Dunmore woman diagnosed with cancer as surgery prep begins for elective bilateral mastectomy [The Times-Tribune, Scranton, Pa.]

Oct. 20--Breast cancer doesn't respect busy schedules.

It doesn't respect education or money, healthy habits, parenthood, careers or personalities.

It appears when it's least expected and least welcome, and it is a reality an estimated 299,220 men and women living in the United States will face upon diagnosis in 2013 alone.

October is Breast Cancer Awareness Month, and local patient Cassie Rose Kobeski-Schlittler recently shared the story of her ongoing battle with the disease in the hope that more area residents will seek preventive care and consider early detection methods as a precaution.

It's a choice Ms. Schlittler made prior to discovering her cancer this year, and one that likely saved her life.

Higher risk

During her yearly checkup with her OB/GYN in January, the Dunmore resident and her doctor discussed her family history, which included breast cancer diagnoses for her mother, Rose Kobeski; two aunts, Theresa Rinaldi and Joanne Murrin; and her maternal grandmother, Josephine Scrimalli. At 33, Ms. Schlittler was not eligible for coverage of a mammogram through her health insurance for another two years, but the physician recommended she undergo BRCA gene testing to better understand whether Ms. Schlittler was at higher risk for breast cancer.

Following a saliva swab, Ms. Schlittler found out a few weeks later that she was positive for BRCA 1 (a first cousin's results also came back positive). The wait for her results was a nerve-wracking time, Ms. Schlittler said, and she began to consider her options, including an elective bilateral mastectomy.

"I had come to the easy decision to have surgery if it was positive," the artist and educator explained.

Despite her healthy eating habits and regular exercise -- she was working to lose the weight she gained while pregnant with her daughter, Zoey, now 2 -- the gene mutation meant Ms. Schlittler was at an estimated 87 percent increased risk for breast cancer over her lifetime, according to her doctors.

"It was devastating knowing I had it and could pass it on to my daughter," she said.

Cancer discovery

From there, Ms. Schlittler met with an oncologist as a prevent-ive measure. Women who test positive for BRCA are encouraged to get mammograms or MRIs every six months, and the doctor sent Ms. Schlittler for what would be her first -- and last -- mammogram.

Though Ms. Schlittler felt healthier than ever, the photos showed two suspicious sites of microcalcifications, and she was scheduled for a stereotactic biopsy a few days later.

Ms. Schlittler and her husband, Eric, waited with bated breath for the results over a painful couple of days.

"I think I had this gut feeling (that it was positive)," she said. "I met with the biopsy doctor, and when they said 'I'm sorry, it's cancer,' I almost fell over."

The diagnosis was given on March 27, and just a few days later, Ms. Schlittler met with local general surgeon Dr. Joseph J. DelSerra, a family friend who had treated other relatives affected by breast cancer, to discuss her cancer and her options. At the conclusion of that meeting, arrangements were made for a six-hour procedure conducted on April 15, during which Dr. DelSerra performed a bilateral mastectomy and plastic surgeon Dr. Ira Krafchin followed with reconstructive surgery.

"It was the right decision for me and my family," Ms. Schlittler said. "It's such a life-changing event. It's physically and emotionally taxing, because as a woman, you identify with that (part of your body)."

The recovery was challenging for the new mother, but she began to feel more like herself after a couple of weeks.

Yet her journey to beating the cancer wasn't over. Local and University of Pennsylvania oncologists recommended chemotherapy, so Ms. Schlittler underwent eight treatments every two weeks from early June until late September.

"Chemo was the most difficult thing of the ordeal," she said. "You have low energy, nausea, losing your hair. That made me the most uncomfortable out of everything, because everyone else can identify me as sick."

Zoey knew to be extra gentle because "Mommy has boo-boos," and her husband gave unwavering support, but Ms. Schlittler was determined to gain some measure of power back on her own by reading up on and researching the disease.

"It was really important to me to empower myself," she said. "The lesson I learned is you have to be your own advocate. Being knowledgeable was very beneficial.

"For anybody, my message would be to trust your instincts and take advantage of preventative healthcare."

Dolly Woody, executive director of Susan G. Komen Northeastern Pennsylvania, agreed that it is important for women to take an active role in their healthcare.

"One woman every two minutes in the U.S. is diagnosed with breast cancer," Mrs. Woody said. "Every 13 minutes a life is lost.

"(Some) women are afraid, and fear can incapacitate people," Mrs. Woody added.

Mammograms are the best tool available for early detection of breast cancer, Mrs. Woody explained, though self-exams, MRIs and other methods can be helpful, too.

The local affiliate of Susan G. Komen For the Cure has given out more than $3 million in educational and screening grants since 1991, Mrs. Woody said, and offers options to women who do not have health insurance coverage for mammograms.

"Information is wonderful, but you need accessibility," Mrs. Woody said.

Building a support system of family, friends and fellow patients also is an important step on the path to recovery for people living with breast cancer. The Northeast Radiology Oncology Center in Dunmore hosts a support group for area women, and many general cancer support groups exist throughout the region.

Ms. Schlittler channeled her diagnosis into her art with a series of prints that juxtaposed classical compositions of ideal beauties with portraits of herself. She recently shared the pieces in a faculty show at Marywood University, where she teaches art part-time, much to the surprise of some of her colleagues, who were unaware of her ordeal.

"Some people didn't even know until they saw, but I did hear from others reaching out to me saying they're thinking of testing or have been tested," Ms. Schlittler said. "That's positive for me because it starts the dialog, which is what I wanted."

Ms. Schlittler said she now looks forward to her future more than ever, and treasures each small moment with her daughter as she continues her recovery. She plans to keep advocating for preventative healthcare even after she gets through her battle, and offered a word of advice to other young women who have not looked into their own risk factors.

"Know your family history, because even a generation or two can really affect your health," Ms. Schlittler said. "I do feel like a survivor at this point. I feel this new energy and see new possibilities. Had I not taken those steps, who knows what would have happened."

Contact the writer: [email protected], @pwildingTT on Twitter

Meet Cassie Rose Kobeski-Schlittler

Age: 33

At home: Lives in Dunmore with her husband, Eric Schlittler, and daughter, Zoey, 2. She is the daughter of Francis and Rose Kobeski, Dunmore.

At work: She is a part-time art instructor at Marywood University and an artist.

Breast Cancer Statistics

For women living in the U.S. in 2013:

232,340 new cases of invasive breast cancer

64,640 new cases of in situ breast cancer

39,620 breast cancer deaths

For men living in the U.S. in 2013:

2,240 new cases of invasive breast cancer

410 breast cancer deaths

In Pennsylvania, the rate of invasive breast cancer

(per 100,000 women) was 126 between 2005-2009.

Detecting breast cancer

The warning signs of breast cancer are not the same for all women. The most common symptoms are a change in the look or feel of the breast (including lumps, hard knots, thickening, swelling, warmth, redness, darkening, puckering, dimpling, change in size or shape) and/or a change in the look or feel of the nipple (including itchy, scaly rash or sores, pulling in or new, enduring pain) and nipple discharge.

Preventive Measures

n Mammograms

n Breast self-exams

n Gene testing

n Ultrasounds

n Breast MRIs

n Clinical breast exams

source: Susan G. Komen for the Cure

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