Where the best outcomes begin

Melisa Bennett had regular well-woman exams. She had annual mammograms. And when she discovered what seemed to be a common skin condition on her right breast, she went to two different dermatologists.

If she had known then what she knows now, Bennett would have gone straight to MD Anderson Cancer Center. Instead, two years went by before the second dermatologist performed a biopsy and found Bennett didn't have eczema, she had Paget disease of the breast, a rare type of cancer involving the skin of the nipple and, usually, the darker circle of skin around it.

"By then, my only option was a mastectomy," says Bennett, a physical therapist and mother of three.

Her cautionary tale reinforces an oft-repeated message from Kelly Hunt, M.D., professor and chair of MD Anderson's department of Breast Surgical Oncology: Where a cancer patient goes first for treatment may be the most important decision she makes in controlling her health and saving her life. 

"Three doctors knew about my problem (before it was diagnosed correctly)," says 45-year-old Bennett. "I love those doctors. I've never felt angry with them. I just know that had I gone to MD Anderson from the beginning, the doctors there would have known what to do."

A 'cocoon of care'

Hunt reinforces the message: MD Anderson is the right place for patients with cancers of all types — both common and rare. In the institution's Breast Surgical Oncology and Breast Medical Oncology departments alone, several hundred breast cancer experts devote their professional lives to eradicating the disease in its many forms.

Paget disease of the breast is one example. When Bennett visited Hunt in 2016, the surgeon ordered another mammogram and an ultrasound. When both tests were negative, Hunt knew to keep pressing. She ordered an MRI. 

That's when the disease, which had two years to spread, was clearly revealed.

"The staff gave me such confidence, 100 percent," Bennett says, "and I never had to worry that there might be a better option somewhere else. The other patients and I walked around MD Anderson in a little cocoon of care." 

Breast cancer patients haven't always felt the love. Fifty years ago, Hunt says, the standard treatments were so harsh some described them as slash, burn and poison. Today, she says, doctors are able to treat patients with much more finesse.

Advances in breast cancer treatment

Decades ago, all axillary lymph nodes would be removed during a mastectomy, then biopsied for evidence of disease. Now MD Anderson surgeons do sentinel node biopsies first, a process that shows which nodes are most likely to harbor cancer. By sparing the healthy tissue, patients experience fewer problems following surgery, including arm swelling, numbness, nerve damage and range-of-motion issues.

In the past, patients underwent surgery, then chemotherapy. Today, treatment often starts with chemo, which reduces the tumor size or eliminates it and, again, allows surgeons to save healthy tissue. Some patients are able to replace intravenous chemotherapy treatments with chemo pills, which are easier to take and sometimes reduce the extent of surgery needed.

Today physicians know how their patients will tolerate radiation and recover from reconstruction, based on their genetic makeup. “My colleagues in Radiation Oncology found a specific gene mutation that predicts which patients will have more fibrosis and scarring, which can result in a worse cosmetic result," Hunt says. "We're also understanding that immune therapies that have been very successful in lung cancer and melanoma might be effective in breast cancer, depending on the tumor’s genetics."

Access to a robust clinical trials program

Hunt points out that MD Anderson patients also benefit from access to clinical trials. They offer patients the first crack at promising new treatments, which means a win for them and a gift to future generations.

That was the hope of Jana Pankratz when she arrived in Hunt's office in the summer of 2017 with a lump in her breast. Pankratz was expecting immediate surgery but jumped at the chance to participate in a clinical trial first.

"If I could help somebody in the future, that would be the best," she says.

In August, Pankratz began a standard course of chemotherapy, which had a 50-50 chance of shrinking her aggressive, triple-negative tumor.

"Fortunately, mine was reactive — the tumor was shrinking so fast we were shocked," she says.

But when her progress started to slow, the doctor in charge of the trial, Stacy Moulder, M.D., added another chemo drug to the mix. The combination worked. 

"In my instance, the tumor completely shrank," Pankratz says. "All you could see left was the marker clip."

More specialists and fewer surgeries

That's when the Pankratz returned to Hunt, who performed a lumpectomy on the right breast. During the same procedure, a plastic surgeon reduced the size of her left breast.

"At the end of the day, things were a little more symmetrical," Pankratz says.

During the lumpectomy, pathologists were able to check breast tissue samples to make sure all evidence of disease was gone. 

"They said, 'take out a little bit more just to be sure,'" says Pankratz, 57. 

This attention to detail prevented the need for another surgery, she says. In some hospitals, she adds, patients have to wait days for those test results, then undergo additional surgeries. Most likely, the breast reduction would have been a third surgery.

Pankratz still required one final step — 30 days of radiation. She considered staying in Austin, where she lives, to have the daily treatments, but she felt so comfortable at MD Anderson that she rented a small apartment near the Texas Medical Center for the month. 

"That time will always be near and dear to my heart," says Pankratz, who is married and has one adult son. "I'd walk the hospital's skybridge for exercise, and the people who drive the carts (carrying patients and others between Mays Clinic and the Main Building) would say, 'Hey, how are you?' My doctors would stop and give me hugs, and the nurses and techs would, too. MD Anderson is this huge, giant place, but it's really a small community."

Remaining on high alert

She finished her treatments this past May, but needs to be vigilant for the next five years.

"Sure, I worry," says Pankratz, who worked in administration for the University of Texas System for more than two decades. "It was a driving force in my decision to retire."

 "I didn't want to spend the next five years sitting behind a desk planning someone else's time," she says. "I used to do everything at the speed of light, but this has been a message to slow the heck down. I'm a much calmer and more centered person after all this, I really am."