Transcript of Penn Vital Signs - Breast Cancer
 Heather
Kahn (host): It's news no one expects to hear.
Rachel Avolio: "Well, the situation that
my mom is in is, she has breast cancer and it's
actually a real shock to us…because we've
never had to deal with this before."
 Rob
Avolio: "When you hear the word cancer, it's
fear. But, the more you learn, you realize there
are appropriate treatments and it's something
we'll get through. We'll work it out."
Donna Avolio: "I found out that I have breast
cancer about a month ago. And, it was a shock...
I mean, I have no history in my family. I really
have been in wonderful health… forever."
Heather Kahn (host): Now, an expert team has
been assembled to give Donna Avolio a fighting
chance against a disease that without treatment…
could take her life.
GRAPHIC: A story of promise.
 Dr.
Fox: "The sentinel node biopsy has been the
most significant surgical advance in the treatment
of breast cancer in a quarter century."
GRAPHIC: A story of determination.
 Dr.
Domchek: "In a sense, what we do is detective
work. We're trying to find the genetic changes
that are responsible for cancer."
GRAPHIC: A story of love.
 Rachel
Avolio: "I'm just going to pray… a lot
and I hope that she can pull through and she'll
be okay."
NARRATOR: Penn Vital Signs is brought to you by
Merck. Now, here's your host, Heather Kahn.
Heather Kahn (host): It's a frightening statistic.
Every year, more than 190,000 people are diagnosed
with breast cancer. This year, it struck Donna
Avolio, a mother of three. Tonight, we'll follow
her courageous journey as she and her family confront
this disease together. We'll meet another amazing
woman, Helen Blocker, who refuses to let breast
cancer intimidate her. And we'll show you new
technologies that doctors at Penn are using to
better understand breast cancer. Donna Avolio
works at the Pennsylvania School for the Deaf
where she mentors children with hearing loss.
She's a wife and mother, and stays active playing
tennis. But life as she knew it was derailed in
an instant.
 Donna
Avolio: "I was devastated at first. I went
for my routine mammogram... about two weeks before
I thought I had felt something but I couldn't...
you know.. in the shower... typically that's when
I do my breast exams, and I thought I felt something
but I thought, well... going for my exam... my
mammogram in two weeks... I'm sure it's fine,
no big deal. I went for the mammogram and really
didn't think much of it."
Heather Kahn (host): In the days following, Donna
and husband Rob received the phone call that would
change their lives. Doctors have found the tumor,
and a needle biopsy confirms it is cancerous.
At age 45, Donna Avolio's battle with breast cancer
had begun. Her Oncologist at the Abramson Cancer
Center of the University of Pennsylvania is Dr.
Kevin Fox.
Dr. Fox: "She and I sat down and talked
about the "what ifs" based on what the
surgeon would find. The what ifs - what if the
tumor is big, what if the tumor is small, what
if my lymph nodes are involved with cancer, what
if they're not, what are my choices going to be."
Heather Kahn (host): Surgery is Donna's treatment
choice, as she begins educating herself on various
options using the Abramson Cancer Center's website
called Oncolink.
GRAPHIC: www.oncolink.com
Dr. Fox: "It is a comprehensive listing
of all the patient services provided by the University
of Pennsylvania Health System, but more than that,
it's an information source for patients to have
access to other information sites. Particularly
those associated with the National Cancer Institute."
Rob Avolio: "Initially, Donna's choice was
either a lumpectomy, which is just a removal of
a portion of the tumor itself, or a mastectomy,
which is removal of the entire breast. She's chosen
a lumpectomy and that's been the recommendation
of her doctor, as well."
Heather Kahn (host): As she considers the options,
Donna draws strength from her family.
Rachel Avolio: "I want to be strong for
her, because she can see it in my eyes if I'm
scared and I don't want her to see that."
Heather Kahn (host): When we come back, surgery
day arrives and Donna's husband Rob is faced with
an unexpected decision.
Dr. Fraker talking to Rob Avolio: "I didn't
think I'd find something, a very small part of
the node. So that changes her stage. This is not
good news."
Heather Kahn (host): We'll also introduce you
to a remarkable woman who is surviving breast
cancer on her own terms.
Helen Blocker: "The hair is
gone, but it will grow back. This is the real
me, accept me, not just for the hair, it's for
the person that I am. So, by the time it grows
back, I'll be on a cruise and looking very good.
