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Publish Date: 10/13/2005

Dr. Horacio Gutierrez, a radiologist specializing in breast MRI, poses for a portrait at Twin Peaks Medical Imaging in Longmont. Gutierrez said that, for those women with a high risk of breast cancer, MRI “can detect breast cancer that is not otherwise seen on mammograms or ultrasounds.” Times-Call/Kristin Goode
Health News Headlines


LONGMONT — Susan Bakken never figured she would shop for scarves or buy wigs, including one with a ponytail for weekend wear.

But today she’s got a stash of both, given her breast cancer diagnosis in May and subsequent chemotherapy treatment.

“I’m looking forward to getting my hair back,” she said. “But this is better than the alternative.”

The 59-year-old high school art teacher in Centennial said her status as a cancer survivor resulted from tapping the best breast cancer survival tools available.

An annual mammogram detected the cancerous tumor growing in her left breast. But a more sophisticated test that debuted in 2004 fine-tuned her treatments and likely saved her life.

Oncotype DX Genomic Assay analyzes a 21-gene profile in the tumor tissue to calculate a recurrence score — a predictor of the likelihood of cancer recurrence within 10 years.

This test is not for everyone diagnosed with breast cancer; it’s only for those with early-stage, lymph node-negative, estrogen receptor-positive tumors.

Bakken fit that profile and discovered that, despite other indicators to the contrary, her recurrence score proved high enough to justify post-surgery chemotherapy and radiation.

About 25 percent of women scored with the Oncotype DX fall into this high-risk category that benefits greatly from follow-up chemotherapy. Another 25 percent fall in the mid-risk range and generally go ahead with the treatment.

But for the remaining half of patients diagnosed with this type of breast cancer, the score reflects a low enough risk of recurrence that chemotherapy offers only negligible benefits.

Though Bakken would have skipped chemotherapy if she hadn’t taken the test, Oncotype DX made headlines last winter for sparing low-risk women the stress and expense of chemotherapy.

“It works both ways,” said Dr. Dev Paul, the oncologist at the Rose Office of Rocky Mountain Cancer Centers in Denver who treated Bakken.

Paul said insurance tends to cover the test because it more often than not determines that chemotherapy is unnecessary.

The test costs about $3,600, he said.

But sparing patients chemotherapy when it’s not needed can save them even more money.

A standard chemotherapy dose costs $2,000. When coupled with neulasta, a $6,000-a-dose infection prevention medication usually administered with the chemotherapy, the total dosage runs $8,000. So a typical eight-dose chemotherapy cycle costs $64,000.

If chemotherapy complications require hospitalization, that bottom line can balloon still more, Paul said.

Gold-standard enhancements

Impressive as new screens and treatments are, mammography is the gold standard in battling with breast cancer through early detection.

However, the New England Journal of Medicine recently reported that digital mammography may outperform conventional film mammography in certain groups.

The study unfolded at multiple institutions and used both digital and conventional mammography in 49,000 women with no signs of breast cancer.

Researchers discovered breast cancer in 335 members of the group, and digital mammography proved better at finding tumors in women under age 50, those with dense breast tissue — which can obscure tumors — and those not yet menopausal or recently menopausal.

However, digital mammograms failed to outperform conventional mammography in women over age 50, without dense breast tissue and clearly menopausal.

Medicare covers both types of mammography, according to the American Cancer Society. But digital mammography is more expensive and only available at about 8 percent of breast-imaging centers nationwide.

Women with difficult-to-interpret mammograms and those with breast cancer gene mutations BRCA1 and BRCA2 may take advantage of a more refined screen called breast MRI.

Dr. Horacio Gutierrez, a radiologist at Twin Peaks Medical Imaging in Longmont, specializes in women’s imaging. He said breast MRI can reduce risk of breast cancer mortality by 30 percent to 40 percent in patients screened.

First, breast MRI costs about $1,000 making it 10 times costlier than conventional mammography.

Its great sensitivity also makes it impractical for lower-risk women because it picks up too many benign tumors, which could lead to extensive, expensive and unnecessary testing, Gutierrez said.

Still, he called the test 99 percent accurate and credited it for diagnosing cancer in 20 percent of appropriately referred cases — mostly women with invasive cancer that has moved beyond the original tumor site in the milk duct.

To conduct the exam, Gutierrez injects a dye called gadlinium into the breast.

This dye, he said, helps map cancer growth because abnormal cancerous vessels forming near the site often leak and the chemicals secreted by the tumor typically are more vascular.

That seepage shows up as bright white on the MRI shot from the computed tomography scanner used to create a three-dimensional image.

Breast cancer’s back story

After skin cancer, breast cancer is the next most frequently diagnosed cancer in American women, according to ACS.

In 2005, an estimated 211,240 women will get word that they have invasive breast cancer.

The problem starts with a tiny single cell that goes AWOL, usually in the ducts of the breast or the lining of the milk glands, and begins dividing abnormally.

Because this type of cancer moves relatively slowly, the cancer can grow undetected for several years until it reaches the critical mass needed to form a recognizable lump.

At this stage, the tumor contains about 1 million cells and is often about 0.4 inch, or 1 centimeter, across.

Kandace Hunt, Kaiser Permanente’s radiology supervisor in Boulder where Longmont patients go for screening, recommended quick action for any suspicious self-exam finding.

“Don’t ignore it. Don’t panic. Just get it checked out,” she said.

A 1 centimeter mass may still be too small or too buried in breast tissue to feel during a self-exam. That is when mammography can become a lifesaver.

ACS recommends annual mammograms for women age 50 and older or those with risk factors. They include a family history of breast cancer; early onset of menstruation and late menopause; bearing no children or bearing them after age 30; never breast-feeding; and a history of abnormal biopsies.

Some women balk at booking a mammogram appointment because of the associated discomfort.

But Bakken is living proof that booking this appointment can be a life or death decision.

“So it pushes and squeezes a bit,” she said. “But it’s better than the alternative, and it takes less than five seconds. In fact, they tell you to hold your breath, and it’s over.”

Pam Mellskog can be reached at 303-684-5224, or by e-mail at pmellskog@times-call.com.

Doctor Q’s

•Would you please write down the exact type of cancer I have?

•May I have a copy of my pathology report?

•Has my cancer spread to lymph nodes or other organs?

•What is the stage of my cancer? What does that mean in my case?

•What treatment choices do I have? What do you recommend? Why?

•What are the risks or side effects of different treatments?

•Will I lose my hair? If so, what can I do about it?

•How long will each course of treatment last?

•Will I be out of work? For how long?

•Will I be able to drive myself home after treatment or will I need help?

•What are the chances of my cancer coming back with the treatment you suggest?

•What kinds of breast reconstruction are possible in my case?

•Will I go through menopause as a result of my treatment?

•Will I be able to have children after my treatment?

•What should I do to get ready for treatment?

•Will I have normal feeling in my breasts after treatment?

•What are my chances of survival, based on my cancer as you see it?

Source: American Cancer Society

For more info

American Cancer Society

800-ACS-2345 or www.cancer.org

Encore Plus Program of the YWCA

Office of Women's Health Initiatives


National Breast Cancer Coalition

800-622-2838 or www.natlbcc.org

National Cancer Institute

800-4-CANCER or www.cancer.gov

Susan G. Komen Breast Cancer Foundation

800-IM-AWARE or www.komen.com

Y-ME National Breast Cancer Hotlines

800-221-2141 (English)/800-986-9505 (Spanish) or www.y-me.org

Centers for Disease Control and Prevention

888-232-6789 or www.cdc.gov/des


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