A chair and an IV pump await a chemotherapy patient in the infusion room at Central Peninsula Hospital.
Debbie Clonan sounds like she was made up, one of those medical worst-case scenarios used to scare patients into losing weight, stopping smoking or, in this case, getting a mammogram.
She has no family history of breast cancer. She did self-breast exams every month and never found a single lump, bump or abnormality to be worried about. She was faithful about getting yearly doctor exams. There was no reason for anyone to think she had cancer.
But she did, and if she hadn't had a mammogram when she did, it would have killed her.
"A mammogram saved my life, it truly did," Clonan said.
Mary Lee Kreger, a family nurse practitioner at the Planned Parenthood of Alaska clinic in Soldotna, reviews some paperwork. The clinic has an extensive breast cancer awareness program.
The 43-year-old Sterling Elementary School library aide moved from Michigan back to her childhood home of Sterling in 2003 with her husband, John, and daughters Carol, now 14, and Katie, 13. Shortly after the move she saw a doctor for her annual exam. She was 41, and the doctor said it was time for her first mammogram.
Forty is the age recommended for women without risk factors for developing breast cancer to get their first mammogram so it can be used as a baseline comparison to set what is "normal" for scans throughout the rest of their lives.
The Planned Parenthood of Alaska clinic in Soldotna has a great deal of literature on breast cancer and women's health available. Planned Parenthood will host a mammogram clinic Tuesday, Wednesday and Thursday. For more information, call 262-2622
But normal hadn't been the case for Clonan for quite some time.
"I got called back because they found something on the film," Clonan said. "As soon as I saw the mammogram film up on the X-ray box I knew I was out of luck. It was like, 'One of these things is not like the other.' There was this giant white starburst on the film."
Clonan became a human pincushion for a slew of biopsies and tests, which she did not pass with flying colors. Three weeks later a diagnosis was made: stage 3C triple negative invasive ductal carcinoma.
If the term sounds scary, it should. Ductal carcinoma is the most common type of breast cancer, but stage three invasive means it was as far advanced as it could possibly be without being stage four, which typically carries a death sentence.
Debbie and John Clonan, middle row, sit on the steps to their back porch with their daughters, front row, Carol, left, and Katie, and Deb's parents,top row, Julie, left, and Lee Bowman, and one of the family's dogs, Ginger. Debbie said family support was important in her battle with breast cancer.
Even at stage three, Clonan's prognosis was grim. But she decided early on not to apply the accepted diagnosis-to-life-expectancy equations to her cancer, or to anyone else's.
"I've also thrown statistics out the window because mine all sucked," she said.
She had cancer in three places in her breast. Her treatment involved a lumpectomy, sentinel node surgery, removal of 32 lymph nodes 27 of which were cancerous a grueling, nauseating six months of chemotherapy, a bilateral mastectomy and 33 weeks of radiation.
Her doctors estimated she'd had a tumor for five years before it was found. But it had soft ("feathered" in doctor-speak) edges so even knowing it was there, it wasn't detectable by touch. And breast cancer, except for the most extreme form, doesn't generate pain or other obvious symptoms. In retrospect Clonan marvels at the irony of a self-proclaimed worrywart having cancer for so long and not knowing it.
"All the (crap) I worried about for five years, and I had cancer," she said.
Without the mammogram, she wouldn't have known until it was too late, as it almost was. Since her tumor wasn't detectable by other means, Clonan is the poster patient for why mammograms are so important.
The American Cancer Society recommends women get mammograms every year starting at age 40. Women with risk factors for developing breast cancer should get their first mammogram in their 30s. ACS also recommends that women do monthly self-breast exams starting in their 20s and get clinical breast exams by a health care professional at least every three years until age 40, and every year after that.
When doing self-exams, it's important to do them at the same time every month and to look for any abnormalities, including puckering, dimpling, lumps and discharge, said Jacqueline Barsis, co-manager of the Planned Parenthood of Alaska clinic in Soldotna.
But self-exams don't catch everything, as Clonan's case proves, which is why mammograms are so important. Not only can the scans catch tumors that can't be felt, they can catch potential problems before they become cancerous.
"A lot of times if they find something suspicious they can remove it before it turns into cancer, if it's going to," Barsis said. "It's a very effective way of preventing breast cancer."
Under the "prevention is the best cure" heading, Planned Parenthood in Soldotna offers a variety of cancer-screening services to women. Nurse practitioners can conduct cervical cancer screenings and clinical breast exams, as well as teach women how to do exams themselves.
"It's important to realize that there are different stages we go through as women that require different kinds of care, and we provide that," Barsis said. "We care about women. That's what we do and we just want people to understand that."
A special grant program about five years ago funded a door-to-door campaign to educate women about the importance of mammograms.
A partnership between Planned Parenthood and the Breast Cancer Detection Center of Alaska in Fairbanks is taking that education to the next level. A few months ago the center sent certified technicians to do a mammogram clinic in the Soldotna Planned Parenthood office. In honor of October being Breast Cancer Awareness Month, Planned Parenthood will host another mammogram clinic Tuesday, Wednesday and Thursday.
As with all services at Planned Parenthood, the mammogram clinic is provided on a sliding fee scale. If patients have insurance that will cover the service, the clinic will bill insurance for payment. If insurance isn't an option and finances are tight, payment is determined by a client's ability to pay. Services may even be provided at no cost with the help of grant funding.
An appointment and doctor's order are required for a mammogram at the clinic, but Planned Parenthood will have a doctor available who can provide orders. An appointment is needed for the doctor, as well. The clinic also will attempt to accommodate last-minute requests. If a woman is unable to make it to the clinic, Planned Parenthood operates a grant program that helps women get mammograms year-round based on income eligibility.