Don't you think so?"
Heather Kahn (host): As always,
you can chat LIVE with some of the doctors and
staff you've seen here by logging on to pennhealth.com
now and for two hours after the show. You can
even make an appointment.
Commercial Break 1
Rob Avolio: "She had a mammogram done, which
turns up with something to explore further. The
mammogram turns into a suggestive biopsy. The
biopsy turns into a positive or malignant tumor.
And the status now is to go through, what we've
decided to do is a lumpectomy to determine the
extent of the problem. The lumpectomy procedure,
I understand, is approximately an hour, and she'll
be handled on an outpatient basis, and we expect
to be home about dinner time."
Heather Kahn (host): It's 8:30 a.m. and Donna
Avolio is getting ready to face a series of procedures
that will lead her into surgery. Doctors begin
by placing a thin wire in Donna's breast to pinpoint
the exact location of her cancer.
 Dr.
Conant talking to Donna Avolio: "Okay…
that's the little needle going in. You may feel
a little bit of pressure here. We have to do two
mammographic pictures, very gentle. That's to
show Dr. Fraker exactly the orientation of this
wire through the little area seen on the mammogram.
So it almost acts as a map for him. And those
pictures will go with you to the operating room
so that he can look at them and say, 'Oh yes,
I see the little area is right at the tip of the
wire, this is just where I'm going to go.' So
he can be very accurate."
Heather Kahn (host): With the guide-wire placed,
Donna is wheeled into Nuclear Medicine. A radioactive
dye is injected at the site of the tumor and will
travel to the sentinel lymph node. Dr. Douglas
Fraker is Donna's surgical oncologist.
 Dr.
Fraker: "She's already been to nuclear medicine,
as I guess you've seen, and had radioactivity
injected around the tumor. It's marked a lymph
node in the armpit, that's draining that part.
That doesn't mean that the lymph node has tumor
in it, that just means that if any lymph node
will have tumor, that'll be the one."
Donna Avolio: "Well, I'm hoping that we
can get it, and that it's not in the lymph nodes,
and that I don't have to be looking on to any
further surgery, and then I'll do whatever else
the doctors suggest I do to make sure... I can
beat this thing."
Heather Kahn (host): With Donna asleep, Dr. Fraker
injects a blue die that will later help visually
identify the Sentinel node. A Geiger counter is
then used to detect the radioactivity, guiding
him directly to the sentinel node.
SENTINEL NODE & TUMOR ANIMATION
Heather Kahn (host): The cancerous tumor is located
in Donna's breast with the Sentinel Node just
centimeters above that, near the underarm. Dr.
Fraker will remove the tumor and surrounding tissue,
then the Sentinel Node.
Heather Kahn (host): Upon examining the Sentinel
node, Dr. Fraker finds something that concerns
him. He immediately sends it to Pathology for
a report ... vital information he will need to
decide his next move. As Rob waits for the results
on Donna, another patient at Pennsylvania Hospital,
Helen Blocker, tackles the same diagnosis of breast
cancer. Helen's surgeon is Dr. Allen Bar.
 Dr.
Bar: "I think with Helen, she really, she
was just so educated and so with it, and she didn't
hesitate for two minutes to say this is, I don't
want the breast cancer, do the mastectomy."
 Helen
Blocker: "I think I shocked the doctors.
Because it was on a Friday and they said well
Helen what do you want to do, so you want a second
opinion. And I said a second opinion for what?"
Heather Kahn (host): At age 67, Helen has survived
more than her share of adversity. She lost her
son and husband two years ago. That same year,
her daughter died of breast cancer. But Helen
says all of this prepared her, for her own diagnosis…
and a double mastectomy.
Helen Blocker: "I didn't panic. I didn't
cry. I thought back on what had happened to me
two years ago. At that time, everybody said, Helen
how you go through three deaths in 12 months?
They had never heard of anything like that, and
two of them were cancers."
Heather Kahn (host): Now, Helen is nearing the
end of her chemotherapy treatment. Her Oncologist,
Dr. David Mintzer, knows how significant this
day is for Helen.
 Dr.
Mintzer talking to Helen Blocker: "All set
for your last treatment? Graduation Day. Congratulations…"
Helen Blocker: "Well, this is number four
treatment. Honestly, I have not been tired or
sick from day one of the treatment. Maybe it's
my genes, my personality, or my body makeup, I
have no idea. I'll leave here and take two buses
and go home, fix dinner for my mom and see to
my dog. Anything can be conquered. You don't give
up because you get knocked down, you get back
up and you fight."
