CINDY ELLEN RUSSELL / CRUSSELL@STARBULLETIN.COM
Dr. Stephen Sener, national president of the American Cancer Society, visits with Lyn Kagawa of Hilo, 83, a 45-year breast cancer survivor and 40-year volunteer for the group.
Breast cancer fight improving
A Hilo survivor from the 1960s testifies to the leaps in detection, treatment and recovery
When Lyn Kagawa of Hilo was diagnosed with breast cancer 45 years ago, chances of survival were 50-50.
Now the average woman with breast cancer has a 90 percent chance of survival, says Dr. Stephen Sener, American Cancer Society president.
That is because of significant advances in prevention, detection and treatment, such as mammography and chemotherapy, said the professor of surgery at Northwestern University Feinberg School of Medicine and vice chairman of the Department of Surgery at Evanston Northwestern Healthcare.
"So we've come a long way here."
"They didn't have any of those things in my day," said Kagawa, 83, as the two compared notes in an interview at the American Cancer Society's Pacific Headquarters on Nuuanu Avenue.
Sener, 55, was here to speak at the organization's annual board meeting and volunteer appreciation luncheon Saturday at the Honolulu Country Club.
He said Tamoxifen cuts the risk of another breast cancer in half, and the drug Arimidex might be even more effective. It appears to prevent about 75 percent of new tumors in women with breast cancer, and it is in trials to determine if it can be used to prevent cancer in women who have never had it, he said.
"So this is this year's news in breast cancer."
Kagawa, an active cancer society volunteer on the Big Island for 40 years, said no one talked about breast cancer in her day. When she found a lump in her left breast at age 37, she thought it was just a cyst, and so did her doctor, she said. He sent tissue away for tests and called her back nine days later. "I had to go in and have it removed, and he wanted to do a hysterectomy. ... I looked at him and said, 'No, I don't want it.'"
At that time, Sener said, ovaries were removed as a form of hormone suppression to improve survival of women with breast cancer, especially younger women. Kagawa had a radical mastectomy, which was very disfiguring, she said. "They took all your lymph nodes and everything down to your ribs, completely."
Prostheses also were a problem, she said. The one she bought in Honolulu was made of a sponge so hard that "if someone bumped into you, they would bounce back," said Kagawa, whose family owns Hata Drygoods in Hilo.
The alternative was a breast-shaped vinyl balloon that she blew up every morning with a straw, she said, laughing. "I was never the same size twice. And when I raised my arm, oops. ... It went all over the place."
About a year later, the plantation doctor's wife told her about a silicon prosthesis, and she ordered one for $25 from Tacoma, Wash., where she was born and raised. "Now it's almost $200," she said.
Kagawa had cancer in her other breast in 1986, 26 years after the first one. "The doctor said it was just my tough luck to get another one. It was a different type, nothing to do with the first one." She had a partial mastectomy. By then, she said, "It was much more modified."
Chances of a woman getting cancer in the second breast are about one-third of 1 percent per year up to age 85, Sener said, adding that up to 17 percent in Kagawa's case.
When she needed a pacemaker 10 years ago, doctors could not find any place to put it on her left side because the first radical mastectomy "left only skin over ribs," she said. The pacemaker was implanted on her right side with some adjustments.
It was not until the early 1970s, about 10 years after her diagnosis, that the first chemotherapy drug, LPAM, was developed, Sener noted.
Since 1991, breast cancer deaths have dropped 20 percent through better utilization of screening techniques and better treatment, he said.
For example, his community has an aggressive mammography screening program for women over age 40, and the average size of cancers detected is about 11 millimeters, he said. The average size was close to 2 centimeters in 1991, and in 1960 it was 3 to 4 centimeters, he said.
"If you find it when it's small -- that's how you get this survival rate," he said.
Treatment has more effect on survival than detection in communities without widespread mammography screening, and major developments have occurred in that area in the last decade, he said.
They include a specific chemotherapy agent called adriamycin, aromatase inhibitors such as Arimidex and a drug, Herceptin, that is effective for tumors with the HER (human epidermal) receptor, Sener said.
TRAM flap breast reconstruction, using tissue from the abdomen, also is "very sophisticated, easy to do, with long-term results," Sener said.
Treatment 45 years ago involved what was called a "deep X-ray," Kagawa said, noting that the machine was broken in the Hilo hospital, so she had to go to the Queen's Medical Center in Honolulu.
She had 15 minutes of therapy every weekday for a month, but the dosage and depth of treatment could not be controlled accurately, and she broke out in black blisters after returning home.
She started a support group for the American Cancer Society in Hilo after Terese Lasser, noted breast cancer survivor from New York City, visited 30 years ago.
Lasser founded Reach for Recovery, a worldwide movement that has changed women's view of cancer, Sener said.
Kagawa said a doctor told her when she started the program that it was not needed because he could answer all the questions.
"I said, 'No, you're not a survivor. It's different, woman to woman.'" A Reach for Recovery volunteer is "living proof" that there is reason for hope after breast cancer surgery, she said.
Sener said the ACS goal is to reduce cancer mortality by 50 percent by 2015. "Given what we know today, I think we will only get halfway there."