A Mother Daughter Duo
BY VICTORIA CLAYTON
Marina Del Rey resident Nancy Mamann loves that she shares many of her mother’s qualities—a health-conscious and proactive approach to living, creativity and remarkable youthfulness. But there’s one thing she had no desire to share: a diagnosis of breast cancer just weeks after her mother Lois Sattler was also diagnosed. “At first, I couldn’t believe it. It was actually really shocking,” says Mamann, who was told she had stage 1 invasive ductal carcinoma in early 2019, just two weeks after Sattler was diagnosed with stage 2 invasive lobular cancer.
The two cancers are extremely different. And after a complete genetic workup, the women were told there was no genetic link between their cancers. The link they did share: their doctor, Janie Grumley, MD, director of the Margie Petersen Breast Center at Providence Saint John’s Health Center.
Sattler was referred to Dr. Grumley first. A celebrated ceramic artist, Sattler had lived an active, healthy life. But she’d had breast cancer in the other breast in her 50s and continued having regular mammograms. “If I had not had one, I would have not known I had cancer,” Sattler notes.
With this latest bout of cancer, she knew she wanted a female doctor. “To me, there’s something more powerful about women treating women,” she says.
At first, she had the typical fears of getting a cancer diagnosis. Once her daughter was diagnosed, however, she says her fear for herself abated and all she wanted was to be strong for her.
Mamann was initially shocked by the news. She’d eaten healthfully, exercised and had checkups and routine screenings religiously—she did everything she possibly could to preserve her health her entire life. She even works in the wellness industry as a marketing executive. But, with every mammogram, “I had that thought in the back of my head that, given my mother’s history of breast cancer, I hope they don’t find anything,” she says.
Dr. Grumley reassured both women that they did exactly everything a doctor could ask for—but most important, they showed up for annual mammograms. “Mammograms don’t prevent cancer, yet they often detect it extremely early,” says Dr. Grumley. Early detection can mean better options and outcomes for patients.
After meeting Dr. Grumley, both women say shock and fear melted into relief. “Dr. Grumley’s team makes you feel like you’re wrapped in a blanket—OK, this is happening, but it was caught early, it’s small and we can take care of this,” says Mamann.
They were not just in good hands, though. They were in expert hands. Dr. Grumley is one of an elite team of surgeons nationwide specializing in a breast-conserving cancer treatment called oncoplastic surgery. Since graduating from the Keck School of Medicine of USC nearly a decade ago, Dr. Grumley has performed roughly 1,000 oncoplastic surgeries and published her results in numerous academic journals. In fact, Dr. Grumley is one of the instructors who teaches other surgeons the technique for the American Society of Breast Surgeons.
Traditional breast cancer surgery—whether a mastectomy or lumpectomy—removes the cancer but can leave patients with indentations or deformities. While some women decide to have reconstruction, the oncoplastic surgical technique presents yet another option. The aim with oncoplastic surgery is to remove the cancer and preserve the patient’s own breast tissue, leaving women cancer-free with an excellent, natural cosmetic result.
How does this happen? An oncoplastic surgeon uses traditional breast lift or breast reduction to take out the cancer. “We take out the area of the cancer along with a little normal tissue around the cancer to get a “margin,” Dr. Grumley explains. “To minimize the deformity left, excess skin is removed to allow for tightening and reshaping of the breast. This leaves the patient with little to no indentations or visible scarring.”
The surgery even provides a measurable breast lift (called a mastopexy) because the surgeon has to pull the breast tissue together. To preserve symmetry, some women have the second breast treated with the same lift, which adds minimal surgery time, and recovery is not impacted, says Dr. Grumley.
When the cancer is caught early, as was the case with both Mamann and Sattler, surgeons may even opt for interoperative radiation therapy (IORT). IORT means radiation is administered as a single dose to just the cancer area. About 40% of patients qualify for this type of radiation. For about 80% of those patients, IORT is the only treatment needed—an eight- to 10-minute one-and-done procedure.
The patients have radiation and surgery combined—in fact, they go home the very same day of surgery—and never endure the three to six weeks of follow-up radiation treatments that are the norm with traditional surgery. Dr. Grumley says researchers have followed IORT patients now for nearly eight years, and the evidence is convincing that IORT works as well as the lengthier and more burdensome multi-month treatment of standard radiation in patients with early breast cancer.
Mamann was among the particularly fortunate patients. Her molecular testing indicated her cancer would not require follow-up chemotherapy either. She was completely done with active treatments after one oncoplastic surgery and interoperative radiation therapy.
Dr. Grumley closely monitored her with follow-up mammograms, and Mamann saw a nutritionist and an Eastern medicine doctor to ensure she was doing everything she could to remain strong and healthy. Very quickly she was back to herself—hiking, biking, doing Pilates and being the “rock” for her mother, who lives in the same neighborhood.
Mamann says the experience, however lucky she was, still changed her. “It’s where strength and grace come at the same time and become part of who you are,” she says. There’s a badge of courage that comes with being a thriver—the term Saint John’s uses for cancer survivors—but having a medical team that ensures you’re well taken care of helps in the bravery department. “Sharing these stories is important because it reminds us we’re all human. We’re fragile and we’re resilient—particularly if we get the right care,” says Mamann.
Dr. Grumley’s research, which is made possible through philanthropy, has shown that oncoplastic patients are less likely to need second operations than with traditional breast conserving surgery because oncoplastic procedures are less likely to leave cancer behind. Because of the nature of Lois Sattler’s cancer, however, she did require two additional oncoplastic surgeries. Each time, aided by her daughter, Sattler went home the same day and experienced minimal discomfort and recovery time. Dr. Grumley says that is one of the benefits of oncoplastic surgery, a more conservative approach.
“Some doctors might say, ‘Oh, let’s just do a total mastectomy and get it done,’” says Dr. Grumley. “But a mastectomy is a major surgery with significant recovery.” Cosmetics aside, Dr. Grumley says very often it’s not medically needed and is less appropriate than a more conservative approach—even if multiple oncoplastic surgeries are needed.
Oncoplastic surgery may not be the best option for women who discover their cancer has a genetic component that means recurrence is likely. In those patients, some may be better served with a mastectomy in order to provide them with peace of mind, Dr. Grumley says. However, for those without a genetic component, oncoplastic surgery offers women, even those with larger cancers, another option.
“The procedure has evolved to the point where now I can take out larger areas—say 16 centimeters of disease—and still save the breast,” she says. “The biggest thing I stress is that when women are told they need a mastectomy, it’s a good idea to get a second opinion from someone who specializes in oncoplastic surgery. Not enough surgeons are trained to do it yet, but it’s definitely a growing area.”Sattler and Mamann say their treatment by Dr. Grumley and her team couldn’t have been warmer or more reassuring. More than a year later and cancer-free, mother and daughter participated in a webinar hosted by the Margie Petersen Breast Center in which patients spoke about their experiences. “It was only then that it really hit me,” says Sattler. “Women are so brave and so strong.” Especially when they have each other.