Screening for Breast Cancer
- Registered dietitian Vanessa Rissetto, 45, was diagnosed with Stage 1A HER2 triple-positive breast cancer after suffering from itchy breasts for months. Now, cancer-free, she’s urging others to take action sooner than later when it comes to your health.
- Triple-positive breast cancer (TPBC) is a subtype of HER2-positive breast cancer where the tumor cells have estrogen receptors, progesterone receptors and a larger than normal number of HER2 receptors on their surface. The protein HER2 manages how cells grow and divide.
- To learn more about HER2-positive cancer, which is classified as an invasive and often fast-growing type of cancer, check out SurvivorNet’s guide to help you through in the weeks and months after your diagnosis.
- Trying to catch breast cancer at the earliest stages requires that people prioritize breast self-exams and breast cancer screenings. There are many different recommendations regarding when people should start getting mammograms, but all women should talk with their doctor about the benefits and harms of mammography as well as when and how often they should be screened based on their individual risk factors.
Rissetto, a registered dietitian and CEO of Culina Health, and “TODAY” Show nutrition expert, admitted in a recent interview with TODAY.com that she was aware “itching can be a sign of cancer” and decided to go see a doctor when the discomfort persisted.
Read MoreIt was then one of her friends suggested she see a dermatologist, thinking it was “eczema,” but the steroid she was given didn’t cure her itchy breasts.View this post on Instagram
She recounted being itchy for months until she changed her primary care physician and had a third mammogram, which led radiologists to see something that needed attention.
Three days later, she was told by the radiologist that the calcifications found in her breast needed to be biopsied and “could be something, or it could be nothing.”
About a week later, on May 26, 2023, she was informed she had stage 1A HER2 triple-positive breast cancer. She was also told that due to there being no tumor, and only calcifications, her treatment plan would consist of surgery, chemotherapy and radiation.
Triple-positive breast cancer (TPBC) is a subtype of HER2-positive breast cancer where the tumor cells have estrogen receptors, progesterone receptors and a larger than normal number of HER2 receptors on their surface, typically referred to as ER-positive, PR-positive and HER2-positive. Depending on which type you have, it determines your specific course of treatment.
Rissetto explained, “This is kind of, like, woo-woo, but I would wake up in the middle of the night and I would go to the bathroom and look at myself in the mirror and I’d be like, ‘I have cancer.’
“And I felt crazy because everybody was like, ‘You don’t,’ but I knew there was something wrong.”
View this post on Instagram
Despite getting answers, she decided to seek multiple opinions to “get the whole picture” on her diagnosis.
Rissetto, who had her first surgery on June 14, 2023, said, “maybe a week later, my surgeon said, the pathologist doesn’t like these margins, and I need you to go in again,” so she underwent a re-excision surgery about three weeks later.
Soon after she had chemotherapy infusions every three weeks and underwent 16 rounds of radiation. She had a followup mammogram on December 1, 2023, which was clear, and finished her treatment plan this past Spring. Now she’s cancer free and urging others to make necessary breast screening appointments.
Rissetto pointed out that although she lives a healthy lifestyle of not drinking alcohol, not smoking, no drug use, and daily exercise, that she still fell victim to cancer. However, she still works to inspire others to eat healthy, exercise, and be their own advocate when it comes to their health.
In honor of breast cancer awareness month, she wrote in a recent Instagram post, that “as a survivor” she wants to “remind you to schedule your screenings & preventative care! Things can be booked out so don’t wait too long. Get to it!”
She added, “This post is very raw. I’m ok but I am not great and I think sometimes we just have to know that’s okay. I am grateful to be alive no doubt but this sickness has definitely tested me.”
View this post on Instagram
Understanding Triple-Positive Breast Cancer
According to MD Anderson Cancer Center, triple-positive breast cancer is a type of breast cancer that occurs when breast cancer cells use estrogen receptors, progesterone receptors and the human epidermal growth factor 2 (HER2) protein to grow.
“Triple-positive breast cancer is a subtype of HER2 positive breast cancer; it accounts for about 10 percent of all breast cancer diagnoses.”
Treatment for HER2-Positive Breast Cancer
Breast medical oncologist Jason Mouabbi, M.D. told MD Anderson Cancer Center in an earlier interview that symptoms of triple-positive breast cancer are similar to other types of breast cancer.
Dr. Mouabbi said, “A lump is the most common symptom. Sometimes, very early-stage breast cancer can only be detected on a screening mammogram. That’s why it’s so important to get your breast cancer screenings.”
“With an IHC [immunohistochemistry] test, we’ll stain the tissue and look at it under a microscope. We’re staining for the estrogen receptor, progesterone receptor and high levels of HER2. If all three of them come back positive, the patient is diagnosed with triple-positive breast cancer.”
Some positive news on this type of breast cancer is that it’s “very responsive” to offered therapies. Dr. Mouabbi told MD Anderson Cancer Center that “triple-positive breast cancer has a more favorable prognosis” and “patients with triple-positive breast cancer who respond to treatment have excellent five-year survival rates.”
Know the Signs of Breast Cancer
Stage three breast cancer, the type Vanessa Rissetto was diagnosed with, typically refers to a relatively large tumor that may have invaded nearby skin or muscle tissue. It may also mean that lymph nodes near your breast and/or under your armpit are involved.
In most cases, stage three breast cancer will need chemotherapy. If the cancer is also hormone receptor-positive, aggressive hormonal therapy may be offered as well.
It’s always important to try and catch the disease at the earliest stages and requires that people prioritize breast self-exams and breast cancer screenings.
