Duke Colleagues United in the Breast Cancer Fight

See how breast cancer – the disease that affects one in eight American women – touches lives at Duke as medical benefits open enrollment begins

A mammogram

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Mammograms are recommended for women starting at age 40. and are available at no-charge under employee plans.

Yes, her hair will fall out.

And no, with her Duke medical insurance plan, the family would not lose their house.

“My doctors told me I was going to be fine,” said Allen, 51, who underwent chemotherapy, a partial mastectomy and radiation treatments at Duke that left her cancer-free. “I just had to go with that.”

According to the American Cancer Society, roughly one in eight American women will be diagnosed with invasive breast cancer. The Centers for Disease Control and Prevention (CDC) reports that breast cancer is the second-leading cause of cancer death for women, and the leading cause of cancer death among Latino women. Black women have a higher rate of death from breast cancer than all other women.

At Duke, cancer is the top condition for staff, faculty, retirees, and dependents covered by Duke’s medical plans with breast cancer among the most common cancer diagnoses.

During her breast cancer journey, Eleanor Allen, center, was surrounded by the love of her husband, Dan, and their five children. Photo by Alex Boerner.

In addition to being Breast Cancer Awareness Month, October marks Duke’s annual medical open enrollment period, which begins today (Oct. 16) and runs to Oct. 27. Staff and faculty covered by Duke’s plans are equipped with preventive services from world-class caregivers and annual screening mammography, which is covered in full under all Duke medical plans.

This year, the U.S. Preventive Services Task Force proposed new guidelines, advising people who are assigned female at birth and at average risk for breast cancer to begin screening at age 40, rather than 50.

“Most doctors who work specifically with breast cancer care have always recommended starting screening mammograms at age 40 on an annual basis,” said Associate Professor of Radiology and Duke Radiology Division Chief for Breast Imaging Dr. Karen Johnson. “The evidence shows that, if implemented, this is what would save the most lives because screening mammography is how you catch breast cancer before it becomes a lump. And studies show that the smaller the cancer, the less likely it is to have spread.”

The National Cancer Institute projects that this year, roughly 43,170 Americans will die from breast cancer, which has shaped the lives of Duke colleagues. Here are some of their stories.

Community for Black Women

As a breast cancer survivor and Duke Cancer Center Patient Navigator, Valarie Worthy inspires others who face a breast cancer journey. Photo by Alex Boerner.

In 1999, Valarie Worthy, a Durham County Health Department nurse at the time, was diagnosed with cancer in her left breast. While she had helped people through their health crises, experiencing her own was terrifying, leaving her unable to imagine life beyond the diagnosis.

“Everything I learned in nursing school went out of the window. I was just a scared 40-year-old woman,” Worthy said.

Now cancer-free for two decades, Worthy gives patients hope as Duke Cancer Center’s Patient Navigator Manager.

“In the African American community at that time, people didn’t talk about cancer, it was like a death sentence,” she said. “I thought, if you get it, you die. Nobody talked about how you could make it through.”

Worthy is determined to be a face of survivorship for the Black community, which carries breast cancer hardship. While the Breast Cancer Research Foundation reports that gains in awareness, detection and treatment have led to a 43% decline in breast cancer deaths in the U.S. over the past three decades, the gap between the outcomes of Black and white women remains stark.

The American Cancer Society reports that Black breast cancer patients are 40% more likely than white patients to die from the disease. According to the Breast Cancer Research Foundation, Black women are more likely to face cancer risk factors such as diabetes, heart disease and obesity. They’re also less likely to have adequate health insurance or access to health care facilities for screenings, therapy and follow-up care.

In 2003, Worthy launched the Triangle chapter of the Sisters Network, a breast cancer survivorship community for Black women that provides support groups and outreach programs, such as knocking on doors of underserved neighborhoods, encouraging women to get mammograms.

“I learned early on that I had to make this part of my purpose,” Worthy said. “And so I learned how to talk to people
in a way that would make them lean in and not out.”

During her treatment at Duke, Worthy fought her cancer with chemotherapy, radiation, a lumpectomy and hormone therapy. Through her treatment, and ever since, she’s shared her story. She’s invited Duke experts to talk at her church about the importance of screenings and how to overcome barriers to care.

“My whole intent was to put a different face on what breast cancer looked like,” Worthy said. “I thought the best
 way I could convey that message was for people to see me live and in living color. There is life after breast cancer.”

