Sutter Cancer Centers
Julie - Early Detection and Treatments
Julie DeNapoli is diligent about her health and well-being. She takes care of herself by scheduling regular annual exams with her doctor's office and conducting monthly breast self exams.
Last year, as a part of her routine preventive care, Julie, a Vacaville resident, went in for an exam and scheduled a mammogram as a follow-up to her annual visit. Julie's mammogram came back normal and negative for cancer. Julie was relieved about the results because of her family's history of breast cancer.
Weeks later during a women's health visit with Diane Griffith-Parker, certified nurse midwife, Julie discussed her mammogram results. Because of her family history of breast cancer, Diane suggested that Julie take a Breast Cancer Risk Assessment as a follow-up to the mammogram.
Julie has full faith in Sutter Health and her caretakers. She worked as a consultant for Sutter Health and its affiliates for 15 years as a project manager, and her husband, family medicine physician Ricardo DeNapoli, D.O., works at Sutter Medical Foundation in Vacaville.
The Breast Cancer Risk Assessment Tool designed by scientists at the National Cancer Institute is composed of eight questions that take about five minutes to answer via the online form. The questions are intended to assess a woman's risk of developing invasive breast cancer in her lifetime. If the results from the test indicate that a patient's risk is over 20 percent, additional testing is recommended.
"This tool is used to assess women who are 35 years and older and are concerned about their risk for developing invasive breast cancer," Diane says.
Upon completion of the Breast Cancer Risk Assessment Tool, Julie was deemed "high risk for developing breast cancer. Diane referred Julie for an MRI, which was covered through her insurance because of her risk status. An MRI was ordered and her test results showed abnormalities. Specifically, Julie had two spots on her right breast.
Julie went in for an MRI-guided biopsy to take samples of the tissue. One tumor was found to be benign. The second biopsy results indicated that her cancer cells were stage zero - ductal carcinoma in situ (DCIS). Julie underwent a lumpectomy with Sutter Medical Group surgeon Alicia Silva, M.D., to remove the area where the biopsy showed DCIS. After surgery, the samples were sent in and studied by a pathologist.
Contrary to the findings from the MRI biopsy, Julie's post-surgical tissue samples revealed that only a small amount of the tumor was DCIS, but the majority of the tumor was invasive ductal carcinoma (stage one). Julie's case was presented by her oncologist, Melissa Williams, M.D., to Sutter Cancer Center's Tumor Board to discuss treatment options. Tumor Board care providers meet monthly, working together to manage patient cases to determine the best course of treatment for patients on a case-by-case basis.
"By working together in a multidisciplinary approach, we are able to provide the best care possible for our patients, Julie's surgeon, Dr. Silva, explained about the Tumor Board.
Fortunately, all of the DCIS and the invasive cancer was removed during the first surgery and Julie did not need any additional breast surgery. Because Julie's cancer was invasive, Dr. Silva recommended that her lymph nodes be tested using the less-invasive sentinel lymph node technique. When presented at Tumor Board, the board agreed. Julie went in for her second surgery to have her sentinel lymph nodes sampled, which only required a small incision near Julie's underarm.
With lymph node testing, doctors are able to determine if cancer cells have spread. Luck was on Julie's side the cancer had not yet spread to her lymph nodes. After the second surgery, Julie continued her course of treatment with an abbreviated three weeks of radiation as opposed to the standard six weeks.
Dr. Silva recalls Julie's outcome post-surgery: "Julie was very lucky in terms of the sequence of events because the cancer was caught early.
As a follow-up to her treatments, Julie is undergoing genetic counseling and continues to take an oral medication to keep cancerous cells at bay. Fortunately, because of the risk assessment and additional testing, Julie's cancer was found early on. Julie attributes her positive outlook and prognosis to the care she received at Sutter Health, and specifically the care and attention to detail provided by her women's health provider, Diane, who suggested the risk assessment.
"Who knows what would have happened if I had waited a year, says Julie.
Julie's hope is that other women will feel empowered to ask follow-up questions after a normal mammogram if there is a strong family history of breast cancer. Take the Breast Cancer Risk Assessment Tool and ask if an MRI is indicated to enable early detection. If you have any questions about your risk for developing breast cancer, schedule an appointment and talk with your health-care provider.
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