Sisters benefit from personalized breast cancer treatment plans

In August 2015, Judith Smith was diagnosed with a type of breast cancer called mixed ductal and lobular carcinoma. A week later, her sister, Dianne Marks, received shocking news: she, too, had breast cancer -- specifically infiltrating duct carcinoma.

The two sisters are only 14 months apart in age and have always been close. They both live in Port Arthur, just a little over an hour outside of Houston, and they both work as nurses. Eventually, they found comfort in their shared diagnosis.

“It ended up being a good thing,” Dianne says.

While Judith went through radiation first and could help Dianne prepare, Dianne had surgery first and was able to help Judith prepare.

“We were able to share our stories,” Judith says.

The differences between their treatment exemplified how MD Anderson breast cancer experts used personalized care to help both sisters overcome cancer.

Judith’s breast cancer treatment

After an abnormal mammogram and an ultrasound, Judith came to MD Anderson. While scheduling her appointment, she learned that MD Anderson has a location in League City, a suburb closer to her home. She decided to seek treatment there. 

Judith saw breast cancer surgeon Cristina Checka, M.D., who performed two separate needle biopsies at two different appointments after the first one showed that they needed to test deeper. The second biopsy confirmed Judith had breast cancer. By that point, Judith knew she was in good hands.

“I knew when I met Dr. Checka that she was the absolute best doctor for me,” she says.

Checka’s warmth put her at ease and the two spoke about their family, their faiths and football. Checka collaborated with oncologist Amy Hassan, M.D., to create Judith’s breast cancer treatment plan.

“My treatment was targeted and set up to be what was right for me,” says Judith, who underwent chemotherapy every three weeks for six months. “It was pretty rough, but I was still able to work.”

During the first phase of chemotherapy, her side effects included abdominal pain, constipation, nausea and fatigue. The second phase was harder. Judith developed mouth sores that made it difficult to talk and eat, but eventually, they subsided.

With chemotherapy behind her, Judith began preparing for surgery. She was given the option between a mastectomy and lumpectomy. Ultimately, she chose a partial mastectomy, in which only the tumor and the part immediately surrounding it are removed.

Judith was able to go home shortly after the outpatient surgery. The next morning, she felt well enough to get out of bed and put on makeup, impressing her adult children on their video call.

Once she had recovered, she underwent five weeks of daily radiation therapy in Port Arthur.

Throughout her treatment, Judith quickly realized that talking with others about her experiences helped her cope.  

“It gave me some peace and relief,” she says.

Of course, talking with Dianne helped the most.

Dianne’s breast cancer treatment

Once a year, Dianne drove to MD Anderson’s Lyda Hill Cancer Prevention Center for her mammogram. She was prone to developing cysts, so she wanted care from a team with expertise.  

“It wasn’t an imposition at all to drive to MD Anderson, and it was worth it to see the best,” she says.

As a nurse, Dianne knew how common breast cancer is, but she never suspected that she had it. She was too worried about her sister’s diagnosis and her daughter’s upcoming wedding.

When Dianne’s team at the Cancer Prevention Center told her she had breast cancer, they referred her to Mariana Chavez Mac Gregor, M.D., an oncologist. The transition was seamless, but Dianne wasn’t ready to focus completely on her own cancer care. At this point, her daughter’s wedding was just a week away. Dr. Chavez Mac Gregor listened to Dianne’s concerns and determined that since the cancer wasn’t aggressive, the could delay her breast cancer treatment.

After the celebration, Chavez Mac Gregor helped Dianne determine that the best treatment plan for her was participating in the LORELEI trial. This clinical trial was designed to determine if combining the drugs letrozole and taselisib helped reduce the size of the breast tumor.

Diane was unsure about participating in a clinical at first, but a coworker pointed out, “You could really help someone else.”

Dianne took the drugs daily for 16 weeks, and her tumor shrank almost 80%.

After chemotherapy, she had a partial mastectomy, followed by four weeks of radiation therapy. Having just watched Judith recovery from the procedure, Dianne had a better idea of what to expect. Knowing that the recovery process would be quick helped put her mind at ease.

With the clinical trial, surgery and radiation behind her, Dianne prepared for the next part of treatment: an additional four rounds of chemotherapy to ensure that the cancer would not come back. About three or four days following each chemotherapy treatment, Dianne started to feel nauseous and fatigued, but little by little she felt better.

Once chemotherapy was complete, Dianne began taking a maintenance dose of letrizol, the same drug she took at the beginning of her treatment. She continues to return to MD Anderson for checkups every six months.  

Like Judith, Dianne kept working throughout her treatment.

“I didn’t feel I had to put my life on hold,” she says.

Personalized care for breast cancer treatment

Despite both having breast cancer, the sisters’ cancer treatments differed greatly because their doctors coordinated their care and developed a comprehensive treatment plan unique to each of them and their diseases.

Both sisters underwent genetic testing for the BRCA gene, which increases a carrier’s risk for breast and ovarian cancers. 

“While I’m a nurse, I’m not an oncology nurse and there was a lot I didn’t know about cancer treatment until Dianne and I were diagnosed. Seeing the difference between each of our treatment plans really helped me better understand personalized care,” Judith says. “There’s no one-size-fits-all.”

Not even for sisters.