From the Duke Cancer Institute archives. Content may be out of date.
In late September 2017, Ginger Connor was enjoying a family vacation at the beach when she felt a lump in her left breast. At the age of 48, Connor had been doing self-breast exams regularly for years and she immediately realized this was something new.
When she returned from vacation to her job as a mammography technologist at Duke Women’s Cancer Center Raleigh, Connor underwent a biopsy, followed by a breast MRI the next day. When that identified two additional areas of concern, the next steps included an ultrasound and more biopsies. On October 6, Connor received the diagnosis she had already feared: breast cancer.
Connor’s breast cancer was identified as invasive ductal carcinoma, present in two different quadrants of her breast. On October 23, 2017 – during Breast Cancer Awareness Month and less than a month after discovering the lump – Connor had a double mastectomy. It was undoubtedly the most life-changing month of her life, but not without a few good memories. In addition to treasured family portraits taken during that beach vacation, Connor also enjoyed the Bruno Mars concert that she had waited more than a year to attend.
Having both breasts removed when cancer was only present in one was a very personal decision for Connor, but it was one she had made even before her diagnosis.
“Having worked in the mammography field for more than 20 years, I already knew what I’d do if it ever happened to me,” Connor explained.
Knowing that additional surgery would be required on the other breast as part of reconstruction down the road, as well as believing that it could potentially lower her risk of developing new cancer, made a double mastectomy the right choice for her.
Trusting the Science
Advances in breast cancer testing and typing can help predict a patient’s risk of recurrence. A sample of Ginger’s tumor was examined using MammaPrint, a genomic test that analyzes the activity of certain genes in early-stage breast cancer. Connor also underwent Foundation One genomic profiling, a method that uses next-generation sequencing that looks at more than 300 cancer-related genes to detect the four main classes of alterations known to drive cancer growth. Both of these tests identified Connor as being at low risk for her cancer coming back.
Because her cancer was invasive and due to her experience in the field, Connor had fully expected to need chemotherapy after her mastectomy. But she trusted the science behind the testing – and she trusted her oncologist, Stacy Telloni, MD, MPH, even more. They briefly discussed radiation treatments but decided that it was unnecessary based on Connor’s low recurrence risk and the fact that her breasts had been removed.
“Knowing what I know, it was a little hard to lay the decision to not do radiation or chemo to rest. But I believe in the medicine and trust my team, so it was the right thing to do,” Connor said.
The emotional and physical aftermath
Connor was relieved that her breast cancer was caught early, treated quickly and determined to have a low risk of returning. But coping with the aftermath of her diagnosis and double mastectomy was still understandably traumatic.
As she put it, “Seeing yourself without something you’ve had for 48 years leaves you feeling vulnerable and broken. I felt like I had aged 10 years in that one month and all those unfamiliar emotions slapped me in the face more than once.”
Reconstruction was a year-long process that included painful tissue expanders, physical therapy to help with loss of motion and muscle spasms and finally, implants. Connor describes this period of “growing breasts back” as being harder than the mastectomy itself. There were also a bevy of meds that made her menopausal and surgery to remove her ovaries.
Getting back to “normal” was difficult for Connor. She realizes now that she rushed everything in an effort to make those around her feel better.
“By protecting everyone else, it’s easy to neglect yourself,” she said.
Looking ahead – and what she’s learned
Ginger Connor and her family.
Connor is three years out now, and she’s feeling pretty good about things. She’s not experiencing any side effects and looking in the mirror is comfortable again. She has an annual breast MRI and meets with Telloni (her oncologist) every six months. She will continue on her medication regimen for 10 years.
Recently promoted to her current role as supervisor of Ambulatory Mammography and Ultrasound for Duke Health, Connor’s breast cancer experience has given her a unique perspective. She truly understands the roller coaster of emotions that patients feel when they receive the diagnosis, and she spends a lot of time sharing her story with them.
“I’ve always been in the field of helping people,” she said. “I can do that on a higher level now and it’s actually part of how I cope with what has happened to me. I do a lot of ‘show and tell’ – and that helps other women make decisions and realize that they really can be okay.”