Two Diagnoses within Two Years

After two bouts with breast cancer, Laura Bushong has learned how to savor happy moments, especially with her dogs. Photo by Alex Boerner.

At 52, Laura Bushong hadn't missed a yearly mammogram since age 40 and lacked a family cancer history. Yet, in March 2021, persistent soreness, redness, and an inverted nipple led her back to the doctor after an unremarkable mammogram a few months earlier.

An ultrasound-guided biopsy revealed that she had stage 3 invasive lobular breast cancer, which accounts for 10 to 15% of all invasive breast cancers, according to the Breast Cancer Research Foundation.

The disease’s slender, elongated tumor shape is hard to detect with standard mammograms in women with dense tissue, such as Bushong. A few weeks later, Duke surgical oncologist Dr. Laura Rosenberger shared additional news following the removal of Bushong’s right breast.

“Based on the pathology after the surgery, Dr. Rosenberger said, ‘You’ve probably had this anywhere from five to 10 years,’” said Bushong, Director of Professional Services for Duke University Health System. “That just floored me. I was like, ‘Are you kidding me?’”

The diagnosis marked the first of two breast cancer journeys for Bushong. By December 2022, she completed treatment and showed no remaining signs of the disease. Three months later, she was preparing for an 11-day trip to Japan when a routine mammogram detected stage 1 triple-negative ductal breast cancer in her left breast.

She didn’t let that stop her. In a cross-country excursion from Tokyo to Hiroshima, she took in the beauty of blooming cherry trees and visited Hiroshima’s
Peace Memorial Park. She began treatment again in May 2023, set to conclude this year.

“I refuse to allow the cancer to dictate my life,” said Bushong, who was raised in Wilkesboro, the only child of a corporate pilot and administrative assistant. “I'm not going to allow it to make me miserable. I’m going to be better than it is.”

Amidst the challenge, Duke’s medical plan and support from friends, family and colleagues buoyed her spirits. A rainbow mohawk wig lightened chemotherapy visits.

Bushong’s total out-of-pocket expenses for both breast cancer treatments amounted to $3,000, despite the overall $500,000 treatment cost. She also had minimal co-pays for weekly appointments and surgeries.

“My insurance was completely stress free,” said Bushong, who joined Duke in 2019.

A Son’s Fight

Through his research into breast cancer vaccines, Dr. Zachary Hartman, right, works to improve the lives of people with the disease, including his mother, Sandy, left. Photo courtesy of Zachary Hartman.

On a morning in March of 2020, Duke Associate Professor of Surgery Dr. Zachary Hartman was working from home when he got a call from his mother, Sandy Hartman.

Sandy, then 70, told him that after a recent mammogram, she’d been diagnosed with metastatic cancer that had spread to her spine, lymph nodes and beyond.

“I was completely floored,” Dr. Hartman said.

A Duke faculty member since 2012, Dr. Hartman is part of the Center for Applied Therapeutics team investigating cancer vaccines that could help patients’ immune systems attack their cancer cells to slow growth and give other treatments a greater chance of success.
It’s work he was inspired to take on after his father, Randy Hartman, waged a battle against prostate cancer before he died in 2012 at the age of 67.

With a second parent facing cancer, Hartman knew that improvements in care and potential breakthroughs meant his mother’s experience didn’t have to have a bitter ending. The National Cancer Institute reports that the 5-year relative survival rate for people diagnosed with breast cancer is 90.8%.

Three years after her diagnosis, Sandy enjoys spending time with her five grandchildren – who call her “Gaga” – and relaxing with a Stephen King book.

“I keep telling my grandchildren that it’s lovely being old,” said Sandy, now 73. “You get to sleep in if you want. You can more or less choose what you want to eat, watch whatever you want to watch on television, and pick whatever activities you want to do. It’s great.’”

A cocktail of drugs has kept the cancer from growing, and in 2021, Sandy enrolled in a trial of a breast cancer vaccine that her son worked on.

“My mom is on therapies which haven’t been around very long, and has also participated in these experimental trials, and she’s alive and doing pretty well,” Hartman said. “The science has saved her. As the science and treatments progress for this generation and my kids’ generation, hopefully we can do even better and  give people the ability to have more control, less pain, more choice, and longer more fulfilling lives.”

Learn more about open enrollment for medical benefits in 2024 here.

Jack Frederick contributed to this story.

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