PAnews.com, Port Arthur, Texas

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October 15, 2013

Breast cancer treatment more personal than in the past

PORT ARTHUR — Had Denise Hatchel been diagnosed with breast cancer two decades ago, she would have had two options — to treat, or not to treat.

“If you say, ‘I have breast cancer — do I need hormone therapy? Do I need radiation? Do I need surgery? — the answer to every one of those questions is, 'It depends,'” said Dr. Ernest Hymel, an oncologist at the Medical Center of Southeast Texas who is currently treating Hatchel.  “Whereas 20 years ago, the patients didn't have a lot of say because there were fewer options. The choice was maybe, ‘Get treated or not.’”

When Hatchel was diagnosed with Stage 1 breast cancer in April after discovering a lump in her breast, not receiving treatment was out of the question. However, after a discussion with her doctor, Hatchel opted not to have a mastectomy — the surgical removal of one or both breasts.

“That doesn’t really mean anything,” Hatchel said. “You take it off, it can still come back somewhere else.”

Hatchel had her first radiation treatment on July 23. Recent technological strides made the radiation bearable, she said. For six weeks, she drove to the Medical Center of Southeast Texas to receive radiation at 8 a.m. every weekday, before driving to her job in human resources (HR) at Mobil Oil Credit Union in Beaumont.

“Years and years ago, it would just burn you so bad,” said Hatchel, who was in the process of moving to her current home in Nederland from Port Arthur when she was diagnosed. “Now they’ve got all this specialized equipment. It blistered my skin like a sunburn, but it really wasn’t that bad.”

Like Hatchel, Susan Weatherford — who was diagnosed in January 2010 and declared cancer free six months later — also opted out of the mastectomy. Both women underwent radiation treatment and received a lumpectomy — a surgical procedure designed to remove the malignant lump from the breast.

“Mine was small when they found it,” said Weatherford, also of Nederland. “They thought this would be the best course for me.”

That’s where the similarities end between the two women’s treatments. An examination of eight of Hatchel’s lymph nodes deemed removal unnecessary. Weatherford, on the other hand, had several removed — and just two decades ago, she would have been missing all of her lymph nodes. Until a procedure called the sentinel lymph node biopsy became available in the ‘90s, the only option was a complete axillary dissection — the removal of all lymph nodes, which contributed to a condition called lymphedema, or swelling of the arm.

“That allows us to take a far fewer number of lymph nodes so that you have less side effects from the surgery down the line,” Hymel said. “It almost completely eliminates lymphedema.”

After 33 radiation treatments, all that remained for Weatherford was to take a daily dose of Tamoxifen, an estrogen blocker often called the 5-year-pill, for the next five years. On Sept. 16, Hatchel began the first round of chemotherapy, a process she will repeat every three weeks until she has completed four to six rounds.

“Whether or not you need chemotherapy varies quite a bit,” Hymel said. “There are maybe 10 factors that we have to consider before we can make a specific recommendation.”

During the past 20 years, Hymel said, breast cancer treatment has become more about the tailoring of breast cancer treatment to the individual patient. Gone are the days of the doctor acting as the sole decision maker. Hymel said he acts as more of an advisor for his patients.

“A lot of times my conversations are, 'OK, here are the pros and cons of those particular approaches — which one would you like to do?’” Hymel said. “It’s a partnership.”

Another recurring theme of breast cancer treatment, Hymel said, is, “Can we do less safely without compromising the ability to cure?”

“Treatment is tailored in a way to minimize the side effects and hopefully even minimize treatment,” Hymel said. “There's a great advance in technology that lets us give less treatment because we find out the patients are not going to benefit from it.”

One constant Hymel has encountered throughout his 12 years in oncology is that early detection is the key to high cure rates. Without early detection, he said, these options wouldn’t exist — something that both Hatchel and Weatherford second. Weatherford’s cancer was detected during a yearly mammogram.

“It was a very early stage,” she said. “That’s why they’re thinking I won’t have any more problems.”

Even in the throes of side effects from the chemotherapy that include bone pain, low-grade fever and loss of energy, Hatchel has never once regretted her decision to undergo treatment.

“If you walk away from something that can help you, what benefit is there if it comes back?” she said. “Who wants to go through it again?”

Email: ecallahan@panews.com

Twitter: @ErinnPA

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