Caryl Engstrom, at her clothing store in Los Angeles, is now cancer-free. (Christina House, For the…)
Breast cancer is no longer considered a single disease. New molecular tools are allowing doctors to see what is going on inside tumors with much greater accuracy, enabling them to tailor their therapeutic approach to fit the traits of each cancer and the needs of each patient, as the women below illustrate.
Name: Caryl Engstrom
Current age: 51
Home: Los Angeles
Diagnosis: Stage 2B breast cancer that was ER-positive
Age at diagnosis: 49
Engstrom had a mastectomy, followed by five months of a combination chemotherapy known as ACT (which includes the drugs Adriamycin, Cytoxan and Taxotere) and 61/2 weeks of radiation. She now takes Tamoxifen, an estrogen-blocking pill, to reduce her risk of recurrence. She is cancer-free.
"My feeling is that the minute I had my surgery, I was cancer-free. The chemo and the radiation are what I call the insurance policy. For me it was about making decisions based on what's going to give me the best possible chance of having a cancer-free life.
"I know it sounds crazy, but I never felt like, 'This is gonna kill me.' It was like, 'Let's figure out how to make this work.' My oncologist told me to have my normal life — every three weeks you're going to have this treatment, you're not going to feel well for a few days but you'll bounce back. It was completely manageable. If you have a healthy diet and a healthy mindset, you exercise, you have a good support system, good friends, you sail through it."
Name: Christina Eason
Current age: 37
Home: Thousand Oaks, Calif.
Diagnosis: Stage 1 ductal carcinoma in situ (DCIS) that was ER-positive and PR-positive
Age at diagnosis: 32
Eason's type of tumor carries an excellent prognosis —96% to 98% of women are alive 10 years after their diagnosis, according to the National Institutes of Health. Eason had a lumpectomy to remove her tumor but, against the advice of her doctor, she did not have a radical mastectomy, radiation or follow-up drug treatments. (Chemotherapy wasn't recommended because her tumor was localized). Instead, Eason relies on a diet of what she calls "nutrition therapy," which includes alternating between a vegetarian and vegan diet and doing an annual "detoxification" that involves drinking nothing but specialized juices for three to 10 days. She also takes a combination of vitamin, mineral and herbal supplements to maintain her cancer-free status.
"I didn't just do chemo and walk away. I have a battle ahead of me for the rest of my life to make choices about what I eat and how I am affecting the estrogen in my body. It's a daily thing. I want to be around for the next 50 years for my kids, so what am I going to do to make sure that happens?
"I've just come out of a season of dealing with paralyzing fear — of learning to cope by controlling where my mind is going. It's a lot of prayer. My life isn't guaranteed from this day to the next."
Tackling high risk
Name: Clare Hobby
Current age: 41
Diagnosis: Stage 2 ductal carcinoma that was ER-positive and HER2 positive
Age at diagnosis: 38
Hobby was diagnosed in 2008 and then discovered she had a mutation in her BRCA1 gene that increased her risk of developing breast cancer by 55% to 87%. Now that she has had one tumor, she is at greater risk of developing a second primary breast cancer. Hobby had chemotherapy, radiation and a double mastectomy, among other surgeries. As a preventive measure, she had her ovaries and uterus removed last year. She is also taking a drug called Arimidex to kill any stray cells that may have evaded her chemo and radiation treatments and to block her body's production of estrogen, a hormone that can feed breast cancer tumors.
"I feel fortunate that due to this individualized approach I know more about my cancer and can take more active steps in working preventively with my children, who may have also inherited the gene. Individualized medicine has been a huge gift for us because we can talk to our kids in a completely different way."
The lonely fight
Name: Faina Sechzer
Current age: 59
Home: Princeton, N.J.
Diagnosis: Stage 2 breast cancer that was ER-positive
Age at diagnosis: 57
Sechzer's cancer was discovered at an early stage, but a lumpectomy revealed that it had spread to a lymph node, requiring a second surgery. She opted for chemotherapy with the drugs Cytoxan and Taxotere and also received three weeks of radiation treatment. She is cancer-free and is in the midst of a five-year course of Arimidex to suppress her body's production of estrogen.
"After all this research, I ended up making decisions out of my gut and out of knowing myself. I wanted to live my life knowing that whatever there was to do, I did.
"The biggest difficulty was not physical pain but emotional pain. You find yourself very lonely at that time. I have a loving husband, loving children and a loving support group. But you still find yourself very lonely."
Hitting on the right drug
Name: Margaret Mauran Zuccotti
Current age: 42