Learn how our region’s hospitals are helping women and their families achieve a better quality of life.
It can be scary to know the truth about your health.
Knowing that you have cancer, or knowing you have a high-risk pregnancy – it most certainly increases your worries. But knowledge of the unpleasant is essential, since it leads to proactive care.
Utilizing knowledge and compassion, the health centers in our region deliver quality care to women in all stages of life.
Genetic Testing for Breast Cancer
Thank God Tammy Hautamaki went in for a routine mammogram earlier this year.
The 58-year-old didn’t notice anything out of the ordinary when she went to her appointment last January at OSF Saint Anthony Medical Center. But after a radiologist saw a suspicious spot on her mammogram, Hautamaki had a follow-up biopsy and was shocked to learn she had an aggressive tumor in her breast.
“No one wants to hear the word cancer,” she says. “It’s scary because you’re facing the unknown. The moment of your diagnosis, you don’t know what it means, how bad it is, or what’s next.”
Within minutes of hearing her diagnosis, Hautamaki and her husband Bruce met with Nurse Navigator Lisa Bruno, who gracefully communicated the ins and outs of the diagnosis. She also explained that OSF has a genetic program with a company called Cancer IQ.
This past February, the American Society of Breast Surgeons came out with a recommendation that all women diagnosed with breast cancer should undergo genetic counseling and testing. To keep up with this recommendation, all women who receive routine mammograms at OSF answer eight screening questions related to their health and family history. If their answers indicate risk, they’re referred to undergo genetic testing at OSF’s Patricia D. Pepe Center for Cancer Care.
“I told Lisa that my mom had breast cancer, and she also died of pancreatic cancer,” Hautamaki explains. “So, Lisa asked me if I’d want to do genetic testing, and while we were sitting in the same room, she called and got me set up with an appointment to get that done as soon as possible. Because as soon as you know your genetic results, the sooner you and your doctor can decide what route to take for treatment.”
Next, Hautamaki met with Peggy Rogers, a nurse practitioner at OSF who conducts genetic risk assessments for cancer.
Rogers was able to dive further into Hautamaki’s personal and family history.
“There’s an online program we have patients fill out, and the company again is called Cancer IQ,” Rogers explains. “We’re always interested in what someone’s ancestry is. For example, is there any Jewish ancestry? Because one in 40 Ashkenazi Jews can have a BRCA mutation in their genes. Most women have heard about that mutation thanks to Angelina Jolie, when she shared about having a BRCA 1. That really opened up a lot of doors for genetic counseling because women became more interested in finding the gene.”’
Hautamaki sat down with Rogers and went through her family history and personal health history. The genetic testing itself was simple and quick.
“It was super easy – I just went to the OSF Cancer Center and got a blood draw,” Hautamaki says. “And during it, Peggy explained what they were looking for, what it would mean to me, what they might find or not find, and why it’s important to have done.”
BRCA 1 and BRCA 2 are considered high penetrance genes, meaning if someone inherits these gene changes, their chances of developing breast cancer are in the 60-80% range, Rogers explains. Within the past six to eight years, testing has expanded to include more genes, like moderate penetrance genes, which indicate a 20-40% likelihood to develop breast cancer.
Rogers sent Hautamaki’s blood sample out for DNA testing to look for any suspicious gene changes.
“We probably use three or four companies and they have very reliable results,” Rogers says. “Results usually take about two to four weeks to get back, depending on the size of the panel.”
Hautamaki’s results showed that she did not have the BRCA gene or any DNA changes. In fact, her results didn’t indicate a predisposition for any type of cancer. It was surprising to Hautamaki, who was anticipating otherwise.
But according to Rogers, it’s rare to actually find the BRCA mutation.
“The thing about genetic testing that I think people misunderstand is that there’s only about a 5-10% chance we’re going to find a gene change, because we only know about a third to a half of the genes that contribute to breast cancer,” Rogers explains. “So just because you have a negative test doesn’t mean there’s no risk for getting cancer. We explain to patients that it is often due to an undiscovered gene with less risk than the ones we know of.”
But still, negative results from a DNA test can be useful when combined with knowledge of one’s family history. Empiric risk (statistical) models can help predict someone’s lifetime breast cancer risk. If a woman’s lifetime breast cancer risk is 20% or greater, they are eligible for heightened surveillance, which includes a breast MRI alternating with a mammogram every 6 months, Rogers says.
Women who do have BRCA 1 or 2 mutations are oftentimes recommended for a bilateral mastectomy, or having both breasts removed, since there’s a high risk of the cancer returning. Knowing that Hautamaki didn’t have the BRCA gene, she and her doctor came to the conclusion that a lumpectomy procedure would be the best course of action.
Hautamaki’s journey unfortunately didn’t end there, since her doctor found DCIS (ductal carcinoma in situ) in the margins of her breast after the lumpectomy procedure, meaning she still possibly had cancer. After undergoing 11 weeks of chemotherapy, a bilateral mastectomy procedure and the start of reconstruction surgery, she only just recently returned to her job at OSF as the supervisor of central scheduling. To say “It’s been a long year” is an understatement.
“It makes me more empathetic to people with any kind of chronic illness. Having been so sick myself, I wonder how people get by when they’re sick every day. It makes me really want to help those people,” Hautamaki says.
Rogers recommends that women start getting screening mammograms at age 40 and have them done annually.
“I think sometimes people are afraid of mammograms, but if I hadn’t gone to get one, then that aggressive tumor would’ve grown and spread.” Hautamaki says. “And yes, this is a lot that I’ve been through. But it was caught early, and it was treatable, and that made all the difference.”
