Back in Fighting Shape After a Bout with Breast Cancer
In the summer of 2014, Shannon Hayes, RN, a nurse with the Comprehensive Heart Failure Program at Abington – Jefferson Health, was in practically the best shape of her life. After losing her mother to lung cancer in 2013, Shannon, 45, had given herself a complete health makeover, which included changing her diet and joining a cardio boxing gym. Starting in January 2014, she’d also scheduled health checkups with her primary care physician, gynecologist, dentist, eye doctor and dermatologist. There was just one thing she kept putting off: A mammogram.
In August, she went to the Mary T. Sachs Breast Center to check the appointment off her to-do list. She mentioned a few nagging concerns to the technician, including an odd firmness around her right breast and some pain she’d felt while working out. “I thought I was probably just developing muscle,” she says.
A week later, Shannon was asked to return for a follow-up mammogram and ultrasound. “I was concerned,” she says. “But I knew many women who’d been called back, and everything turned out fine.”
After the tests, however, when she was ushered into a consultation room with breast cancer pamphlets and breast surgeons’ business cards prominently displayed, she knew things were not fine. She was referred to breast surgeon James T. Moore, MD, who recommended biopsies of all three areas. The biopsies, performed by Lynn Lucas-Fehm, MD, a week later, revealed invasive ductal carcinoma, the most common type of breast cancer.
“The diagnosis was unbelievable to me,” Shannon says. But as she struggled to absorb the news, she realized that an entire team was ready to support her through the coming ordeal.
A Coordinated Plan
Dr. Moore met with Shannon and her husband the day after she received the biopsy results to go through her surgical options. Shannon elected to have a bilateral mastectomy with reconstruction, even though there was no cancer in her left breast. “I didn’t want to think about ever going through this again,” she says. She also met with plastic surgeon Brian R. Buinewicz, MD, who explained that reconstruction would be a two-part process. He would place tissue expanders at the time of the mastectomy and replace them with permanent implants a few months later.
As a mother of three daughters, Shannon worried that her diagnosis might indicate an increased breast cancer risk for her children. She therefore elected to be tested for the BRCA1 and BRCA2 gene mutations with Abington – Jefferson Health’s Genetic Counseling and Testing Service. “When the results came back negative, it was the first bright spot I’d had since the diagnosis,” she says.
The second bright spot came after her mastectomy in September, when she learned that the cancer hadn’t spread to her lymph nodes. “That was the first question I asked when I woke up from anesthesia, although it took a week to get the results,” she says. Knowing that she was most likely in the clear made her recovery a bit easier.
In October, she met with oncologist Mark L. Sundermeyer, MD, to discuss her follow-up treatment plan. Because of her relatively young age and her unaffected lymph nodes, Dr. Sundermeyer recommended the Oncotype DX test, a genomic analysis that would help determine her risk of recurrence and her likelihood of benefiting from chemotherapy.
“The Oncotype DX test analyzes a group of genes in the tumor and assigns a Recurrence Score of between 0 and 100,” Dr. Sundermeyer explains. “A score of less than 18 means that the cancer has a low risk of coming back. It also means that the benefit of chemotherapy would not outweigh the side effects and might even be detrimental.”
“In the past, we probably would have considered chemotherapy for any breast cancer patient,” he adds. “But the Oncotype DX test is one of the tools we’re using to customize treatment based on the biology of the tumor.”
The results were Shannon’s third bright spot: Her Recurrence Score of 12 meant she could forego chemotherapy and that her only follow-up would be Tamoxifen, a once-a-day pill that would reduce her chance of recurrence. She will continue to follow up with Dr. Sundermeyer and will likely be on Tamoxifen for at least five years.
In January 2015 – exactly a year after she first resolved to get healthy – Shannon had her reconstruction surgery with Dr. Buinewicz. After that, she worked her way back into fighting shape. “I’d been exercising on my own throughout my treatment, but in April I finally went back to the gym,” she says. “That was a big step. By June, I was back to doing military-style pushups.”
Today, she’s also back at work at the Comprehensive Heart Failure Program, where she’s worked for eight years (she’s been an Abington nurse for 20 years). She had missed about nine weeks of work after her mastectomy and one week after her reconstruction, and that was more than enough. “My patients are part of my family,” she says. “I loved all my doctors and nurses, and now I’m very happy to be rejoining them as part of the Abington – Jefferson Health team.”