Technician shares own breast cancer experience

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Seward Memorial Hospital Radiology Technician Mandy Cutshall said mammography is a passion of hers. 

Cutshall has always been an advocate for getting regular mammograms, even before being diagnosed with breast cancer herself. 

“Everybody thinks it’s a disease that’s going to affect somebody else, but we all know somebody that’s afflicted with it,” Cutshall said. 

One in eight women will develop breast cancer in their lifetime, and no one is too young to get breast cancer. Cutshall said the youngest person to get breast cancer was an 8-year-old. 

“Make sure you’re doing self breast examinations from the time you turn 18. You should be doing them once a month. If you feel anything you do not think is normal, make sure that you go (to your doctor),” she said. 

Cutshall said she encourages everyone to play a big part in their health care. 

“Make sure you know your body and you know when something is changing,” Cutshall said. “If you have nipple discharge, that’s a sign. If you have skin changes, it can be a sign. Your pores looking bigger, it’s called the orange peel effect, that’s a sign of breast cancer. Knowing your body and being a proponent of your health care is good.” 

Cutshall said if women have family history they should start their mammograms at age 35. She said if women have a first-line relative, such as a mother or sister, who had breast cancer, their risk nearly doubles for also developing the disease.

Even if women have no family history, they need to start yearly mammograms at age 40.

“People are like ‘well I don’t have any family history so I don’t have to worry about it.’ That’s not necessarily true,” Cutshall said. “Seventy-five % of women that get breast cancer have no family history and that’s something a lot of people don’t know.” 

Even though a woman’s chance to develop breast cancer doubles if she has a first line relative, only 7% of  cancers are genetically driven, Cutshall said. The other 93% just occur, either environmentally or by mutation. 

Cutshall wants everyone to know that mammograms are not scary. 

“If you communicate with your tech it shouldn’t be the horror story we’ve all heard about,” she said. “A screening mammogram probably isn’t going to ever be a comfortable exam, but it shouldn’t truly hurt.” 

Cutshall said she tries her best to explain to her patients, especially women who are coming in for their first screenings, that getting asked for another look is normal. 

“For a baseline, I always let them know, every year for your mammogram the radiologists compare your images year after year, see what’s new, grown, changed, different,” Cutshall said. “If it’s your very first one, they don’t know what’s normal for you and what’s not, so I always let them know it’s a higher chance of recall for your very first one.”

Cutshall said she knows getting called back can be stressful, but no one should truly worry until there is something to worry about. 

“I explain to them we all know somebody that’s gone all the way through to biopsy and it’s been negative. We all know people that have had it so try not to worry,” she said. 

Seward Memorial Hospital has a 3D mammogram machine.

Cutshall said with 3D more is seen, especially for women with dense breasts. Cutshall explained that there are all different types of breasts, some with more fatty tissue than density and others are mostly dense. 

She explained that fatty tissue breasts are like a plain piece of paper, and if there is a speck you can easily see it. A dense breast is like a piece of paper with a lot of words on it, and a speck is harder to find. 

“With that 3D, it’s separating out the tissues and going slice by slice, from skin margin to skin margin. You have less chance of something being missed or hidden,” Cutshall said. 

Memorial Hospital Director of Community Relations Mallory Gibreal said when 3D was first implemented in the hospital they noticed many women opt out of it because their insurance would not cover all of the costs. 

“We just said that’s unacceptable. We’re here for the community and we want the community members to have the best options possible and we don’t want that to be in the way,” Gibreal said. 

Since then, the hospital has decided to write off the extra expenses for women to have access to the best care. 

“The only time we will do a 2D mammogram any more is if a patient’s insurance refuses to pay anything at all if 3D images are done,” Cutshall said. “That’s only come up twice I know of in at least three years, and that’s really a detriment to the patient. But we give them the option but if their insurance won’t cover the radiologist reading, they won’t cover anything at all for the exam — that’s a little bit different then just writing off the additional portion for 3D.” 

Cutshall said the hospital hasn’t had that issue in at least a year, so she believes insurance companies are starting to change their minds. 

With the 3D mammography, Cutshall said there was an uptick in additional views at first. The new technology has been able to catch cancers sooner than the 2D, which Cutshall said is a better prognosis for patients. 

“As those technologies become the gold standard of care, we’re going to be catching things earlier and earlier for women as long as they’re getting their screenings,” she said. “It’s just amazing the way technology is just leapfrogging and increasing our patient care.” 

Cutshall added that the hospital has done male mammograms, as well. 

“A lot of time, sadly, men wait too long and it’s usually fairly far progressed by the time a man comes in and they think men don’t get (breast cancer),” Cutshall said. “The numbers are a lot lower. A man’s lifetime risk is like one in 800 men, but it still happens.” 

Cutshall said once a woman with family history starts her baseline screenings at age 35, and 40 for those with no history, coming in every year is important. 

Cutshall was about six months past due for her mammogram when her cancer was caught. 

“We had ACR, a federal thing that regulates for mammograms all across the nation so that you kind of have a standard of care for mammograms and we were like ‘Oh we have ACR. Who’s due for their mammos?’ So we realized I was past due for mine,” she said. 

Every woman is told their breast density and a TC risk score, or the chance you have to get cancer in your lifetime. 

“So if your (TC) score is over 20 and you have C or a D breast (more dense breasts), it recommends an MRI,” Cutshall said. “So my breast density is a D, and my TC score was a 22.” 

Cutshall went in for her MRI and a small speck was found. 

“My cancer was actually not caught on mammo. It was caught on MRI because it was so tiny that even on 3D mammo it was not seen. But we have those protocols in place for a reason,” she said. 

Cutshall said she was lucky she did not need chemotherapy to treat her cancer or a mastectomy.

“(Doctors) said a mastectomy wouldn’t improve my survivability at all and it would only reduce my recurrence rate by a percentage point. For me going through a radical surgery to take my breasts off wasn’t necessary,” Cutshall said. 

Some women are not as lucky, Cutshall said. Most women, after being diagnosed, do genetic testing to see if they have BRACA1 or BRACA2 which are mutations in genetic code. 

“If you have the BRACA1 mutation in your genetic code, you have a 72% risk of developing breast cancer in your lifetime. If you have the BRACA2 gene then you have a 69% risk of getting breast cancer.” Cutshall said. 

Women who have the BRACA genes will most likely have full mastectomies Cutshall said. 

“Some women that get tested — they get the prophylactic mastectomies to not risk it, because 72% that’s a pretty high rate of risk,” she said. 

Other cancer treatments are radiation and chemotherapy. Depending on the cancer, some people have one or both. Cutshall said there is also a pill some people take, again depending on the type of breast cancer. 

“Depending upon if (the breast cancer) was estrogen or not, you usually take a pill for five to 10 to 15 years, depending on your age,” Cutshall said. 

Cutshall continuously stressed that women need to know when their baseline screening should start and continue yearly after. Mammograms should not be a horrific event for anyone she said. 

“If you don’t like a place or the person that’s doing your mammogram, don’t be shy to ask for somebody different next time,” Cutshall said. “It’s just like anything else. You’ve got to find somebody you’re comfortable with and work well with.”