Heather Kahn (host): Back in Surgery, the initial
Pathology report has returned - and the news is
not what the Avolio's had hoped for. A tumor is
confirmed in the sentinel lymph node… Donna's
cancer has spread.
Dr. Fraker talks to Rob Avolio: "I did see
tumor just on the sentinel, which is not typical,
and the reason I'm coming to talk to you now is
that… to just get your permission to go ahead
and take out the rest of the lymph nodes. She's
asleep… it's the right thing to do."
Rob Avolio: "Having just found out that
the cancer has spread to the sentinel node, that's
not good news in terms of prognosis and in terms
of other involvement. The other thing that's disconcerting
is that there really is no way to know how far
it's going to go until the pathology is done and
that's five days. I'm worried for her. She obviously
is still asleep, so doesn't really know what's
going on yet, and I'm anxious to be there when
she wakes up."
Heather Kahn (host): This turn of events in surgery
changes Donna's diagnosis from localized to metastatic
breast cancer, meaning it has spread. Donna now
faces several months of chemotherapy that, only
this morning, she hoped she wouldn't need. When
we return, Donna begins chemotherapy and you'll
learn about new programs that could help you determine
your risk of breast cancer.
Lori Wilkinson: "We've never been diagnosed
with breast cancer, but because we have a high
risk on both sides of our family, mother and father,
we come here just to prevent it."
Heather Kahn (host): While Donna and Helen did
self-exams, both had lumps that could only be
detected by mammography. For information on scheduling
a mammogram, call 1-800-789-PENN or log on now
to pennhealth.com. You can also chat on-line with
some of the doctors featured in this program.
Commercial Break 2
Heather Kahn (host): It's been one month since
surgery, and Donna's first chemotherapy visit
to Penn's Rena Rowan Breast Center brings both
nervousness ... and tremendous hope.
 Nurse
Walton: "What I like about being an oncology
nurse is that I do develop these relationships
with people that are long standing, and with so
many of our success stories you see them coming
back for years to come for their follow-up visits."
Heather Kahn (host): Like many women across the
nation, Donna is facing the reality of breast
cancer - one that became known only after a routine
mammogram.
Dr. Bar: "It's the number one cancer for
women. One out of 7 to 8 will get it if they live
the full length of their life. The idea is to
be aware of it and not be frightened of getting
mammograms, although they are anxiety provoking,
and just take care of yourself. The search for
a cure is to figure out what causes the breast
cancer and stop it before it even starts."
Heather Kahn (host): That has become the mission
of the Cancer Risk Evaluation Program, which helps
women and men better understand their risk for
breast cancer - and how to manage that risk. Sisters
Lori Wilkinson and Dawn Stear have come seeking
genetic counseling.
  Lori
Wilkinson: "We've never been diagnosed with
breast cancer, but because we have a high risk
on both sides of our family, mother and father,
we come here just to prevent it. To do what we
can to not ever get it."
Dr. Domchek: "What we do in the Cancer Risk
Evaluation Program is see women who are at increased
risk for developing cancer. In those cases, we
can offer genetic testing; we do genetic counseling
in terms of the risk that there is an alteration
within the family and what that means. A lot of
the women we see, though, don't have such dramatic
family histories, and they just come in to get
a better sense of what their breast cancer risk
is."
 Dr.
Weber: "We also have a pretty big effort
in understanding which populations are more likely
to have gene mutations, what those genes look
like and what those mutations actually produce
in terms of cancer risk. There have been many
times where it has been very, very personally
rewarding particularly being able to tell women
who thought they were at tremendous risk that
they weren't … or that …even more rewarding
in a way is those women who have the mutation,
who have cancer, whose daughters get tested and
they are able to find out that their daughters
didn't inherit the mutation… that's our favorite
thing to get to tell them."
Lori Wilkinson: "You know, I think it's
empowering. We're really proactive. Instead of
just sitting back and waiting to possibly find
a lump and have breast cancer, we come every year
to make sure that doesn't happen, and if it does,
I think we feel more prepared if it does happen."
Heather Kahn (host): Today, doctors are using
emerging technologies not only to understand how
cancer starts but also to track its progress.
One innovative program at Penn and Phoenixville
Hospital is Positron Emission Tomography, or P.E.T.
