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Ask the Expert – What’s on the Horizon for Breast Cancer?


What’s on the horizon for breast cancer?

By Dr. Nimmi Kapoor

Research in breast cancer is very fast-paced with an emphasis on earlier detection and easier treatment regimens that minimize harm to patients. I make it a priority to “stay on-top” of the latest and best advances in these aspects of breast health and cancer care so I can give my patients the best advice.

Detecting breast cancer involves at least two aspects of science and technology: having the best equipment for screening and knowing who needs to be screened.  The revolution in breast cancer screening equipment has already made a big impact on early cancer detection.  Dedicated breast MRI has been the most sensitive method of detecting breast cancer for the past decade, however is still costly and, for some, like me, claustrophobic.  3D-mammography, or tomosynthesis, has proved to decrease call-backs (that awful phone call where they tell you they aren’t sure they found something, so they need to do some more testing) and it has a higher rate of detecting cancer.  Tomo, as many call it, is better than a regular mammogram and is starting to get covered by insurance more regularly.  Coming-up, I think we will hear more about molecular breast imaging which is kind-of going to be in the middle of 3D mammography and breast MRI in ability to detect cancer at it’s earliest stage.

Figuring out who, and when, to be screened is another challenge.  Recently, the USPSTF and ACS both changed guidelines for screening to suggest that average risk women should be screened at age 50 instead of age 40.  The real challenge is understanding who is average and who may have a higher risk.  We offer a sophisticated “Risk Assessment” program that takes into account personal and family history risk factors to give each woman personalized guidelines for screening.  For some women, this screening will involve genetic testing to identify a hereditary risk.  Genes, such as BRCA1 and BRCA2, are well-known to increase the risk of breast cancer over 50%, however we now know of over 30 genes that can be implicated in cancer development that can be inherited.  Multi-gene panel testing has now become part of standardized genetic testing for people who meet appropriate testing criteria.

As a surgeon, I have watched the history of breast cancer treatment expand and then condense to now eliminate some of the basic treatment regimens we used to apply to all patients.  Not everyone needs a mastectomy, or an axillary lymph node dissection, or radiation, or chemotherapy.  We have entered the era of “tumor genomics” to understand tumor biology so well that we can predict which tumors are more likely to recur and which are more likely to benefit from chemotherapy.  There are now research trials that randomize patients with Stage 0 breast cancer (DCIS) to no surgery and Tamoxifen only, with close observation of course.  Tumor immunology will also be up-and-coming as we learn to create individualized targets for each person’s cancer.

In all, I am still glad I chose to become a breast surgeon as all of these changes are fascinating and are sure to bring about improvements in care and longevity for today’s thrivers and tomorrow’s patients.


Volunteer Spotlight- Ann Houseal and Lauri Rivetti



Ann Houseal

Ten years ago, after losing my mother to cancer, I went to a Wellness Community “informational” meeting. By the time the meeting was over I was one of the Volunteer Co-chairs for the Holiday Homes Tour.

I have continued to give my time for many reasons but mainly because CSC provides comfort, support, and education to those affected by cancer for free. My efforts at CSC are usually based around the Holiday Homes Tour events. I have been one of the Co-chairs for the Volunteers on and off and have been one of the Co-chairs of the event for a number of years.

It has been such a pleasure working with such dedicated and compassionate people to produce this extraordinary weekend. It warms my heart to see the visitors and especially the survivors, smiling and enjoying the event. This is my small way of giving back and hopefully letting those struggling with this disease know that they aren’t alone in this battle. Then on Sunday night I can go home, put my aching feet up and be proud that we did our best to add another year to the Holiday Homes Tour tradition.


Lauri Rivetti

I have been a volunteer for 8 years.  I started out as a Docent, then became a Volunteer Co-Chair, and then have been the HHT Co-Chair for 4 years.  My husband is a colon cancer survivor of 21 years now.  Going through that with him in our early 40’s, with young children, was frightening.  I did not know about Cancer Support Community back then.  I wish I did.

My sister has been battling ovarian cancer for the past 8 years.  Watching her fight cancer every day is heart breaking.  I know the support from CSC helps cancer survivors, and those currently going through cancer, with education and comfort along the way.  During the Holiday Homes Tour, we see many guests, obviously battling cancer, come through our beautifully decorated homes, and see the smile on their faces, thanking us for the support they so desperately need.

Member Spotlight- Sherri Rosenthal


I first walked into Cancer Support Community Valley/Ventura/Santa Barbara (CSCVVSB) in November as a newly diagnosed breast cancer patient. I was given the name of a “Buddy” who I spoke to as I began my journey.

