Connecticut Post (Sunday)
‘DO YOUR MAMMOGRAM EVERY YEAR’
Bridgeport woman’s case shows power of breast-cancer testing
Martha Chiaravalloti has undergone a mammogram every year since she turned 40. This year, the 56-year-old Bridgeport resident’s dedication to her breast-imaging exams has proven to be more crucial than ever.
In August, she was diagnosed with breast cancer after undergoing her latest mammogram. The early detection of her cancer paved the way for her to undergo successful surgery the same month at St. Vincent’s Medical Center in Bridgeport. Additional testing has allowed her to avoid chemotherapy and she now looks forward to a cancer-free future.
Chiaravalloti’s experience highlights the effectiveness of mammograms and other types of exams such as genetic and genomic testing in screening for and treating breast cancer, as survival rates have steadily risen in recent years. But breast cancer still looms as one of the leading causes of cancer deaths, so patients such as Chiaravalloti and medical professionals have been speaking out during Breast Cancer Awareness Month in October — and the rest of the year — about the importance of testing.
“My advice is for every woman, starting at 40 years old, to do your mammogram every year,” Chiaravalloti said in an interview at her home, which is a few blocks north of
“Women have to get their mammograms. A diagnosis is not a death sentence. We have so many more options. The outcomes have gotten so much better over the past three decades.”
St. Vincent’s Medical Center. “It’s very important.”
Importance of early detection
Chiaravalloti’s advice aligns with the recommendations of medical professionals at St. Vincent’s and other health care organizations that urge women with an average risk of breast cancer to start undergoing annual screening mammograms at age 40. Such exams are done for women who have no breast problems or symptoms such as lumps, pain or skin changes.
Reflecting the prevalence of mammograms and other imaging exams, the breast cancer death rate in the U.S. has steadily declined in the past 30 years. From 2011 to 2017, the five-year “relative survival rate” for women diagnosed with female breast cancer ran at about 90 percent, according to the National Cancer Institute.
“Women have to get their mammograms,” said Dr. Richard Zelkowitz, Chiaravalloti’s oncologist and regional medical director of the breast program for the Fairfield region for the Hartford HealthCare system, which includes St. Vincent’s. “A diagnosis is not a death sentence. We have so many more options. The outcomes have gotten so much better over the past three decades.”
Chiaravalloti’s breast cancer was first detected in her latest screening mammogram on Aug. 18, and then diagnosed through a breast biopsy the next day and follow-up diagnostic imaging.
“It was tough when they told me that I had cancer,” Chiaravalloti said. “The first two days (after diagnosis), it was horrible — I was crying, I was screaming. I thought I was going to die. But after two days, I felt better. I didn’t know what was going to happen, but I knew I was in good hands.”
The diagnosis came early enough to enable the removal of the cancerous tissue with lumpectomy surgery, which
Chiaravalloti underwent on Aug. 27. In September, she started a four-week course of radiation treatment.
As the COVID-19 pandemic has abated in recent months in Connecticut, demand for preventative services such as mammograms has surged. Much of the increased turnout reflects appointments from patients who were either unable or unwilling to receive in-person treatment during earlier stages of the global health crisis.
St. Vincent’s does not yet have publicly available data on screening mammograms for 2021 and 2020, but hospital officials said in a statement that “patients have been returning in increasing numbers for screening mammograms throughout 2021.” In 2019, about 4,000 screening mammograms were carried out at St. Vincent’s.
Throughout the Yale New Haven Health system — which includes Greenwich, Bridgeport and Yale New Haven hospitals — about 8,900 mammograms of all types were performed in September, up about 10 percent from the approximately 8,100 mammograms performed throughout the system in September 2020.
More personalized care
Dr. Richard Zelkowitz, regional medical director of the breast program for the Fairfield region for the Hartford HealthCare system
Other tests are also helping to boost breast cancer survival rates and offer more personalized treatment.
Chiaravalloti underwent Oncotype genomic testing to further analyze her tumor. Using a specimen that was part of the tissue removed during her lumpectomy, the genomic analysis helped doctors determine that she would not need chemotherapy, but that she would benefit from hormone therapy after she completed radiation.
Based on the size of her tumor, Chiaravalloti likely would have been given chemotherapy had she been diagnosed in an earlier generation, according to Zelkowitz.
