HACKENSACK, N.J. — One year ago, despite having had a negative mammogram and ultrasound four months earlier, 67-year-old Doris Barnhill of Cliffside Park did a quick dance of her fingertips around her breasts to feel for lumps anyway — until she stopped at what felt like a pea-sized marble beneath her skin in one of them.

The following week, Barnhill made an appointment with her primary care physician who referred her back to a breast specialist who saw her that day. Last September, she was diagnosed with Stage III Triple Negative Breast Cancer. According to BreastCancer.org, this type of breast cancer, found in 10-20% of patients, tests negative for estrogen and progesterone receptors and excess HER2 protein, meaning the cancer is not triggered by these hormones nor the HER2 protein and thus does not respond to hormonal therapy medicines or the ones that target HER2 protein receptors. However, other medicines are used to successfully treat it.

“It took me over the edge,” said Barnhill through her pink surgical mask at a table outside Hackensack University Medical Center’s Breast Cancer Awareness Month kickoff event Thursday, organized by the Betty Torricelli Institute for Breast Cancer. “Hearing that for the first time was devastating for me because I lost a sister, so all I could see was, ‘This is it.’ I couldn’t see past the fact that it’s breast cancer. She didn’t survive, why would I?"

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Barnhill had lost her estranged sister, Dolores, to breast cancer 15 years ago just two years after she was diagnosed. While the circumstances surrounding her sister’s condition remain unclear, Barnhill says she’s glad she advocated for herself when her body told her something felt off. And breast specialists at Hackensack University Medical Center, where Barnhill is currently being treated, agree.  

“You never want to be cavalier and ignore something,” said Dr. Gail Starr, Chief of Breast Imaging at Hackensack UMC. “You should always bring it to medical attention and have it evaluated. Early detection is the key to finding things earlier , when they’re more treatable , and you have less aggressive treatment options."

Any noticeable changes in a woman’s breasts merit a trip to the doctor, Starr said, especially changes in the areola like flakiness, clear or bloody discharge from the nipple, and of course, firm lumps. Barnhill received chemotherapy at the John Theurer Cancer Center at Hackensack UMC in Edgewater closest to her home. While she was scheduled for a mastectomy this past May, her surgery was on hold when she was diagnosed with Covid-19 on April 10 when the virus — which has to date claimed more than 1 million lives around the world — was at its apex. Barnhill was five days shy of her last chemotherapy treatment when she was diagnosed with the potentially deadly virus. 

“I just could not get up,” she recalled of her symptoms. 

Apart from chronic fatigue caused by the highly contagious virus affecting the respiratory system, she had been experiencing bouts of nausea and vomiting. While her Covid diagnosis temporarily derailed her cancer treatment, the mother of three and soon-to-be grandmother of five decided to stay positive and applied the same optimistic attitude she used to power through her cancer diagnosis to get her through Covid. 

“I refused to give up,” she said. “My attitude was such that I came through my chemo treatments with flying colors. I remember there was hair loss and skin discoloration. In terms of how I felt when undergoing chemo, I didn’t have those issues. I continued to work. I did everything I needed to do.”

Because Barnhill’s cancer was more aggressive, she wound up going in for surgery in May despite having had the virus still. Her Covid-19 test was negative the following month. After overcoming Covid, Barnhill completed her radiation treatments following her mastectomy and is currently on pill therapy, which she will continue for the next five years. A retired manager for a health care plan working in the customer service division, Barnhill continues her life’s purpose of serving to interact with others to teach everyone with whom she comes in contact diplomatic relations so they walk away feeling like they were treated with respect and dignity, she says.

Similarly, at Hackensack UMC, the same can be said of the hospital staff who she said continue to assume the role of her cheerleader throughout her cancer journey.    

“You don’t feel like you’re another cancer patient coming in,” said Barnhill. “It’s been so very personal. I’m just not accustomed to people as personable as they are and constantly assuring you. I initially didn’t have any hope.”

While many newly diagnosed cancer patients can feel that way, treatment options are promising provided early detection. While genes can play a role in one’s development of breast cancer, physicians say a number of patients don’t have any risk factors or family members diagnosed. Breast specialists say being female alone and older age significantly increase your risk, in addition to younger women carrying the BRCA gene.   

“Patients who are considered high-risk classically are the patients who carry the genetic mutations of the BRCA 1 and 2 breast cancer mutation genes,” explained Dr. Leslie Montgomery, a surgical oncologist specializing in breast cancer at the hospital. “People with a strong family history of breast or ovarian cancer. Women who have had radiation very young in life sometimes for lymphoma. People who get radiation to their breasts in their teens and 20s. Those are the people who are at very, very high-risk and we follow them in high-risk programs and do additional imaging and do an even earlier than the average person who starts getting mammograms or MRIs. There are also certain types of pathology that we see on breast biopsies that will make people high risk. But even a person with a first-degree relative — a mother, a daughter or a sister who has breast cancer — is considered higher risk than the average population.”

A woman who has a grandmother who had breast cancer could also contract cancer if her father carries a breast cancer gene, she said. For women who have a history of breast cancer in her family, with multiple members having had the disease, genetic testing is recommended to test for the nine genes associated with the cancer via a simple blood test performed by her gynecologist. 

While other risk factors such as having dense breasts, or breasts with more glandular tissue than fat, and a woman having her first child after age 30 can also increase one’s risk for the disease, doctors agree that limiting alcohol consumption in addition to quitting smoking can also help to reduce one’s risk for developing breast cancer. A healthy lifestyle in addition to post-menopausal women remaining at a healthy weight by incorporating a personalized exercise regimen on top of following a healthy diet are also ways to prevent most other diseases including heart disease, another top killer of women, especially African-American. 

“I think everything in moderation is a good strategy,” said Montgomery. “With respect to preventing breast cancer, I think all of us need to recognize that women are 10 times more likely to die of heart disease in this country than we are to die of breast cancer. And I think for some reason we may make so much effort to try to prevent breast cancer, but obesity, hypertension, diabetes, these are the things that are really killing us in terms of heart disease. I do agree with not gaining weight, drinking alcohol in moderation, exercising, the things are also very beneficial in reducing heart disease so they go hand in hand.”

Dr. Starr recommends women begin having annual mammograms at 40, and for those who test positive for the BRCA gene to test 10 years sooner than that. 

“Most patients don’t carry the gene,” said Starr of the women diagnosed. “Being a woman and getting older are the two most common risk factors you can’t change or do anything about.”

She said if women do test positive for the BRCA gene, having a mastectomy is one way to reduce her risk for developing breast cancer in the future. However, having one does not guarantee breast cancer’s prevention. 

“Having mastectomies does not make your risk zero,” said Starr. “There’s still always a small risk because there are cells underneath the skin and against the chest wall. But it does decrease your risk significantly."

Starr added that if women do have the BRCA gene, the best approach is seeing a breast specialist and oncologist who can explore breast imaging and hormone therapy as preventative treatment options.  

In addition to the Prospect Avenue hospital’s Breast Cancer Awareness and Risk Evaluation Program, Hackensack UMC also offers cutting-edge technology for detection, including 3-D imaging which allows doctors a clearer viewing of any hidden tumors, which lead to a reduced need for further biopsies.

As for Barnhill? 

“I feel great,” she said. “I feel healthy. I’ve survived a lot. When I take a minute to think about what I’ve gone through based on my original diagnosis where I had no hope to get to the point where I am now…  I can’t give up.”