2013 was one of the hardest and most life-changing years of my life. I was dealing with the loss of my mom, when my then 28-year-old older daughter was diagnosed with thyroid cancer. On November 8, 2013, I was diagnosed with Invasive Ductal Cancer, stage I. The cancer was not visible on my mammogram because I had dense breast tissue. I had a follow-up ultrasound that clearly showed the cancer. From the moment I was diagnosed, I knew that a bilateral mastectomy (BMX) was the right surgery for me. My decision was reinforced when my genetic test results showed that I have the BRCA2 gene mutation. One of the biggest lessons I have learned is to always listen to your gut. I was very fortunate that my cancer was found very early and that I did not need chemo or radiation. I had my BMX in December 2013 with the first stage of reconstruction. I had several surgeries to complete my breast reconstruction, finally finishing in November 2014. My experiences helped my younger daughter when, again at the age of 28, she underwent a preventative bilateral mastectomy and breast reconstruction because she, as well, has the BRCA2 gene mutation and had already had a very large breast lump removed that was fortunately benign.

When I was diagnosed with breast cancer, I always knew that I would be okay. I took it one day at a time and have gotten through this journey easily especially because I kept a positive attitude. There is always a silver lining in everything that happens! I am a stronger woman since my breast cancer journey and truly value each day. I spread the word that further testing beyond mammogram is very important for women with dense breast tissue.

I found an online support group called after I was diagnosed. I met women from around the country and Canada, many of whom were also newly diagnosed while some were veterans of the BC journey. While enduring 5 surgeries in 11 months, these were the women I spoke to daily. They truly understood what I was going through. Before long, I became one of the seasoned ones offering advice and encouragement, especially to the young women. I had been fortunate to meet of few of these women in person. A coffee date usually lasted 2-3 hours.

After a while the contact we had with one another, although often daily, wasn’t enough. A large group of us became a private Facebook group, where we could send private messages and it gave us a better view into the everyday lives of these “friends”. We are there to support each other through the many medical issues that follow initial treatment for breast cancer and we have been able to celebrate wonderful occasions such as the birth of babies after cancer, weddings, anniversaries.

Soon the private Facebook group wasn’t enough either, so we started to plan a weekend getaway. A year in the planning, 28 of us breast cancer survivors, aged 35 to 65, (with a few children and husbands) met in Estes Park, Colorado on August 3, 2016. It’s hard to describe how incredible it was to finally be able to hug each woman and tell her how she had made the journey much easier. We had shared our darkest fears and our dreams for the future with each other and we discovered we had deep friendships far more valuable than those around us daily who “just don’t get it”!  Goodbyes were very difficult at the end of the long weekend, but we know we’ll see each other again. These are lifelong relationships founded in adversity but proof of the silver lining of getting and surviving breast cancer!


I believe that I got breast cancer so that I can help others. I am active in several other online support groups, lending an ear and encouraging newly diagnosed women or women suffering from the side effects of treatments, metastasis or just trying to get used to their “new normal”. I started to volunteer at the CSC twice a month at the front desk in October 2014. I love giving back and enjoy the opportunity to talk to patients and survivors. I participated in Cups for Courage in 2014, decorating my bra to represent the silver lining that is always there!

rosenthal3I decided to take on a larger volunteer job for Let’s Bake a Difference this year. I was the Baker Coordinator, communicating with the professional and amateur bakers, organizing the baked goods and making sure everything was set up for the judging of the goodies. I enjoyed working alongside the other volunteers and the amazing staff at CSC.

I now make the most of each day and consider myself more of a Thriver than a Survivor. However, I was constantly reminded of what I had been through and what I had lost every time I looked in the mirror and saw all the scars. I saw a national news report on a wonderful organization called (Personal Ink) that helps breast cancer survivors transform their mastectomy scars with tattoos. I realized that this was the answer for me. After multiple sessions with 2 different tattoo artists, I now have beautiful, colorful floral tattoos and a butterfly hiding my scars. I have been given back that which was taken from me! The bra I decorated for Cups for Courage 2016 is a representation of the tattoos I love! I am the local leader for Day Los Angeles this month where two very deserving survivors will get their tattoos. We are only one of 14 cities in the US and Canada where other women will have this empowering experience.


My days are busy volunteering for various organizations and spreading the word about dense breast tissue through, about transformative mastectomy tattoos through and about support for breast cancer patients through and the Cancer Support Community. I feel so fortunate to live in Westlake Village with my husband, a community of wonderful people with the incredible resources of the Cancer Support Community.