Caitlin Patten, MD, FACS, an oncology surgeon and associate professor at Froedtert and the Medical College of Wisconsin, was seeing patients on a regular workday. As a healthy 41-year-old woman, Dr. Patten went in for her routine screening mammogram between patients, expecting the usual results. But within hours, she got a call: The imaging showed new abnormal findings. A week and three biopsies later, her pathologist broke the news that she had early-stage breast cancer, which led to her sitting in the clinic as a patient. "How could I, as the healer, now need to be healed in my own clinic?"
Dr. Patten shared her story on Coffee Conversations with Scientists, a program presented by Advancing a Healthier Wisconsin Endowment. She discussed what women and people with breasts should know about risk, prevention and screening.
Dr. Patten explained that breast cancer is mainly a disease of postmenopausal women, and most breast cancers are found in women older than 45. (But the risk in younger women has risen about 0.7% per year since 2000.) Since women under 40 typically don’t get screening mammograms, it’s important that they know their breasts and notice any changes. Self-exams or engaging partners in exams are vital for seeing a new lump, nipple discharge or a skin change.
In the past, breast cancer surgery often meant a mastectomy with no reconstruction, leaving a flat chest wall, or a large lumpectomy that left the breast deformed. Today, oncology surgeons like Dr. Patten now take out less tissue and partner with plastic surgeons to ensure breast symmetry. More women get to keep their breasts with less deformity, which leads to more confidence.
Some options for those who are afraid of having a foreign body or aren’t interested in having implants include:
As research advances, treatments can become more targeted, which means fewer side effects for the patient. Systemic treatment options are described by Dr. Patten as “all the medications we give to women,” such as chemotherapy and anti-estrogen pills. Since about 75% of the breast cancers she sees are estrogen-sensitive, these can be treated with anti-estrogen pills.
Along with preventing recurrence, these pills can prevent spread and mitigate symptoms, especially for older patients who aren’t interested in undergoing surgery. Dr. Patten hopes systemic treatment works so well that surgery becomes unnecessary: "I'm hopeful someday I'm not going to need to operate on people, and I can retire because these medications are going to work so well."
After Dr. Patten's diagnosis, she found that her training and experience as a surgeon didn't prepare her for the emotional challenges: an identity crisis and questions about her mortality. She focused on her husband and children as sources of motivation and pushed forward using the best evidence and most up-to-date science. She had three surgeries, started taking an anti-estrogen pill and began consistent occupational therapy.
Her screening mammogram, she said, saved her life. Her breasts are very dense, and the findings were subtle, but the mammogram caught them. Because the cancer was found at an early stage, she did not need radiation and avoided chemotherapy. "I know it saved my life," Dr. Patten said. She tells people who have put off screening that the longer cancer goes undetected, the more treatment they are likely to need. Dr. Patten uses her personal experience to motivate her patients through treatment, offering extra insight, empathy and understanding.
To learn more about the science behind breast cancer,
watch the full Coffee Conversations with Scientists episode featuring Dr. Patten.