Connor has an 18-year-old daughter and is already passing on the lessons she’s learned.
“I’m teaching her to learn about her own body, to be comfortable doing self-exams. It’s amazing what a woman’s body can do – like birthing a baby – but our bodies go through many changes and we have to be aware of them, so we’ll know when something is wrong," she shared.
Her advice to other women? Know your body, trust your intuition and follow screening recommendations. Connor wants to remind others of all the advances in imaging (3D mammograms, for example, can detect tumors three to four years earlier than traditional scans), testing, treatment and research. She also wants to send the message that if you are diagnosed with breast cancer, there’s plenty of reason to hope.
“We tiptoe around cancer, especially breast cancer. But it isn’t an automatic death sentence anymore," she said. "Don’t let it consume you and don’t give up.”
For decades, a diagnosis of metastatic breast cancer has carried a clear message: while treatments can help control the disease and extend life, the disease is generally considered incurable. As a result, treatment strategies have traditionally focused on managing cancer and maintaining quality of life rather than pursuing a cure.New advances in breast cancer therapies are changing that conversation. Research led by Duke Cancer Institute breast surgical oncologist Jennifer Plichta, MD, suggests that some patients with limited metastatic breast cancer may benefit from a more aggressive treatment approach than has traditionally been offered. The findings, published in JAMA Surgery, add to growing evidence that metastatic breast cancer is not the same for every patient and that treatment decisions may need to become more personalized.Plichta's research builds on years of work focused on improving how physicians classify and predict outcomes for patients with breast cancer. Historically, a diagnosis of metastatic, or stage IV, breast cancer, was associated with poor survival. However, the development of targeted therapies and other advances in systemic treatment have dramatically improved outcomes for many patients."Many women with metastatic breast cancer are now living for years and sometimes even a decade after diagnosis," Plichta said. "We've come a long way in terms of treatment options and survival."At the same time, researchers have discovered significant variation among patients with metastatic disease. Some experience aggressive cancer that progresses quickly, while others have relatively limited disease that remains controlled for long periods.This variability led Plichta and her colleagues to ask an important question: Are there certain patients with metastatic breast cancer who could benefit from treatment strategies typically reserved for patients with earlier-stage disease?The study focused on patients with what is known as oligometastatic breast cancer, a form of metastatic disease in which cancer has spread to only a limited number of sites. Researchers believe this group may represent a distinct subset of patients whose disease behaves differently than widespread metastatic cancer.Using data from the National Cancer Database, which captures information on many newly diagnosed breast cancers in the U.S., the team analyzed outcomes among patients with limited metastatic disease. They examined whether patients received treatment directed at the primary breast tumor, treatment directed at metastatic sites, both treatments, or neither.The goal was to determine whether a treatment approach that more closely resembles care for stage III breast cancer—combining systemic therapy with aggressive local treatment—might improve outcomes for selected patients."What stood out was that removing the primary breast tumor seemed to be the factor most strongly associated with improved survival," Plichta said. "Treating the distant sites did not appear to offer the same survival advantage on its own."While previous studies have explored surgery for patients with metastatic breast cancer, results have been mixed. Plichta believes one reason may be that metastatic breast cancer is often treated as a single category, even though patients can have vastly different disease characteristics and prognoses.One of the most significant implications of this research is how clinicians think about treatment goals. Patients with stage III breast cancer are typically treated with curative intent, meaning doctors use every appropriate therapy available, including chemotherapy, surgery, and radiation, in an effort to eliminate the disease. Patients with metastatic breast cancer, by contrast, are usually treated with palliative intent, focusing on disease control rather than cure.But as outcomes improve, the line between those groups may not be as clear as it once was."We're seeing some patients with metastatic disease living longer than patients with locally advanced breast cancer," Plichta said. "That raises important questions about whether some patients with limited metastatic disease should be approached differently."Because the study was retrospective, the results point to an important association that warrants further study. Several clinical trials are now being developed to investigate curative-intent treatment strategies in specific subgroups of metastatic breast cancer patients, including those with HER2-positive disease. Duke hopes to participate in these multi-institutional studies as the field continues to evolve.As breast cancer treatments continue to improve, researchers are gaining a more nuanced understanding of metastatic disease. For Plichta, the study represents an important step toward that goal."I hope this work encourages further research into which patients may benefit from a curative-intent approach," she said. "The ultimate goal is to find the right treatment strategy for the right patient."
