Face down on a platform several feet off the ground, Karen McArthur soldiered through a stereotactic biopsy of her left breast in June 2009. As Seattle Cancer Care Alliance specialists measured, scanned and extracted tissue samples, McArthur lay still. She let down an emotional wall and confronted her mortality.
She had felt bumps in her breasts for years – cysts, she said, from the hormones she’d taken after a hysterectomy at age 35.
“We’d done a couple of biopsies over the years and nothing showed up. I thought this would be just another routine mammogram, but this [stereotactic biopsy] was a step beyond anything I’d done before.
“And you start thinking, ‘What if? … No, I don’t, really. … But what if?’”
Four excruciating days of waiting later and then a phone call from her personal physician confirmed McArthur’s case of ductal carcinoma in-situ.
Upon retiring from Boeing, McArthur, 66, felt so hearty that she traveled for a time in a motor home, forgoing easy medical access.
“I see the doctor once a year for a physical and once in a blue moon for a cold or sore toe or something,” the West Seattle resident said.
In 2005, she had a routine checkup with Dr. Sandra Lord at the UW Neighborhood Kent/Des Moines Clinic. Both women recognized their easy rapport.
“She is laid back. It seems almost like a daughter connection,” McArthur said of Lord, 40. “We talked about families because I have a granddaughter that’s close to her children’s ages.
“She answers your questions. She listens – which is the part that’s always hard to get to with a doctor.”
Lord described McArthur: “She’s a hoot. She’s vibrant, especially for a grandmother. She’s bright, funny and really easy to talk to.”
Despite relatively few visits, the two bonded. When the physician transferred to the UW Neighborhood Belltown Clinic in 2008, the patient followed.
In May last year, McArthur had her annual mammogram at UW Medical Center’s Roosevelt Clinic. The resulting images showed white spots on her left breast, which technicians said might represent only calcium deposits, she said.
“Then I got a call saying I needed to go to the SCCA again, and they wanted to do a stereotactic biopsy. They lay you on a table that has a hole in it that you put your breast through, and there’s a mammogram scanner and team of physicians underneath you.
They computerize the mammogram, which shows where they want to take a biopsy. They have to numb your breast – that was the most pain I felt – and then they took three biopsies,” McArthur said.
A few days later, Lord called with the diagnosis.
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If you have breast cancer, ductal cancer in-situ (DCIS) is the best possible type, she said. DCIS suggests cancer cells are contained to a breast’s milk ducts and have not invaded surrounding tissue. Further, McArthur’s cancer was deemed “pre-Stage 1” – very early in development.
“Fine. Now I know,” McArthur thought. “It wasn't a shock. I have a family history of ovarian and breast cancer. I just accepted it,” she said.
The SCCA staff quickly scheduled McArthur for an appointment with Dr. Ben Anderson, a UW Medicine professor of surgery. He operated in July, removing from her left breast an egg-sized lump of tissue. Six weeks of radiation followed, also at SCCA outpatient clinic – but no chemotherapy, as DCIS doesn't usually call for it and, besides, McArthur’s cancer’s stage was so early.
Lord is accustomed to helping patients manage the intense feelings that cancer brings.
“You have to be prepared for the whole gamut of reactions,” Lord said. “I've had other patients who cry, of course, or are in shock, and others who don't seem to react at all but then will call or come back later. Karen just kind of took it all in stride. She’s very independent, and has a good support network of friends and family.”
SCCA patients receive some of the best cancer care in the United States. But because the SCCA oncologists are UW Medicine and Fred Hutchinson Cancer Research Center doctors, other benefits are realized by patients, such as McArthur, who seek primary care at the seven Neighborhood Clinics.
“Continuity of care is better because I have a relationship with the [SCCA] specialists,” Lord said. “I may not know the physician personally, but I have access in terms of paging them or e-mail. I can get onto their computer system and look at the oncologist’s notes and know exactly what the plan is. If you are getting all your cancer treatment in a different hospital system, I wouldn't have access to that.
“Let's say you're getting chemotherapy and you come to me with a symptom that might be related to chemo,” Lord said. “If I don't know what your specific treatment is, I'm in the dark. You might have gotten blood work drawn yesterday at your appointment with the oncologist. I can just look at the results on the computer, so I don't need to repeat it.”
McArthur came away satisfied with her SCCA experience.
“The thing that amazes me through is that it feels like I haven't really had cancer. Once it started, everything went so fast. I felt totally taken care of and very confident with what was progressing. It was extremely easy, and that was probably the best part.
For all of McArthur’s resolve, though, her burden of knowledge can intrude on moments of quiet. After radiation, another mammogram led to another stereotactic biopsy. Fortunately, that came back negative.
“So every six months for about the next three years, I think, I'm going to be going in for mammograms. Dr. Anderson said that the odds of it coming back are low, which is good. Yet your brain goes, ‘Yeah, sure.’
“If you have to go down that road again, at least I know the process and I know it's not that tough. You get it done. You go for it.”