Mindy Ricioli was 33 when she saw an episode of Oprah on television that made her take the lump in her breast a little more seriously. Located near her left armpit, she had noticed it off and on for about four months but thought it was a cyst because there was no history of cancer in her family.
The Oprah episode was about a woman named Erin Kramp who, after learning she had advanced-stage breast cancer, recorded a series of videotapes to impart a mother’s wisdom — life lessons she would not have a chance to personally share with her daughter.
After watching the show, Ricioli, a Santa Rosa mother and wife, decided to have the lump looked at just to be sure.
“I think I was kind of making excuses. I was in denial,” Ricioli said, admitting that from the moment she first felt the lump, its presence was always somewhere on her mind.
That fall of 2010, she found out she had invasive ductal carcinoma, the most common form of breast cancer. She said her life passed before her eyes.
“When they said it wasn’t a cyst, I was trying to be hopeful that it wasn’t cancer, but I was so scared,” she said.
“My husband, he’s a numbers guy. He would look up the statistics for a 33-year-old getting a diagnosis. ... That helped me when you think about those odds, they’re in your favor.”
Increasingly, that is true about breast cancer, which is diagnosed annually in an estimated 253,000 American women, or 1 in every 8 U.S. women in their lifetimes, according to the National Breast Cancer Foundation.
Though still a formidable disease — it killed more than 40,000 women in the U.S. in 2014, including 66 in Sonoma County, according to the latest data available — more women diagnosed with breast cancer are now living longer lives.
The trend is causing a shift in how breast cancer is perceived among both survivors and their health care champions, one where the disease is increasingly viewed as a chronic illness that can be managed, like heart disease or diabetes.
“The issues that breast cancer survivors face are not unique to any of the other cancer diagnoses — it’s just that their potential of surviving is higher,” said Rose Cook, breast care coordinator at the Kaiser Permanente Santa Rosa Breast Care Center.
Kaiser’s Breast Care Center treats a significant share of the county’s new breast cancer cases. Each year, the center averages about 200 new cases, Cook said.
The mortality rate, adjusted for age, for breast cancer patients in Sonoma County has declined in the past three decades, from almost 33 deaths per 100,000 women in 1988 to just under 18 deaths per 100,000 women in 2014.
During that period, the rate of new breast cancer cases averaged about 138 per 100,000 women.
Statewide, the incidence of breast cancer among women has declined 10 percent while mortality rates have declined 37 percent since 1988, the year the California Cancer Registry began collecting such information.
While odds of survival are in favor of many women diagnosed with breast cancer, health professionals and patient advocates say they are careful not to minimize the risks and suffering caused by the disease.
“I personally just say ‘I’m here for you if you want to talk,’ ” said Ricioli, 39, now cancer-free and co-facilitator of a local young women’s cancer group. “The truth is I don’t know what’s going to happen. I don’t want to say anything like, ‘Oh, it’s all going to be OK,’ because that doesn’t validate what they’re going through.”
She underwent a year of chemotherapy, a double mastectomy and breast reconstruction.
Her support group, a program of Sutter Pacific Medical Foundation, meets twice a month and is open to anyone in the community, including Kaiser Permanente and St. Joseph Health patients. It is geared toward women younger than 45 who are newly diagnosed or still in treatment.
Many are young mothers, in the early stages of their careers or even dating. Their most frequent questions: Will I lose my hair? What is life like after treatment? What do I tell my family, my kids?
“They want to hear all the positive stories out there,” said Ricioli, who found fellowship and strength in Sutter’s Catwalk for a Cure, a popular fundraiser that supports services for those fighting cancer. This year’s event is Friday at Luther Burbank Center for the Arts in Santa Rosa.
“It’s amazing to be amongst all the survivors and women who have also been through cancer,” she said, adding that the gathering is also a sober reminder of those whose lives ended too soon.
“I’ve met so many amazing people who unfortunately have passed away because of cancer,” Ricioli said.
When she was diagnosed with breast cancer, her two daughters were 8 and 9 years old. Now they’re 14 and 16. She said honesty was a “top priority” in her family and she was forthcoming with her daughters from the start.
“I was pretty much able to tell my kids that I would be OK,” she said. “I told them there’s a treatment plan and everything the doctor has suggested has a good outcome.”
When Cindi Cantril started working as a cancer nurse in the early 1970s, the mortality rate was quite high for cancer patients. During the 1980s and 1990s, the term “cancer victims” was gradually replaced by “cancer survivors,” a term that extends from diagnosis to the “balance of life.”
“It’s really a broad experience of the cancer continuum — living with, through and beyond diagnosis,” said Cantril, director of cancer support services and patient navigation for Sutter Pacific Medical Foundation. “What I tell patients is that more and more patients are either cured or considered living with a chronic disease.”
Sutter’s cancer support services seek to offer comprehensive support for patients, starting from the moment they are told they need a biopsy. Patients are assigned a nurse navigator who helps them schedule appointments and guides them through each step of treatment.
“They think the worst part is going through treatment, when in fact ending treatment can be very anxiety producing,” said Cantril.
Cook, Kaiser’s breast care coordinator, also called out that stage of the process, where the patient transitions between oncology care and regular medical care.
“It’s a very scary gray area and confusing for the patient,” she said. “This is one of the reasons why these survivorship programs are becoming more and more important.”
The National Cancer Institute estimates there were 3.3 million women in the United States living with breast cancer in 2014, while about 12.4 percent of women will likely be diagnosed with breast cancer at some point in their lifetime.
The earlier breast cancer is found, the better the woman’s chance of survival.
According to the American Cancer Society, the share of women with stage 0 or 1 breast cancer who will live at least five years — known as the five-year survival rate — is close to 100 percent.
Those with stage 2 breast cancer have a five-year survival rate of about 93 percent, while those with stage 3 breast cancer have a five-year survival rate of 72 percent.
Breast cancers that have spread to other parts of the body are more difficult to treat. Stage 4, or metastatic, breast cancers have a five-year survival rate of about 22 percent, though there are still a number of treatment options for women with this stage of cancer.
Dr. Ujwala Rajgopal, a surgeon and past chairwoman of the American Cancer Society’s board of directors for California, said survival rates in the mid-1970s used to be about 70 to 75 percent. The overall rate now is close to 90 percent, she said.
“If you look at early diagnosis it’s about 98.9 percent if it’s localized to the breast,” she said. “Overall, survival rates have improved dramatically.”
Advances in screening, cancer diagnosis and treatment have all led to better survival rates, Rajgopal said. Key to early detection is a woman’s awareness of the changes in her body, she said.
“Every woman needs to be in tune with what their body normally feels like,” she said. “As soon as she notices this lump, she needs to take note of the size, the consistency — firm or soft, is it like a gummy bear versus hard marble, is it pulling on the skin anywhere, is it puckering, is there nipple discharge. Take note of it, be mindful of it and make a plan to meet with a doctor as soon as possible.”
Rajgopal said women should investigate and know their family history and whether they have a record of breast or other cancer.
“We all have cancer cells floating in our body. Our immune system usually takes care of it but in some situations it does not,” she said. “That’s why screening and early detection is extremely important. ... If it does get found early, then the survival rate is dramatically higher.”
You can reach Staff Writer Martin Espinoza at 707-521-5213 or firstname.lastname@example.org. On Twitter @renofish.