It’s difficult not to be happy in the presence of Southern Pines resident Elsa Pioquintoricardez.
Her ever-present smile and infectious laugh exude joy and perfectly hide her difficult past and recent bout with breast cancer.
Elsa, a patient at FirstHealth of the Carolinas, told her story to educate women about breast cancer as part of National Breast Cancer Awareness Month, a campaign held every October to increase awareness of the disease and the importance of early detection.
Elsa moved to Southern Pines from Mexico 20 years ago.
“I was forced to migrate here for my safety,” Elsa said and described how her former husband abused her and caused her to lose a child. “Security and safety are much different in Mexico than in America. I couldn’t get any help, and leaving was my only option.”
She traveled to Southern Pines because her aunt was already living here. Elsa said she loves “living in a fabulous country where they accept me with open arms.” Shortly after she arrived in Southern Pines, she met her now husband, Luis, who Elsa said showed her what it means to love.
One day in 2020, Elsa came home from work, and Luis hugged her. She felt pain in her left breast. In the shower, she explored the painful area but dismissed it. A year later, she saw her primary care doctor and requested a mammogram.
“That’s when the top blew off,” she chuckled.
In January 2022, Elsa had a mammogram that confirmed lumps in her breast. A follow-up ultrasound and biopsy revealed advanced stage 2 breast cancer.
Many of Elsa’s family members died from cancer, so Elsa underwent genetic testing to see if her type of cancer was inherited. As it turns out, her breast cancer was not due to her family history. However, for people whose cancer is inherited, doctors can use the results of genetic testing to develop precise, individualized treatment plans for their patients.
Elsa’s biopsy results also revealed that she had triple-positive breast cancer, a somewhat unique form of the disease. Most breast cancer tumors are hormone-positive, which means they grow in response to either or both of two hormones, estrogen and progesterone. A smaller number of tumors are positive for these hormones plus HER2, a protein that promotes cell growth. This was Elsa’s tumor type, triple-positive.
“With something that rare, I considered buying a lottery ticket,” Elsa joked.
Due to having both hormone-positive and HER2-positive cancer, Elsa required a triple-threat treatment plan to combat estrogen, progesterone and HER2. In early March, she started a regimen of chemotherapy and HER2 therapy (commonly grouped under the single term “chemotherapy”) that lasted for 13 weeks.
On June 27, she underwent a lumpectomy to remove the tumor. After reviewing the removed tumor, it appeared there was still some cancer left behind, so surgeons performed another surgery on July 13 to remove the remaining tumor. Radiation followed every weekday for four weeks to kill any remaining cancer cells.
Now Elsa receives targeted chemotherapy to combat the HER2 protein, thereby inhibiting cancer growth, by intravenous (IV) infusion every three weeks until March 2023. In addition, she will also take Tamoxifen, a pill therapy, for at least five years, to block estrogen and progesterone’s ability to attach to cancer cells and fuel their growth. “The last few weeks have been difficult, but I’m not throwing in the towel,” said Elsa, a cook who has worked at local favorites Pine Crest Inn, Chef Warrens, and Meat and Greek.
The importance of early detection
“The earlier we detect and treat breast cancer when it’s small and hasn’t spread, the greater a woman’s chance at recovery, said Laura Hanson, M.D., Elsa’s medical oncologist. Screening tests like a mammogram are the best way to find cancer at an early stage.
Dr. Hanson says that, in general, women should start getting annual mammograms at age 40. However, for women with a family history of breast cancer or who have a known BRCA1 or BRCA2 gene mutation (based on genetic testing), doctors may recommend mammograms starting at age 30.
In addition to getting an annual mammogram, Dr. Hanson encourages women to be aware of and contact their doctors if they experience any signs and symptoms of breast cancer, including:
- New lumps that feel like a hard knot or a thickening in the breast or under the arm
- Nipple tenderness or discharge that may occur suddenly, be bloody or occur in only one breast
- Physical changes in the breast such as a nipple turned inward, a persistent sore or a change in the size or shape of the breast
- Skin irritation or changes, such as puckers, dimples, scaling or new creases
- Warm, red, swollen breasts with a rash resembling the skin of an orange
- Pain in the breast, particularly breast pain that doesn’t go away
What is breast cancer?
Cancer begins when cells change and grow uncontrollably, forming a tumor. Breast cancer starts in the breast cells and spreads as cancerous cells grow into nearby tissues or get into the blood or lymph fluid and travel to different parts of the body.
Breast cancer is the most common cancer type among women in the United States, after skin cancer. The American Cancer Society estimates that by the year’s end in the United States, 287,850 new breast cancer cases will be diagnosed in women, and 43,250 will die from the disease. In North Carolina, where breast cancer ranks at the top of all new cancer diagnoses, that breaks down to 10,220 new cases and 1,450 deaths. In recent years, deaths from breast cancer have declined, thanks to early detection efforts.
Breast cancer care in the Sandhills
Patients in the Sandhills have access to comprehensive breast cancer care at FirstHealth. The multispecialty team offers leading-edge screening and diagnostic imaging, breast biopsies, breast cancer surgery, medical and radiation oncology, genetic testing and clinical trials.
FirstHealth offers the region’s most advanced screening methods for early detection. In particular, the system offers 3D digital mammography (breast tomosynthesis), giving doctors a more detailed view to better detect breast abnormalities, even in dense tissue. This and other leading-edge technologies are available at all FirstHealth hospitals in Pinehurst, Raeford, Troy and Rockingham and at the FirstHealth Lee Campus in Sanford.
For patients with any cancer diagnosis, FirstHealth offers a deep and wide array of support services, including oncology nurse navigators who support and guide patients through their cancer journey. Additional assistance includes a financial navigator, nutritionists, social workers, support groups and spiritual counseling, cancer wellness programs, CARE-Net volunteers and other supports as necessary.
Through funding provided by The Foundation of FirstHealth, people with cancer may receive financial assistance to help cover hospital bills and pay for gas for numerous treatment trips. While Elsa did accept help from the Cancer CARE Fund to help with hospital expenses, she declined assistance for gas.
“I don’t like to abuse help,” she said. “I can still work some, and that pays for gas,” she said.
When FirstHealth’s Comprehensive Cancer Center opens in early 2023, all cancer services will be under one roof.
“This cancer center will change the face of cancer care in the Sandhills and become a hub of cancer care across the area for decades to come,” said FirstHealth Chief Executive Officer Mickey Foster, MHA.
In addition to diagnostic and treatment services, the new, four-story Comprehensive Cancer Center will be home to more nurse and financial navigators, multidisciplinary clinics, expanded genetic testing and clinical trials, grief counseling and outpatient palliative care. More space also means more support services, including meditation, yoga, chaplaincy, exercise, massage, and canine and music therapies.
While Elsa’s treatment may be complete by the time the Comprehensive Cancer Center opens, she will likely have follow-up care in the new facility, spreading sunshine there, too.
“I have to see my life with happiness,” she said. “My family thinks I never take things seriously, but I’m just optimistic.”
Part of her optimism comes from her care at FirstHealth.
“I thank God for everyone at FirstHealth,” said Elsa. “Everyone, from the beginning of my treatment to today, has made me feel loved and like part of their family. And that has helped me to keep moving forward.”
FirstHealth is celebrating National Breast Cancer Awareness Month by offering a free pink manicure kit with a mammogram at any FirstHealth facility in October. Find locations at www.firsthealth.org and call 866-415-2778 to schedule. Women can also contact their primary care provider for a mammogram referral.