

"When I was diagnosed, I was probably in the best shape of my life," she said. "The radiation causes a lot of fatigue and leaves you with this 'radiation hangover' that leaves you not feeling very good for a while."

Her treatment ended in March, and it took a few months for Hines to get back into running. This summer, she did a half-marathon in Estes Park, her first race since her diagnosis.

Best and worst case

Mentally and emotionally, the cancer took a different toll.

"It was such a surreal experience," Hines said. "I didn't have chemo or major surgery, so my life just kept going while I was going through it. But afterward, the reality of it sets in."

She remembers a few days after her diagnosis, a fear gripped her that she'd not survive and her son would not remember her. She traces part of that fear back to the experience of losing her mom.

"My mom was 59 when she died," she said. "My son will never know her. It shouldn't have been that way."

This month, which is Breast Cancer Awareness Month, Hines will head back for her first routine mammogram since her diagnosis. The pink ribbons and fundraising galas take on a different meaning for her now.

"I have lived through both the worstcase scenario and the best-case scenario with breast cancer," she said. "The deciding factor between the two was getting the mammogram. Even if you do get a call that they found something or that it's cancer, you have to ask yourself, 'Do I want the worst or the best-case scenario?' "

BREAST CANCER STATISTICS

1 in 8 About one in eight women in the U.S. – a little more than 12 percent – will develop breast cancer over the course of her lifetime. A woman’s risk of getting breast cancer is highest in North America, Australia, New Zealand and Western Europe.

231, 840 Estimated number of new cases of breast cancer will be diagnosed among women in the United States in 2015. Except for skin cancer, breast cancer is the most commonly diagnosed cancer among American women.

x2 A woman’s risk of breast cancer approximately doubles if she has a first-degree relative (mother, sister or daughter) who has been diagnosed with breast cancer.

5-10% Percentage of breast cancers thought to be inherited gene mutations. An increased risk of ovarian cancer is also associated with these genetic mutations.

2,350 Estimated number of new cases of breast cancer will be diagnosed among men in the United States in 2015. Breast cancer among men is rare, but it does happen.

Sources: www.breastcancer.org, Susan G. Komen Foundation