What is Stage Three Breast Cancer?
There are many different recommendations regarding when people should start getting mammograms. An independent panel of experts called the U.S. Preventive Services Task Force recently changed their guidelines to say that women of average risk should begin with screenings every other year starting at age 40, but other organizations like the American Cancer Society say “women between 40 and 44 have the option to start screening with a mammogram every year.”
Still, there is a consensus that all women should talk with their doctor about the benefits and harms of mammography as well as when and how often they should be screened based on their individual risk factors.
According to the National Cancer Institute, “Women with risk factors for breast cancer, such as certain changes in the BRCA1 or BRCA2 gene or certain genetic syndromes may be screened at a younger age and more often.”
Talk to your doctor about an individualized screening plan and ask questions like whether or not you have dense breasts and if a 3D mammogram is right for you.
To have dense breasts means you have more fibroglandular tissue and less of the fatty breast tissue. This can make it more difficult for a regular mammogram to detect cancer, so a 3D mammogram, which looks at the tissue in several layers, may better detect cancer.
In addition, make sure you’re performing breast self-exams. SurvivorNet advisor Dr. Elizabeth Comen says breast cancer prevention and awareness begin with making sure women are comfortable with their breasts and knowledgeable of what they feel like normally.
Getting to Know Your Breasts with Self-Exams
“For some women, that may mean going to their doctor and walking through what a self-breast exam might feel like so that they know what normal breast tissue feels like, so that if they do feel anything abnormal whether it’s a lump or discharge from the nipple that they know what to ask and what to look for,” she said.
During a breast self-exam, SurvivorNet recommends you look for changes like:
- A new lump in the breast
- New swelling in the breast
- Changes to the nipple (such as puckering)
- Flaking or redness in the breast or nipple
- Discharge (including blood) coming from the nipple
- Pain in the breast
Don’t hesitate to talk to a medical professional if you have one or more of the symptoms above. You never know when addressing a change to your breasts could lead to a serious diagnosis.
Processing a Breast Cancer Diagnosis
SurvivorNet’s medical experts explain that it would be very out of the ordinary if you weren’t scared after a diagnosis. Anxiety and fear are totally normal reactions to the news that you have breast cancer. Acknowledging these emotions can be therapeutic and important to the healing process.
So how do you confront your fears without letting them take over entirely?
- Let your family and close friends know and let them help. So many cancer survivors tell us they want and need support but are often too preoccupied to make specific requests. Urge those close to you to jump in with whatever practical help they can offer.
- Keep a journal. It can be extremely cathartic to let those feelings loose on paper. Grab a pen and a nice journal and chronical your different thoughts throughout the day.
- Join a cancer support group. There are groups in nearly every community offering opportunities to connect with others going through a similar journey. You’ll learn incredibly helpful insight from others who can tell you about what to expect and how to stay strong on tough days.
- Consider seeing a therapist. Ask your doctor to refer you to a therapist so you can discuss your fears and concerns in a safe space. Often, vocalizing your thoughts and feelings rather than internalizing them can provide relief.
Above all, just know that there are countless resources and support here for you to turn to at any time. Here is SurvivorNet’s breast cancer guide to help inform you in between your visits. Hopefully this will help spark some of the many questions you will have for your doctor.
Pushing For A Correct Diagnosis
When it comes to your health, be a little pushy. You know your body better than anyone else. When you see a doctor for a problem, don’t hesitate to make sure that your question is fully answered and that you are comfortable with the plan moving forward. From a doctor’s perspective, every problem should have a diagnosis, a treatment, a plan for follow-up, and a plan for what happens next if the treatment doesn’t work.
As a patient, if you don’t feel like each of these four things has been accomplished, just ask! Even if it requires multiple visits or seeing additional providers for a second opinion, always be your own advocate.
Dr. Zuri Murrell, director of the Cedars-Sinai Colorectal Cancer Center, previously told SurvivorNet that healthcare guidelines are meant to do the right thing for the largest number of people while using the fewest resources.
“The truth is you have to be in tune with your body, and you realize that you are not the statistic,” he said.
Be Pushy, Be Your Own Advocate. Don’t Settle
Dr. Murrell says not every patient will “fit into” the mold, so it’s important to “educate yourself and be your own health care advocate.”
“Every appointment you leave as a patient, there should be a plan for what the doc is going to do for you, and if that doesn’t work, what the next plan is,” Dr. Murrell said. “And I think that that’s totally fair. And me as a health professional that’s what I do for all of my patients.”
Cancer Research Legend Urges Patients to Get Multiple Opinions
Furthermore, getting another opinion may also help you avoid doctor biases. For example, some surgeons own radiation treatment centers. “So there may be a conflict of interest if you present to a surgeon that is recommending radiation because there is some ownership of that type of facility,” Dr. Jim Hu, director of robotic surgery at Weill Cornell Medical Center, tells SurvivorNet.
Other reasons to get a second opinion include:
- To see a doctor who has more experience treating your type of cancer
- You have a rare type of cancer
- There are several ways to treat your cancer
- You feel like your doctor isn’t listening to you, or isn’t giving you good advice
- You have trouble understanding your doctor
- You don’t like the treatment your doctor is recommending, or you’re worried about its possible side effects
- Your insurance company wants you to get another medical opinion
- Your cancer isn’t improving on your current treatment
Bottom line, being proactive about your health could be a matter of life or death. Learn as much as you can from as many experts as you can, so that you know that you did your best to take control of your health.
Contributing: SurvivorNet Staff
Learn more about SurvivorNet's rigorous medical review process.