Case Study

Breast Cancer Case Studies

Case History 1

Sue (not her real name), a 69 year old female, visited Dr. Steven Drosman’s office on 6/14/06 for her annual well woman exam. She underwent the HALO® Breast Pap Test,

producing Nipple Aspirate Fluid from her left breast. On 6/19/06 her HALO sample was viewed by a pathologist, with findings of atypical cells present. Sue’s prior screening

mammograms were all normal. She was then referred to a surgeon who requested that she have a diagnostic mammogram and ultrasound of her left breast before seeing

him. She had the diagnostic mammogram and ultrasound on 8/07/06 which showed “no solid mass or dilated duct.” On 8/21/06, he noted that she did not have a family history,

she had a low risk of breast cancer on the Gail model, and no suggestion of cancer whatsoever. Then, on 9/20/07, as part of Sue’s follow-up, she had a digital mammogram.

There were noted calcifications in the 12 o’clock position of the left breast and a follow up digital mammogram with spot magnification was ordered. On 10/20/07, Sue’s follow up

mammogram confirmed microcalcifications in the 12 o’clock position of the left breast and she was scheduled for a stereotactic core biopsy of her left breast on 11/2/07. The

results of the biopsy were Ductal Carcinoma in Situ (DCIS). The patient was then referred to a surgical oncologist who recommended surgery and radiation therapy.

 

Comments by Dr. Steven Drosman

Sue is like so many of my patients who have no identifiable risk factors for breast cancer.

In the past, we’ve had to just wait for lesions to develop that were large enough to be

seen on a screening mammogram or to be felt on a breast exam. Cellular atypia is a

significant risk factor for developing breast cancer. HALO® helps us stratify patients

according to risk level so we can get the right women to the breast specialists for follow

up, with the goal of catching abnormalities earlier in the disease process.

 

Comments by Sue

I’ll be honest, the abnormal HALO results initially caused me some anxiety, but it was so worth it! It made me much more conscientious about breast exams and getting my

mammograms on time, plus I had the benefit of consulting with a breast specialist.

Thanks to HALO my cancer was caught early before it had a chance to spread beyond the milk duct, and my prognosis is great.

 

Case History 2

Atypia Finding Prompts Follow up That Identifies Lesion

When Judy visited her ObGyn for her annual well woman exam in October 2008,

her recent breast health history was problematic but not overly concerning. She

was 46 with no family history or other risk factors for breast cancer. A routine

mammogram had revealed an abnormality—a calcification in her left breast—

which a follow-up spot compression mammogram had confirmed. The

microcalcification was in the same area as a cyst that had been detected by

breast ultrasound the year before, so the radiologist recommended a stereotactic

biopsy of the left breast.

NAF Result Convinces Patient to Undergo Biopsy

Before deciding to undergo the biopsy, Judy scheduled an appointment with

ObGyn Jigisha Upadhyaya, M.D. for a well woman exam. During the exam,

Dr. Upadhyaya suggested she take the HALO® Breast Pap Test and Judy agreed.

The pathologist analyzing the test results found atypia in Judy’s left breast.

Based on those results, Dr. Upadhyaya strongly recommended that Judy

undergo the biopsy.

“HALO increased my suspicion that something was wrong,” Dr. Upadhyaya says.

“It helped me recommend more forcefully that Judy go after the biopsy.

Ordinarily, she might have ignored the radiologist’s recommendation because

she had no symptoms.”

According to Dr. Upadhyaya, the HALO results also motivated the radiologist

and the surgeon performing the biopsy to be more aggressive in their pursuit of

an answer. The initial biopsy was negative. Without HALO, they might have

stopped looking at that point and recommended another mammogram or

ultrasound in six months. Instead, a second biopsy was performed, which found

atypical papillary hyperplasia, a pre-cancer that the pathologist believed might be

DCIS (ductal carcinoma in situ).

HALO Provides Critically Important Factor

The lesion was removed by lumpectomy in December 2008. Judy also received

three weeks of radiation therapy as a precaution. She agrees with Dr. Upadhyaya

that the HALO results were the critical factor in motivating her to go forward with

the biopsies that ultimately found the lesion. “If I had not had the HALO test, I

might not have thought the situation was serious enough to do anything about

it,” she says. “I tell people this machine saved my life.”

