As the wife of family medicine physician Ricardo DeNapoli, D.O., of the Sutter
Medical Foundation, Julie DeNapoli is no stranger to the importance of staying healthy
and scheduling regular medical visits. Given her family's history of breast cancer,
DeNapoli is especially vigilant about mammograms and monthly breast self-examinations.
Last year, as a part of her routine preventive care, DeNapoli, a Vacaville resident, went in for an exam and scheduled a mammogram as a follow-up to her annual visit. Her mammogram came back normal and negative for cancer, which is always good news. Weeks later during a women's health visit with Diane Griffith-Parker, certified nurse midwife, DeNapoli discussed her mammogram results. Because of her family history, Griffith-Parker suggested that DeNapoli take part in a Breast Cancer Risk Assessment as a follow-up to the mammogram.
"This tool is used to assess women who are 35 years of age and older, and are concerned about their risk for developing breast cancer," Griffith-Parker says.
The Breast Cancer Risk Assessment Tool, designed by scientists at the National Cancer Institute, is composed of eight questions that take about five minutes to answer via an online form. The questions are intended to assess a woman's risk of developing invasive breast cancer in her lifetime. If the results from the test indicate that a patient's risk is more than 20 percent, additional testing is recommended.
Having full faith in Sutter Health and her caretakers, DeNapoli agreed to take the assessment. As a former project management consultant for Sutter Health and its affiliates for 15 years, she knew she was in good hands.
Upon completion of the Breast Cancer Risk Assessment, DeNapoli was deemed "high-risk" for developing breast cancer. Griffith-Parker referred her for a breast MRI, which was covered through DeNapoli's insurance because of her risk status. The results of this advanced imaging procedure showed abnormalities, specifically two suspicious spots on DeNapoli's right breast.
DeNapoli went in for an MRI-guided biopsy to take samples of the tissue. One tumor was found to be benign. The second biopsy results indicated that her cancer cells were at stage zero — or ductal carcinoma in situ (DCIS). She underwent a lumpectomy with Sutter Medical Group surgeon Alicia Silva, M.D., to remove the area where the biopsy showed DCIS. After surgery, the samples were sent to a pathologist for further evaluation.
Contrary to the findings from the MRI biopsy, DeNapoli's post-surgical tissue samples revealed that only a small amount of the tumor was DCIS. Instead, the majority of the tumor was invasive ductal carcinoma — or stage one cancer. DeNapoli's case was presented by her oncologist, Melissa Williams, M.D., to Sutter Cancer Center's Tumor Board to discuss treatment options. Tumor Board care providers meet monthly, working together to manage patient cases to determine the best course of treatment for patients on a case-by-case basis.
"By working together in a multidisciplinary approach, we are able to provide the best care possible for our patients," Dr. Silva says.
Fortunately, all of the DCIS and invasive cancer was removed during the first surgery, and DeNapoli did not need any additional breast surgery. Because her cancer was invasive, Dr. Silva recommended that her lymph nodes be tested using the less-invasive sentinel lymph node technique. When presented at the Tumor Board, the participating care providers agreed. DeNapoli went in for her second surgery to have her sentinel lymph nodes sampled, which only required a small incision near her underarm.
With lymph node testing, doctors are able to determine if cancer cells had spread. Luckily, DeNapoli's cancer had not spread to her lymph nodes. After the second surgery, she continued her course of treatment with an abbreviated three weeks of radiation as opposed to the standard six weeks.
"Julie was very lucky in terms of the sequence of events because the cancer was caught early," Dr. Silva says.
As a follow-up to her treatments, DeNapoli is undergoing genetic counseling and continues to take an oral medication to keep cancerous cells at bay. She attributes her positive outlook and prognosis to the care she received at Sutter Health, and specifically the care and attention to detail provided by her women's health provider, who suggested the risk assessment.
"Who knows what would have happened if I had waited a year," DeNapoli says.
Her hope is that other women will feel empowered to ask follow-up questions after a normal mammogram if there is a strong family history of breast cancer. Take the Breast Cancer Risk Assessment and ask if an MRI is appropriate to enable early detection. If you have any questions about your risk for developing breast cancer, schedule an appointment and talk with your healthcare provider.