When breast cancer is a triple threat

A diagnosis of breast cancer remains one of the most terrifying and unsettling diagnoses a person can receive. For Tina Christian, however, it was her second diagnosis that proved the most frightening.

“I’d been diagnosed before in 2008. I was 35 and opted for the standard procedures: mastectomy and reconstruction. In 2018 I was diagnosed with aggressive triple-negative breast cancer. This time, however, I was more prepared and took greater control over the process.”

For Christian, a nurse practitioner and mother of two, who calls San Juan Island home, her personal well-being, ability to handle the recovery process, and its long-term effects of treatment were top of mind.

Triple-negative breast cancer is a particularly aggressive type of breast cancer that appears to target pre-menopausal women, many of color. According to breastcancer.org, roughly two of every three breast cancers are hormone-based, either estrogen or progesterone positive. A smaller percentage, about 20% is a result of an overabundance of the HER2 protein causing the cells to grow and divide quickly. For patients with hormonal-based cancer, several therapies are available to disrupt the effects of progesterone, estrogen, or the HER2 protein. In about 10-20% of breast cancers, the patient tests negative for all three markers making traditional hormone-blocking therapies or medicines that target the HER2 protein ineffective. It’s the lack of targeted medicines that can make a triple-negative diagnosis even more disconcerting.

Early diagnosis is particularly critical because triple-negative carcinoma spreads fast and wide, potentially causing greater tissue damage and the removal of more lymph nodes.

Facing such aggressive cancer, Christian agreed to chemo, surgery, and radiation. However, instead of the traditional photon radiation which generally damages a greater share of tissue, she opted for proton radiation, a highly-targeted form of therapy that tends toward reducing damage to nearby healthy tissue. Because it’s so targeted, proton therapy can also reduce the side effects of radiation, risks potentially more severe with the addition of chemotherapy and surgery.

According to Dr. Christine Fang, an oncologist with SCCA and the University of Washington, “proton therapy is primarily considered in breast cancer patients who have lymph node involvement or prior radiation to the same area, including triple-negative breast cancer. There are also some other more unusual situations such as unique and challenging anatomy that make conventional radiation difficult.” Fang also notes that the set of long-term side effects for proton radiation is the same as conventional radiation. But because there is less exposure to surrounding normal tissues, both in dose and volume, our expectation and hope is that this will lead to lower rates of long-term side effects compared to conventional radiation.”

For Christian, it was a simple decision. With the possibility of less tissue damage and less potential for complications, she chose proton radiation and fought to have her insurance company cover the treatment.

“I had a wonderful team at Seattle Cancer Care Alliance,” Christian explained. “They worked with me every step of the way helping me understand my options and were incredibly attentive to my needs and concerns.

“Having so much support gave me greater confidence advocating for myself and the right to have the proton radiation covered by my insurance. I knew it was a better choice for me and my future health.”

Christian ultimately underwent 25-30 proton radiation treatments, each lasting 15-25 minutes. Through it all she continued fighting for coverage, ultimately receiving approval. Today she is healthy, cancer-free and happy with her choice of treatment. Still, it wasn’t easy.

“I encourage women to advocate for themselves. Follow your gut. If a treatment or procedure doesn’t feel right for you, talk about it with your medical team. Talk about it with other women. Do your research.

“Don’t be passive,” she stressed.

Dr. Fang stressed that women should not delay their mammograms.

“It’s easy, in the midst of COVID to put off getting checked. Because early detection remains the best choice, I encourage all women to get back on schedule with their check-ups,” she said. Dr. Fang also understands that because of the pandemic, many people are frightened.

“Detecting cancer like Ms. Christian’s early can make a huge difference. Don’t wait,” she stressed.

Breast Cancer Awareness Month ended Oct. 31 but emphasis on detection is year-round.

Women who have been diagnosed with breast cancer and would like to share their experiences with other women in the San Juans are invited to contact this reporter at dmcraig68@gmail.com for more information about an ongoing breast cancer support group.

Editor’s note: Nov. 13 is the third-year anniversary of Diane Craig’s breast cancer surgery.

On Nov. 9, Dr. Fang’s quote was corrected to read that women should NOT delay getting their mammograms. We regret the error.