“Knowledge is power,” Rogers adds. “If somebody has questions or concerns, they should call us. We’re here to help.”
High Risk Pregnancy
Getting pregnant isn’t easy for every woman. But knowing that you’re ready to begin a family is a big milestone in itself.
“I think it’s great when a woman knows she’s ready to begin her family planning,” says Dr. Dennie Rogers, maternal fetal medicine specialist at Mercyhealth. “It’s always a smart idea to seek a pre-conception consultation. That way we can optimize the pregnancy and decrease the risk factors that could be associated.”
It’s best for hopeful mothers to begin management of chronic conditions, such as severe anemia, diabetes, hypertension and kidney disease, before getting pregnant. Rogers can help patients navigate these and other chronic conditions before and during pregnancy. Usually, diet modifications and pregnancy-friendly medications are necessary.
But sometimes, perfectly healthy mothers can experience high-risk pregnancies if complications develop with the baby.
“It can be things ranging from multiple births, so the mother may have twins or triplets, or maybe the baby develops some type of abnormality, like a cleft lip or palate,” Rogers explains. “It can also be that the baby develops with an abnormal genetic blueprint, so chromosomal abnormalities. But these are things that we can absolutely manage so the baby is born healthy.”
Rogers is also prepared to step in if things go wrong in the delivery room. Sometimes, an entire pregnancy can be healthy for both the mother and baby, but complications may develop as the baby arrives.
“It could be problems with the mother’s heart, thyroid, blood pressure – we take care of those things as well,” Rogers says.
Once a woman becomes pregnant, regular appointments with an obstetrician are crucial to monitoring the health of both the mother and baby. The mother’s blood pressure, weight, and blood work/labs are all watched closely in case anything falls outside of the range for what’s normal. Ultrasounds in each trimester are routine to monitor the health of the baby.
For high-risk pregnancies, mothers can most certainly expect adjustments in medication, more ultrasounds, more specialists involved in prenatal care, more in-depth instructions for delivery, and, depending on the severity of the situation, instructions for lifestyle modifications.
“Each patient is different and every situation is unique,” Rogers says. “And, you know, the conversations aren’t easy. The first step, of course, is to be transparent, to be honest, and to be empathetic. Realize that the parents are afraid and they’re counting on you as the expert to tell them what’s going on and to walk them through the process. We share the good possibilities that can occur, but sometimes we also have to share what the reality is.”
“I try to work with families to have reasonable expectations, but at the same time I never take away hope,” she continues. “No matter how much we know in the medical profession, we don’t know everything. There’s always hope.”
The majority of high-risk pregnancies end in a good outcome, at least for Rogers’s patients. It helps that the quality of ultrasound technology has improved and genetic testing has become more widely available. The biggest factor is a mother’s access to health care in both the pre-conception and pregnancy time frames, Rogers adds.
“As soon as people come to our unit, they’re nervous, their thoughts shift to something negative. But we can absolutely have successful outcomes,” Rogers says.
This specific form of depression may just be the most stigmatized of all, since having a new baby is always challenging. New moms are recovering from childbirth, adjusting to significant hormonal changes, coping with sleep deprivation and learning how to care for their new baby. So, in the first few weeks it’s normal to experience some sadness and mood changes, or “baby blues.”
Generally, this resolves on its own in a few weeks, says Dr. Diana Kenyon, a gynecologist at Mercyhealth. But, if symptoms last longer than this and start to interfere with a mom’s ability to function day-to-day, postpartum depression should be suspected.
Kenyon treats a fair share of women who experience postpartum depression, since the mental health complication occurs in about 10 percent of women who have given birth.
“We often think of a person with depression as someone who sits around feeling sad and crying all day, but it is so much more than that,” she says. “I describe it as ‘emotional exhaustion’ that begins to interfere with one’s ability to function.”
Women with postpartum depression have a significantly decreased ability to enjoy life with their new baby and may feel an inability to connect with their baby, Kenyon adds. A mom with postpartum depression may exhibit significant anxiety about the health of her infant, a lack confidence in her ability to care for her baby, or a lack of interest in her baby. Sleep changes are also common, including insomnia.
“Postpartum depression can last up to a year or more in some patients,” Kenyon says. “Getting help with either counseling or medication can help achieve recovery sooner, but it’s important to continue treatment until your medical provider feels it’s safe to stop.”
It’s unclear why some women get postpartum depression and some women don’t. But, it’s important for women to develop a postpartum plan with their doctor if they’ve experienced postpartum depression before, since up to 50 percent of women can experience it again.
“Counseling is a great first step for treating postpartum depression,” Kenyon says. Mercyhealth’s Social Work Department is available for mothers to discuss counseling options. The hospital also has a Perinatal Anxiety and Depression Support Group that serves as a resource for pregnant moms and new parents who are experiencing these disorders.
“It can be very helpful knowing that you are not alone in how you are feeling, and also have the opportunity to connect with others who are in a similar situation,” Kenyon says. “In more severe cases, medication may also be needed. There are many medication options which are safe in breastfeeding moms as well.”
After having a baby, it’s extremely important for moms to be honest with how they’re feeling, Kenyon adds. Having postpartum depression does not make you a bad mom.
“We screen all women for depression during and after pregnancy with a standardized questionnaire, and the unfortunate thing is that many will not report or be honest about the symptoms they are experiencing,” Kenyon says. “There is still a huge negative stigma surrounding postpartum depression, but there doesn’t have to be. If you are experiencing these symptoms, discuss them with your health care provider. There are ways to get help.”