For decades, a diagnosis of metastatic breast cancer has carried a clear message: while treatments can help control the disease and extend life, the disease is generally considered incurable. As a result, treatment strategies have traditionally focused on managing cancer and maintaining quality of life rather than pursuing a cure.New advances in breast cancer therapies are changing that conversation. Research led by Duke Cancer Institute breast surgical oncologist Jennifer Plichta, MD, suggests that some patients with limited metastatic breast cancer may benefit from a more aggressive treatment approach than has traditionally been offered. The findings, published in JAMA Surgery, add to growing evidence that metastatic breast cancer is not the same for every patient and that treatment decisions may need to become more personalized.Plichta's research builds on years of work focused on improving how physicians classify and predict outcomes for patients with breast cancer. Historically, a diagnosis of metastatic, or stage IV, breast cancer, was associated with poor survival. However, the development of targeted therapies and other advances in systemic treatment have dramatically improved outcomes for many patients."Many women with metastatic breast cancer are now living for years and sometimes even a decade after diagnosis," Plichta said. "We've come a long way in terms of treatment options and survival."At the same time, researchers have discovered significant variation among patients with metastatic disease. Some experience aggressive cancer that progresses quickly, while others have relatively limited disease that remains controlled for long periods.This variability led Plichta and her colleagues to ask an important question: Are there certain patients with metastatic breast cancer who could benefit from treatment strategies typically reserved for patients with earlier-stage disease?The study focused on patients with what is known as oligometastatic breast cancer, a form of metastatic disease in which cancer has spread to only a limited number of sites. Researchers believe this group may represent a distinct subset of patients whose disease behaves differently than widespread metastatic cancer.Using data from the National Cancer Database, which captures information on many newly diagnosed breast cancers in the U.S., the team analyzed outcomes among patients with limited metastatic disease. They examined whether patients received treatment directed at the primary breast tumor, treatment directed at metastatic sites, both treatments, or neither.The goal was to determine whether a treatment approach that more closely resembles care for stage III breast cancer—combining systemic therapy with aggressive local treatment—might improve outcomes for selected patients."What stood out was that removing the primary breast tumor seemed to be the factor most strongly associated with improved survival," Plichta said. "Treating the distant sites did not appear to offer the same survival advantage on its own."While previous studies have explored surgery for patients with metastatic breast cancer, results have been mixed. Plichta believes one reason may be that metastatic breast cancer is often treated as a single category, even though patients can have vastly different disease characteristics and prognoses.One of the most significant implications of this research is how clinicians think about treatment goals. Patients with stage III breast cancer are typically treated with curative intent, meaning doctors use every appropriate therapy available, including chemotherapy, surgery, and radiation, in an effort to eliminate the disease. Patients with metastatic breast cancer, by contrast, are usually treated with palliative intent, focusing on disease control rather than cure.But as outcomes improve, the line between those groups may not be as clear as it once was."We're seeing some patients with metastatic disease living longer than patients with locally advanced breast cancer," Plichta said. "That raises important questions about whether some patients with limited metastatic disease should be approached differently."Because the study was retrospective, the results point to an important association that warrants further study. Several clinical trials are now being developed to investigate curative-intent treatment strategies in specific subgroups of metastatic breast cancer patients, including those with HER2-positive disease. Duke hopes to participate in these multi-institutional studies as the field continues to evolve.As breast cancer treatments continue to improve, researchers are gaining a more nuanced understanding of metastatic disease. For Plichta, the study represents an important step toward that goal."I hope this work encourages further research into which patients may benefit from a curative-intent approach," she said. "The ultimate goal is to find the right treatment strategy for the right patient."
