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In It to Win It. RAPP Program Detects Early Breast Cancer

Annie Smith-Jones knew her family history with breast cancer—mother, grandmother and aunt—meant she had a much greater than average chance of being diagnosed with breast cancer herself. Her primary care physician, Patricia Czapp, MD, knew it, too.

“Primary care docs are trained to assess an individual’s risk for various diseases, and getting a detailed family history is just one part of that assessment,” said Dr. Czapp. “In Annie’s case, her compelling family history was key to early detection and effective treatment of her breast cancer.”

She referred Annie to AAMC’s Risk Assessment and Prevention Program (RAPP) for women at increased risk of breast cancer. She was evaluated by a medical breast specialist, who fully assessed her risk, counseled her in prevention strategies and set up a treatment plan, including breast imaging studies. Annie took advantage of the increased surveillance, education and breast exams at six-month intervals.

In January, two years after Annie enrolled in the program, her doctor noticed an area of concern. Collaborating with the expertise of Ronald Duncan, MD, a radiologist with Anne Arundel Diagnostics Breast Imaging Center, they evaluated a very subtle lesion on an MRI (magnetic resonance imaging) that could not be felt during a breast examination. What they saw on a specialized mammogram and ultrasound only heightened their concerns.

A biopsy the next day confirmed a tumor less than the size of a pencil eraser (0.6 cm), indicating a very early Stage I breast cancer.

The following week, Lorraine Tafra, MD, medical director of AAMC’s Breast Center, removed the small lump and two sentinel nodes, which showed isolated tumor cells, despite the very early cancer. Annie’s case was carefully evaluated by the hospital’s tumor board, which recommended chemotherapy and radiation in a clinical trial offered through the Johns Hopkins Clinical Research Network, of which AAMC is an original member. Dr. Young Lee directed the chemotherapy, and Dr. Mary Young directed the radiation therapy.

“My doctor noticed that something, to her, was out of place,” said Annie. “The fact that she was diligent and knowledgeable is why we caught this early. If not for her, it would have taken much longer to find.”

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