 Dr.
Bleshman: "P.E.T. has the major advantage
in breast cancer of being the best single molecular
imaging technique, which means that it doesn't
just image the structure of the tumor, or the
mass, it images what the mass is doing inside
the body."
Heather Kahn (host): When we come back, Helen
triumphantly returns to work… and Donna considers
life as a cancer survivor. Log on to pennhealth.com
or call 1-800-789-PENN now and for two hours after
the show to learn more about the innovative breast
cancer procedures and support services you've
seen here.
Commercial Break 3
Heather Kahn (host): After months of chemotherapy,
Helen Blocker is finally ready to return to work
at the IRS. Her situation, although difficult,
is a story that inspires everyone who hears it.
Helen Blocker: "You have to stay active
and I find that if you can take something personally
from your own life experience and share, it opens
the door and you have interaction."
Helen Blocker talking to work group: "The
big C - admit it you have cancer… What do
you want to do? And you look inside yourself,
you'd be surprised how you can come out and fight,
positively."
STAFF APPLAUDING
Heather Kahn (host): There are many women, like
Helen, who are determined to overcome breast cancer.
For the fight doesn't end with treatment. The
"Living Well After Cancer" program addresses
the needs of these cancer survivors. Supported
by the Lance Armstrong Foundation, this one-of-a-kind
program brings together psychological and medical
assessments, nutrition counseling, and provides
advice with lifestyle decisions - after treatment
has ended.
 Dr.
DeMichele: "We identify patients at the time
they start treatment and follow them indefinitely,
so they have a group of familiar faces… people
who know them from the start and who are going
to follow them lifelong, and that support can
mean something to people going through cancer
treatment."
Heather Kahn (host): For Donna, the struggle
is about more than cancer. It's the determination
to live life as normal as possible as she awaits
her final treatment.
Rachel Avolio: "I think she's getting used
to it, which is kind of good. I think she's getting
used to the fact so she can deal with it more.
From her perspective now that she has it, there's
no more finding out new stuff hopefully any time
soon. And now she just has to get through the
therapy. My mom's strong… I'm so proud of
my mom. She really really thinks positive and
I'm so happy that she does that. That's the way
I would expect her to act. Positive and just go
on with your life. You can't stop your life."
Rob Avolio: "I think the best thing that
you've ever done, and continue to do, is to have
annual mammograms. Because this thing doesn't
hit the board until you had an annual mammogram."
Donna Avolio: "Doing my monthly self-breast
exams and also when I get my notice that my mammogram's
due and the doctor's reminding me I, you know,
I make that appointment right away."
Donna Avolio: "Reflecting on it, I guess
I think it's nice to be here, our favorite place,
you know, so we can be … if we have to be
somewhere this is a nice place to be. To be able
to spend time together and try to… feel better."
Rob Avolio: "Each treatment has brought
something different, but Donna's done really well
for each one of them. So she's half way through
it and the expectation is that she's going to
do just as well as she has in the past."
Dr. Fox: "I have no doubt that Donna's tolerance
to the chemotherapy will improve and by the time
it comes to an end she'll be feeling actually
pretty much back to normal."
Rob Avolio: "The folks at the University
of Pennsylvania have been extraordinary and they
made it a whole lot easier. It's a very personal
thing and you need the medicine side, but you
need that relationship with a good doctor or a
set of doctors that you can rely on and feel comfortable
with."
Donna Avolio: "I believe I will be a survivor.
I really do believe that, but do I really honestly
consider myself a survivor right now. No. I don't…
but I'll get there."
Rob Avolio: "And that's where we disagree
because I do... and I think she was the day of
the surgery… and every day since then."
Heather Kahn (host): Donna and Helen benefited
from some of the latest treatments available to
fight breast cancer. Yet the greatest tool remains
early detection. Learn more about early detection
by calling 1-800-789-PENN or log on to pennhealth.com.
You can still chat live with some of the doctors
featured in this program now and for two hours
after our show.
Heather Kahn (host): On the next Penn Vital Signs…
Heather Kahn (host): A year ago Silvia and Carl
Homa were not able to naturally conceive another
child. Today, they're getting ready for twins.
For Sharon and Jim Kiefer natural conception was
also not an option. Their journey into parenthood
will depend on the skill of a medical team to
help them conceive the child they have longed
for.
Sharon Keifer: "I really think it's going
to work this time."
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