Imagine being diagnosed with breast cancer at age 90 and choosing to undergo a double mastectomy and a five-year treatment to prevent recurrence. That’s what is happening with one of my patients from Sherman, Texas – Dr. Mary Jo Tonelli.
I first met Dr. Tonelli more than 20 years ago. She’d had a long and successful career as a public health director in both California and Texas, dealing with a variety of public health issues ranging from family planning to vaccinations, and she had become a strong advocate for annual breast cancer screenings.
Annual mammograms make a difference
It was after one of those annual screenings in 2002 that Dr. Tonelli’s mammogram showed changes that required a needle biopsy. The biopsy revealed atypical cells that could be a precursor to malignancy. We have a lot of experience with that at the Center for Breast Care. Surgery confirmed the high-risk diagnosis, and no cancer was found.
Because of her concern about side effects, she chose not to follow up with a five-year regimen of tamoxifen, the breast cancer prevention treatment of choice at the time. In order to detect any change as soon as possible, I advised her to continue her annual mammograms, which she has faithfully done, making the 70-mile trek from Sherman to Dallas every year.
Dr. Tonelli’s strong will and perseverance have guided her through life, including her most recent challenge – fighting breast cancer at age 90. In February of this year she found a lump through a breast self-exam; the lump could be seen on her mammogram and proved to be cancer.
Her MRI showed cancer in both breasts, but fortunately the cancers were low grade. Biopsies showed us that one of the cancers was HER2-positive. HER2 is a protein that promotes the growth of cancer cells. Drugs that inhibit the HER2 protein can slow or halt the cancer growth.
Researchers have identified many cancer mutations, which allowed us to develop more specific treatments. It’s a good example of how research is an important complement to the best care and can help us better understand what causes breast cancer.
Cancer drugs for older women
Our multidisciplinary team meets to coordinate patient care so that we have all the specialists needed around one table to identify the best options for treatment. For Dr. Tonelli’s care, our team of experts recommended exemestane as the optimal treatment.
Exemestane is a daily pill that is a type of hormonal therapy called an aromatase inhibitor. For postmenopausal women, exemestane is now one of the preferred treatments. Dr. Tonelli agreed with the recommendation and soon will be taking exemestane, which may be needed for as long as five years.
Of course, we’ll monitor her closely to ensure that her body continues to tolerate the treatment. But overall, Dr. Tonelli remains in good health and continues to stay active. She enjoys volunteering at her local hospital, where she pops popcorn for visitors every Friday. On Mondays, she takes part in Meals on Wheels, which delivers food to the homes of elderly people who can’t get out. Though nearly everyone on Dr. Tonelli’s route is younger than her, you can see how much they depend on her. A little inspiration can go a long way.
Do you want to make a difference in our community, like Dr. Tonelli? Visit our volunteer information center to find out how you can help brighten the day for local cancer patients.