“In 1990, we basically said with any tumor that was bigger than a centimeter, you got chemotherapy. With the advent of these (genomic) tests — particularly the Oncotype — we’ve learned that it’s not just about the anatomy but more about the biology of the tumor,” Zelkowitz said. “It has allowed us to understand the disease better and thus give a lot less chemotherapy to people who, in retrospect, do not need it.”
Avoiding chemotherapy came as a major relief to Chiaravalloti, a former deli clerk at the BJ’s Wholesale Club store in Stratford. She now focuses on taking care of her house, where she lives with her husband, Teodoro Chiaravalloti.
“I was afraid to have the chemo because I was worried about losing my hair and having other problems,” Chiaravalloti said. “I felt much better when I found out I didn’t need it.”
She said her Catholic faith — seen in religious ornaments displayed throughout her house — has been instrumental in helping her manage the stress of the past couple months. She also credited the support of her husband, who is a retired butcher.
“I feel great,” Teodoro Chiaravalloti said. “We’re putting this behind us and now just taking it one day at a time.”
Impact of genetic testing
Many patients screened and treated for breast cancer also undergo genetic tests. Such assessments commonly use blood or saliva samples.
Chiaravalloti’s genetic testing showed that her cancer was not caused by a genetic mutation.
“I knew it was going to be negative because in my family we don’t have a history of cancer,” Chiaravalloti said.
“But it’s still good to know.”
About 5 percent to 10 percent of breast cancer cases are believed to be hereditary, meaning they result directly from mutations that are passed on from a parent, according to the American Cancer Society. The most common cause of hereditary breast cancer is an inherited mutation in the BRCA1 or BRCA2 gene.
“Any new patient who comes to us gives their family history,” said Dr. Barbara Ward, medical director of the breast program at Greenwich Hospital. “So from the very first time we meet them, you’re thinking about the possibility of genetics. It’s inherent in the initial and ongoing evaluation of patients.”
Demand for genetic testing in cancer screening and treatment is contributing to the growth of companies such as Stamford-based health care information firm Sema4.
“What we’ve learned over the last few decades is that there are definite inherited genes that increase the risk of a woman getting breast cancer. It may be up to 10plus percent of women who have one of these risk genes,” said Dr. William Oh, an oncologist and Sema4’s chief medical science officer. “If you know that up to 10 percent of women may actually have a genetic risk and can identify that risk, then you can potentially intervene early and save that woman’s life. That’s really why genetic testing is so important.”
Moving in a ‘positive direction’
Despite the advances in testing and treatment, female breast cancer still comprises the fourth-leading cause of cancer deaths in the U.S., according to the National Cancer Institute. Only lung and bronchus, colorectcal and pancreatic types account for more cancer fatalities.
An estimated 43,600 women in the U.S. will die from female breast cancer in 2021, accounting for 7 percent of all cancer deaths in the U.S., according to the NCI. Between 2015 and 2019, women aged 65 to 74 accounted for the highest percentage, 24 percent, of female breast cancer deaths.
“We still have a huge way to go,” Zelkowitz said. “The mortality of breast cancer has decreased, but we’re still losing women to breast cancer — and that’s just unacceptable.”
In 1990, Zelkowitz’s mother died of breast cancer, at age 58.
“If I think back to when I went into practice — which was just about before she passed away — what we have now compared to what was available then in diagnostic, therapeutic and supportive care is worlds apart,” Zelkowitz said. “The testing has shifted the curves in a positive direction.”
Chiaravalloti’s case attests to that progress. “I would assume her breast cancer has been cured,” Zelkowitz said.
After finishing radiation on Oct. 21, Chiaravalloti started medication-based hormone therapy last week that will last five years.
In addition, testing will continue to play a vital role: Chiaravalloti will undergo a mammogram at least once a year.
Confident in the treatment she has received from St. Vincent’s, Chiaravalloti is now looking forward to resuming with her husband some of their favorite pursuits such as traveling. Next summer, they hope to make their latest visit to Chiaravalloti’s native Colombia. The couple have a condominium in her hometown of Cartago, about 200 miles west of the capital, Bogotá.
“I feel strong,” Chiaravalloti said. “The St. Vincent’s team has been amazing. I’ve had so much support from them. I’ve always believed in them.”