Presented by:

NeoMatrix

 

 

 

 

Case History 3

 HALO Atypia Prompts Woman to Enter Program for High-Risk Patients

Tracy, 44, had more than the usual reasons to be conscientious about her breast

health. Her mother had pre-malignant breast lesions and her mother’s identical twin

sister had breast cancer.

Tracy’s two mammograms prior to her June 2008 well woman exam had both been

negative. When Tracy visited her Ob/Gyn for the exam, her physician recommended

the HALO® Breast Pap Test to her, telling Tracy that she took it annually to help

monitor her own breast health. Tracy decided to take it, as well.

Atypia Leads Ob/Gyn to Refer to Surgeon

Tracy’s right breast secreted nipple aspirate fluid (NAF) during the test, and the

pathology report showed mild atypia. That atypia identified Tracy as a patient at high

risk for breast cancer. On this basis, her Ob/Gyn referred Tracy to Alice Police, M.D.,

a breast surgeon whose practice supports NAF testing with HALO and

offers a breast cancer prevention program for high-risk patients.

Dr. Police found that Tracy had yet another risk factor: extremely dense breasts, which

can also obscure cancer on a mammogram. She ordered three imaging exams for

Tracy: a mammogram, an ultrasound, and an MRI. Correlating the results of these

exams, Dr. Police concluded that Tracy had abnormalities in both breasts and that the

two abnormal areas in the right breast were suspicious for cancer. She recommended

surgery to remove the right breast abnormalities.

The surgical pathology report showed that Tracy had three papillomas in her right

breast that were benign. Still, Dr. Police felt that Tracy’s risk profile including the atypia

justified increased monitoring and further testing. She referred Tracy to a genetic

counseling program. She also recommended that Tracy be examined and have breast

images taken every 6 months, rotating between a mammogram and an MRI. Tracy

quickly agreed to follow the recommendations.

Praise from Patient and Physician

Tracy is grateful for the role HALO played in getting her into a prevention/monitoring

program. “I feel fortunate to have been exposed to the HALO test and think it is a

proactive and incredibly valuable tool,” she says.

Dr. Police believes HALO may have helped save Tracy’s life. “HALO was critical in

identifying Tracy as a high risk patient,” she says. “We’re now following her in a highrisk

follow-up program and are likely to catch any cancer very early. It is unlikely she

will ever die of invasive breast cancer because she will be followed so closely.”

 

Case History 4

HALO Atypia Causes Enhanced Surveillance, Leading to Early Detection

64-year-old post-menopausal Anna had a HALO Breast Pap Test in March of

2008 as part of her well-woman exam. She produced nipple aspirate fluid

from her right breast with cytology findings of mildly atypical ductal cells.

She had been having regular mammograms, all of which were normal, but

her sister had a history of breast cancer. The patient was then referred to the

breast surgeon who ordered a mammogram and breast MRI, which were

both normal.

In October of 2008, a follow-up bilateral screening mammogram and right

breast ultrasound were both negative.

As part of Anna’s annual gyn exam in March of 2009, she again underwent

the HALO test, but this time she produced a large volume of bloody fluid

from her right breast. Again the cytology showed atypical ductal cells. Followup

bilateral mammogram and right breast ultrasound were both negative.

However, based on the abnormal HALO findings another MRI was done.

Abnormalities Visible on MRI One Year Later

This time two areas in the right breast were suggestive of malignancy.

Subsequent ultrasound-guided biopsies of the two lesions confirmed ductal

carcinoma in situ (DCIS). Anna underwent a lumpectomy and sentinal node

biopsy with pathology showing well-differentiated infiltrating ductal

carcinoma measuring 0.5 cm in diameter. She has subsequently undergone

radiation therapy and is about to begin systemic hormonal treatment.

Risk Assessment May Save Lives

“Her chance of survival is very high because of the early diagnosis. Had the

cancer been discovered at a later time it is likely that her prognosis would be

less favorable. I credit HALO for my patient’s early breast cancer detection

and subsequent treatment” says Anna’s gynecologist, Dr. Robin Wedberg.

 

 

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