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Health Matters: Providence Humboldt County | 7 COLLABORATION IS KEY The Cancer Program still maintains relationships with three major universities in Northern California—UC Davis, UC San Francisco and Stanford. "We can readily contact them if we need help in a special case or if we have a case we need to refer out to a university- level program, for at least part of the treatment," says Dr. Mahoney. A major source of progress over her career has been the recognition that there are at least five different kinds of breast cancer. Based on the details of the mutations in the DNA of the tumor cells, and since we now recognize the subtype at the very outset, each type of breast cancer can be treated appropriately by our team. A breast cancer diagnosis during pregnancy is rare and presents unique problems. "When I started practicing," says Dr. Mahoney, "if you were pregnant and got breast cancer, that baby was delivered immediately, even if the baby was not viable. Somewhere, at some time, a brave woman said, 'You're treating my breast cancer and you're not taking my baby.' Now we've figured out there are some types of chemotherapy we can give safely to pregnant women, and although careful monitoring is essential, it has been very satisfying to see outcomes with a healthy baby and a mother who survives to care for them." Another important service Providence offers patients is access to genetic testing. The genetic counselor at sister hospital Providence Santa Rosa Memorial Hospital, Melissa Bitanga, brings specialized knowledge about the potential inherited aspects of a case. Genetic testing is arranged in Humboldt, and the results are put in the medical records system. The counselor and the patient then get together by videoconference to discuss a plan for treatment. Cancer doctors and support staff in Humboldt look forward to collaborating on patient treatment planning, as part of the weekly Tumor Board. The board is made up of doctors and specialists including medical and radiation oncologists, surgeons, a genetic counselor, primary care providers and others who may be involved in a specific patient's care. DISPELLING THE MYTHS Dr. Mahoney says the number of people getting breast cancer is increasing somewhat because of the increase in the overall population and factors such as tobacco, alcohol and obesity. The good news is that the overall survival of breast cancer patients is increasing at the same time. Breast cancer deaths have decreased by 43% since 1989. And in this area, statistics show that survival rates from breast cancer treatment are actually higher than in the country as a whole. Other important facts that are not widely known: Most people who get breast cancer don't have a family history, and most people with a family history don't get breast cancer. "So you have two populations," says Dr. Mahoney, "one that feels secure and shouldn't and another that feels in danger but shouldn't." The most formidable weapon against breast cancer is early detection (see sidebar). That's why mammograms are so critical. Dr. Mahoney says there's some controversy about when to stop getting mammograms. Some guidelines say to stop at age 75, but she doesn't agree. "In my practice, that can result in seeing patients in their mid-80s with bad breast cancers because they are late in being discovered. I prefer to recommend patients keep getting mammograms until one has a life expectancy of less than five to ten years. Realistically, there are 75-year-olds in very poor health and 75-year-olds who are running marathons. It's hard to come up with an arbitrary age." A HOPEFUL FUTURE The need for research in the field of breast cancer remains critical. Dr. Mahoney is amazed at the progress that has been made in the past 40 years, and this gives her a lot of hope. "There are different subtypes of breast cancer. Now there are some where I can say to the patient, especially if it's discovered on a screening mammogram, that their case is curable. That's not a word we ever used in breast cancer before. But we do now." It is indeed heartening to hear such positivity from a renowned breast cancer specialist. "I've seen incredible changes. I'd paint a sunny picture now, because I've seen the way it used to be," the doctor says. And when asked if she is optimistic at this stage in her career, Dr. Mahoney doesn't hesitate before answering, "Yes. Absolutely." For more information about our accredited Cancer Program at St. Joseph Hospital Eureka, visit providence .org/locations/norcal/st-joseph- hospital-eureka/cancer-program. RECOMMENDED GUIDELINES • Start screening mammograms at age 40. • Get mammograms every one to two years. • If diagnosed with dense breasts, get an MRI. • If high-risk, get MRI and mammogram yearly, six months apart. • Consult with a doctor before stopping mammograms.

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