Ringwood Okla. — Michelle Schmidt was in her mid-30s when she found a lump in her breast during a self-examination.
The discovery led to the early detection of breast cancer, the most commonly diagnosed cancer in women in the United States and the second leading cause of cancer death in American women, according to the American College of Obstetricians and Gynecologists (ACOG).
A mother’s fear
Schmidt, who lives south of Ringwood with her husband Scott and their three children, said when she heard the diagnosis her greatest fear was for her kids: “you fear that you’re not going to see your kids raised.”
“My husband’s great, but can he do a pony tail — not really,” she said with a laugh. “It’s all the small things a mom does. You just want to see your kids’ graduations and weddings.”
She’s confident she’ll have that chance, because she caught her cancer early.
Treatment at University of Texas MD Anderson Cancer Center and surgery to remove the tumor, followed by ongoing care in Enid at the former Dexeus Oncology Center, successfully brought Schmidt into remission.
She credits her breast self-exam with leading her to get a mammogram to check the lump, a measure not recommended for most women until they’re in their 40s. She said it was her breast self-exam that gave her a fighting chance against the cancer.
“I’d have never found mine,” Schmidt said. “The only reason I found my cancer was because I did a self-exam.”
Being proactive about her care and requesting the mammogram was instrumental in treating the cancer early, and successfully, she said.
“My personal doctor told me if I’d brought it to him first he probably would have told me not to worry about it because of my age,” Schmidt said. “I’m really thankful I went in to get it checked right away. I feel blessed because I’ve at least been given a chance.”
While Schmidt credits her breast self-exam with leading her to detect and successfully treat her cancer, new medical guidelines are leading women away from self-examination.
Breast self-exams, long a mainstay of early detection recommendations for women, now are not recommended by ACOG and the American Cancer Society (ACS).
ACOG changed the guidelines this summer, citing stress placed on women by false-positive breast exams.
“Breast self-examination is not recommended in average-risk women,” ACOG stated in a July bulletin, “because there is a risk of harm from false-positive test results and a lack of evidence of benefit.”
ACS also changed its recommendations to not recommend self-exams, effectively reversing course on years of marketing campaigns urging women to conduct breast self exams.
Recommendations also became less clear for physical breast exams conducted by a physician.
The July ACOG bulletin states there are conflicting guidelines from ACOG, the National Comprehensive Cancer Network, ACS and the U.S. Preventive Services Task Force on whether or not to perform clinical breast exams in women at average risk of breast cancer.
Clearing up the confusion
Courtney Vetter, M.D., who specializes in obstetrics and gynecology with Integris Bass Baptist Health Center, said there still are some general guidelines women can follow to detect breast cancer early.
Vetter recommends a breast exam performed by a physician every one to three years for women ages 25 to 39, and annually for women 40 years and older. She said women should discuss the costs and benefits of a mammogram with their doctor, and have a baseline mammogram at age 40, followed by a mammogram at least every two years after age 40 and annually after age 50.
She said the intent of the changing guidelines on self-exams and clinical exams appears to be avoiding unnecessary treatments and stress surrounding false-positive cancer screenings.
“There’s a large number of women who have biopsies that are benign, and that comes with a lot of stress,” Vetter said.
She said the new guidelines favor weighing the cost of that stress against the benefits of early cancer detection.
“It does seem we are weighing more heavily the desires of the patient now,” Vetter said. “It’s more of a balancing act now of weighing the costs and benefits, and having more of an open discussion with your health care provider. It’s really about having that discussion with them, and saying ‘Here are the costs and benefits,’ and ‘Do you want to go down this path or not.'”
Vetter said that approach puts more onus on women to be proactive in their care, and to clear up confusion over the changing guidelines.
“The main thing I would tell them is recommendations have changed, and continue to change, and that can be a cause for confusion,” Vetter said. “To clear up that confusion, make sure you have an open conversation with your doctor, and ask questions.”
Take charge of your care
In light of the changing guidelines, and her own experience, Schmidt is urging other women to have that conversation with their doctor, and to be proactive about their self-care.
She’s seen firsthand the effects of waiting too long to get checked.
Several years before Schmidt was diagnosed with breast cancer her husband’s cousin, Marsha Schmidt, found a lump. Schmidt said Marsha did not immediately want to have it checked.
“Even when I talked to her she was scared to go and get checked,” Schmidt said. “Sometimes we think no news is good news, but that’s not the case with cancer.”
Marsha eventually did get checked, and the diagnosis was grim: she had stage four cancer. She underwent treatment, which Schmidt said helped give her several years with her family. Marsha died from her cancer last year, leaving behind her husband and four children.
Schmidt urged women to continue conducting self-exams, and to not wait until a benchmark age to get anything abnormal checked out.
“Do your self-exams and if something doesn’t seem right, don’t wait until they say it’s the right time to get checked,” she said. “If you feel there’s a problem go and get checked as soon as you can.”
Schmidt said getting check is good self-care for women; for women with families, it’s a duty.
“As a parent your goal is to at least get your kids graduated,” Schmidt said. “You have to take care of yourself to get there, so you’re really doing your family a disservice if you don’t get checked and take care of things.”
Continuing the fight
This January Schmidt’s cancer returned, but has not spread. She’s been undergoing chemotherapy, to be followed by a single mastectomy and reconstructive surgery.
Schmidt said overcoming the cancer is a daily fight, but she said women shouldn’t avoid screenings out of fear of treatment.
“Don’t be scared of chemo,” she said. “It’s not fun, but there’s lots of worse things that can happen. I told my doctor, ‘You can bring me to the brink of death, as long as you bring me back.'”
Schmidt said women also need to be open to support from their network of family and friends. With their help, and faith, she said there’s nothing that can’t be overcome.
“Don’t be afraid to ask for help, and rely on your faith, your family and your friends,” Schmidt said. “The Lord’s not going to give you anything you can’t handle, so if he thinks you can handle it, you can handle it.”