Trauma nurse Katy Hadduck had just finished showering when she noticed a red area on her left breast. The unusual texture of the area made Hadduck uneasy, so she called her gynecologist.
“When I found this, of course I freaked out, started dividing up the china,” said Hadduck, 56, of Simi Valley, Calif. “I went on the Internet and saw all sorts of scary things.”
She was in her gynecologist’s office the next day where an ultrasound and mammogram led doctors to call for a biopsy of Hadduck’s left breast.
Because she is a nurse with Ventura County Emergency Medical Services Agency, Hadduck decided to share her experience to help other women.
Hadduck is trauma-system manager for the county agency, so she has plenty of experience with broken legs and bleeding patients, but breast cancer and biopsies were unfamiliar terrain.
“Even though I’ve been a nurse for 35 years, this whole aspect of women’s care mystified me,” Hadduck said. “If I can share my experience and demystify this and dial down the scariness for women, that feels very compassionate and very nurselike.”
Hadduck’s biopsy at the Nancy Reagan Breast Center in Simi Valley came the same week that a research study appeared in the Annals of Internal Medicine showing that more than 60 per cent of women getting annual breast mammographies will get a false positive, requiring them to get additional testing. Of those, seven per cent to nine per cent will undergo a biopsy that turns out to be negative.
The study of about 169,000 women ages 40 to 59 in a breast-cancer registry supported the idea of getting mammograms every two years rather than annually.
When Hadduck went to get her biopsy Oct. 18, she was accompanied by her husband of 35 years, Jerry Hadduck.
“It’s been 35 great years,” he said. “I want 35 more.”
After Hadduck filled out the paperwork and was fitted with a wristband ID, radiologic technologist Kim Monaster took Hadduck from the waiting room into an examining room, where she put on a waist-length drape that opened in the front.
With Hadduck seated on a paper-covered table, Monaster wrapped a cuff around her arm and checked her blood pressure and pulse.
Then, radiologist Dr. Craig Inouye entered the room and explained how the guided ultrasound would work.
The area would be numbed with Novocaine, then Inouye would make four or five “passes,” which means he would insert a long, slim, hollow needle into the breast until he penetrated the area.
Ordinarily, the patient doesn’t feel any pain, but there are no guarantees, Inouye said.
“With the breast, you can’t really tell where the nerve endings are,” he said. “You could do four passes, then on the fifth pass, hit a nerve.”
Inouye was guided by a monitor above Hadduck’s head that was alive with bright lines snaking across the screen, showing Inouye the terrain of the breast. The suspicious area looked like a black crevice in the bright lines.
“Some of the technology still feels medieval and undignified, but breast cancer is scary and undignified, too,” Hadduck said.
Monaster applied conducting gel on the breast, then moved the ultrasound conductor over her breast to get an image of the lesion.
Hadduck put her left arm up under her head as Inouye draped her breast, then injected her with Novocaine. He took a scalpel and made a tiny incision. He inserted a needle five times, each time positioning the needle at a different angle. When he had the needle positioned into the lesion, he would release a trigger that would suck up cells, making a loud snap.
“One, two, three . . . click,” Inouye said each time. “Now, we move another 90 degrees. It’s a special needle. This (the cells) goes in as fast as you can snap your fingers.”
“I thought that was going to hurt. It was surprisingly tolerable,” Hadduck said after the procedure, which lasted about 30 minutes. The only burning was from the Novocaine and it was brief.”
During the last pass, Inouye inserted a titanium clip so imaging in years to come would mark the lesion as tested and biopsied.
After the biopsy, Monaster gave Hadduck one more mammogram to make sure the clip was positioned in the lesion. When Monaster and Hadduck looked at the mammograms, Hadduck laughed when she saw the clip was in the shape of a breast-cancer-awareness ribbon, something Hadduck is passionate about.
When asked about the report supporting less frequent mammograms because of the false positives, Hadduck said she found the recommendation “appalling.”
“We’re willing to trade women’s lives for a greater degree of oblivious peace of mind?”
The controversial guideline first surfaced in 2009 when the U.S. Preventive Services Task Force released the results of clinical trials that balanced the benefits and harms of screening women every year versus every two years. The high number of false positives prompted the task force to recommend screenings every two years, adding that testing every two years would also cut down on the anxiety generated by a false positive.
Getting tests every two years rather than every year would cut false positives by about a third, according to the test in the Annals of Internal Medicine.
Cost was not a consideration and the study was done for women of average risk, according to the task force.
Simi Valley Hospital radiologist Dr. Robert Acquarelli said he still would recommend mammography yearly.
“I have seen a number of cases when you get a rapid change within a year,” Acquarelli said. “I think that going an extra year in those cases would not have been desirable.”
As for the task-force recommendation that women start getting mammograms at 50 rather than 40, Acquarelli had to go back only as far as last summer to recall four patients in their 40s with an aggressive form of breast cancer.
“Statistics are fine until you’re the one who hits the end of the bell curve,” Acquarelli said.
Hadduck said she was perfectly willing to go through the anxiety of additional procedures to get some peace of mind.
But it was not to be. On Oct. 20, Hadduck’s doctor gave her the bad news. Cancer.
The cells showed invasive ductal carcinoma, the most common form of cancer in women.
Hadduck was at work when she heard. She cried at first. She called Jerry. Then she went home and called her 30-year-old twin sons, Tom and Tyson Hadduck.
The next step: visiting a breast surgeon for a lumpectomy. Hadduck said her gynecologist expects it will be followed by chemotherapy.
Hadduck was hoping she would be among the 80 per cent of breast-cancer biopsies that turn out to be benign. She is scared, but grateful the cancer was discovered before it had progressed any further.
“I’m dismayed, scared, confused and worried. I’m also astonished,” she said. “I suppose someone has to be in the 20 per cent, but me? The me who eats salads for lunch every day, exercises, flosses and avoids squishy white bread?”