Barsis said the emphasis on prevention has paid off. Since ramping up their outreach efforts in 2002, Planned Parenthood has increased the number of cancer screening exams it does and decreased the number of cancer diagnoses it has seen. Planned Parenthood hasn't seen a singe positive breast cancer diagnoses through its office since 2002.
"We've found that prevention is obviously the best medicine, and we have found over the years that our cases of breast cancer diagnoses have gone down in our clinic, considerably," Barsis said.
But there is no cure for breast cancer, or guaranteed way to prevent it. The American Cancer Society reports that about 178,480 women in the United States will have invasive breast cancer in 2007. About 40,460 women will die from it this year. A woman has a one in eight chance of having breast cancer sometime during her life.
When prevention fails and treatment is necessary, there are services available on the central peninsula.
It used to be a cancer diagnosis for a Kenai Peninsula resident was tantamount to exile. Patients had few options but to seek treatment in Anchorage or Outside. That is no longer the case. Advancements at Central Peninsula Hospital mean patients can undergo many kinds of diagnostic testing and chemotherapy treatment here. The infusion center at CPH also offers cancer education, a cancer support group and a loner closet from the American Cancer Society that provides wigs and breast protheses for patients who need those items.
Kathy Lopeman, an oncology certified nurse at the hospital, has been a driving force behind CPH's expanded cancer services and is the organizer of the two biggest fundraising efforts on the central peninsula that support cancer patients the Way Out Women smowmachine ride and the Relay for Life.
Lopeman's mother was diagnosed with colon cancer 18 years ago. Watching her mother go through what was available for treatment at the time left Lopeman at first disgusted, then determined.
"Her whole chemo regime made me think I didn't want anything to do with oncology. But a little voice in my head kept saying, 'If you don't like the way something's done, do something about it,'" Lopeman said.
The oncology center at CPH has grown from one room with two chairs seeing about 12 patents a week to three rooms and seven chairs averaging 50 to 75 patient visits a week for treatment and other services from all over the peninsula.
On Oct. 26, in honor of Breast Cancer Awareness Month, the infusion center will hold an open house with a tour, door prizes and breast cancer risk assessments that can predict the percentage of risk a person has of developing cancer in the next three or five years.
Lopeman is encouraged by how far cancer services have come on the peninsula, but said they haven't come far enough. For one thing, she'd like to see more space for treatment at the hospital to keep up with improving diagnostic abilities.
"I think there is better detection all the time," Lopeman said. "Twenty years ago we were still thinking, 'I have this ache or pain, but it's probably nothing.' Now I think people are more aware so they go in and there's better diagnostic equipment so they know. They find out earlier so we can better treat it. There's a better survivor rate."
Adding a staff oncologist and radiology unit at the hospital are the other big advancements Lopeman would like to see. Cancer patients will still have to travel to Anchorage or beyond until radiology is available locally. When it comes to fighting cancer, Lopeman believes it's a battle that should be fought on a patient's home turf.
"People do better when they're at home," Lopeman said. "They have less nausea, they're more relaxed, there's less side effects. Things just go better. Like the 'Wizard of Oz' there's no place like home."
Clonan had surgery and radiation treatments in Anchorage but most everything else was done locally through the infusion center at the hospital, which she raves about.
For Clonan, being home meant being with her husband and kids down the road from her parents off of Robinson Loop Road in the community she grew up in. It meant accepting get-well cards and lasagna after lasagna from people she's given food and well wishes to when they were in need. It also meant keeping a smile on her face when someone's attempt to be positive came out sounding anything but ("Not everyone dies of cancer anymore") because she knew they meant well and their heart was in the right place, even if their tact wasn't.
"I had no clue how many people loved me. I had no clue the kind of support a small community can give when you need it," she said. "I learned to allow people the blessing of doing something for you. ... People cared, and to me that was just people use the word awesome all the time, but I was awestruck by it, I really, truly was."
When her treatment was at its nauseating, painful, toenails-turning-black, hair-falling-out worst, being home meant the difference between still fighting and giving up.
"There were times where I absolutely couldn't do it anymore, and I'd get a phone call or card from someone who said they knew I could do it," Clonan said. "And I thought, if they know I can do it, I must be able to."
The struggle isn't over. Going on two years after her diagnosis, Clonan's body is cancer free, but her life isn't. She still suffers joint pain, numbness in her hands and feet, fatigue and the frustrating "chemo brain" effect that can cause forgetfulness, sleeplessness and short-term memory problems. She's also had to adjust to the specter of feat that becomes the cancer survivor's lifelong companion: What if it comes back?
"I now have canceritis," she said. "... If my eyebrow hurts I am absolutely convinced I have cancer of the eyebrow. Until proven otherwise any bump or bruise or twitch or ache is cancer until you prove it's not."
But she also still has her friends and family, who are there for whatever she needs. It's vital to have supporters who are optimistic with you when you feel that way or just listen and cry along when you don't. Clonan said thinking positive and having a sense of humor were important aspects of her treatment, but she had days where all she wanted to do was pull the covers over her head and cry. She wants others facing breast cancer to know that it's OK to feel either way, or both at the same time.
"It's the pretty pink ribbon cancer. We're women and we're supposed to make it better for everybody. But it sucks rocks. There are days you can't. ... Your only job is to stay as positive as you can in a given time and forgive yourself when you can't be positive."
Clonan has another job for women, one she is dead serious about: Get a mammogram.
"If someone is afraid to go get a mammogram, I will go with them. I will hold their hand. I will talk to them. To me the only good thing that has come out of this is the fact that I now know how important this stuff is, and I really feel that it is every survivor's job to get people tested," Clonan said. "I call myself the mammogram police because we are living proof that it can happen to anybody."
Jenny Neyman is a freelance writer who lives in Soldotna. She can be reached at firstname.lastname@example.org.
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