COLUMBIA — Breast cancer is the most common cancer in women, but if caught early enough, the survival rate is 100 percent.
No longer a death sentence, breast cancer incidence rates have been declining since 1990. Between 1999 to 2006, rates decreased by 2 percent per year, according to the American Cancer Society.
That doesn't mean it's not a frightening prospect for most women, perhaps a terrifying one for those who are diagnosed.
Erin Spears, a nurse clinician for the Margaret Proctor Mulligan Breast Health and Research Program in Columbia, said her job is to help women "get through their breast cancer journey."
She calls herself a patient navigator and makes sure they remain educated about the disease. Spears wants patients to know what they are going to face; if they need anything, she makes herself available.
She recommends mammograms for women when they turn 40 and regularly thereafter because breast cancer risk increases with age. If a woman has a first-degree relative who has been diagnosed with breast cancer, she should begin getting mammograms 10 years earlier than the age at which her relative was diagnosed.
Although great strides have been made to identify the causes, the No. 1 risk factor is just being a woman, Spears said.
The American Cancer Society estimates that in 2009, a total of 192,370 new cases of invasive breast cancer will be diagnosed in women. From that number, 40,170 women will die from the disease — about 1 in 35.
More than 2.5 million breast cancer survivors live in the United States. Here are the stories of three in Columbia.
Kathy Windmoeller: "Now I don't let little things bother me."
Ten years ago, Kathy Windmoeller was preparing for a ski trip in Canada with her husband and some friends. She had never been snow skiing, but she imagined sitting around a fire drinking hot toddies after a day on the slopes.
Just as they were about to leave, Windmoeller, 46, discovered a lump in her right breast. She wasn't terribly worried.
She scheduled regular checkups and performed monthly self-examinations, so she wasn't terribly concerned. Yet she called her doctor anyway to minimize anxiety during her vacation.
A mammogram pointed to a suspicious area, and a biopsy was performed on a Thursday in January 1999. She never made the trip to Canada.
Waiting for test results can be one of the most agonizing periods in a patient's life. Windmoeller waited. And waited. She was so tense, she couldn't go to work.
Finally, a phone call confirmed her worst fears: The lump was malignant.
"I went numb," Windmoeller recalled. "I'd suspected it but didn't want to believe it."
She decided to aggressively attack her disease. Within a two-week period, she set up a lumpectomy to remove the lump in her breast and the surrounding, noncancerous tissue.
After surgery, Windmoeller went through six months of chemotherapy followed by six weeks of radiation.
The radiation treatments were a "piece of cake," she said, compared to the chemo.
"I just didn't feel like myself," Windmoeller said of the chemo treatment.
It took about a year after her treatment ended to feel normal again.
During treatment, she relied on a number of support mechanisms. Her husband went to treatments with her, and friends brought plenty of food.
One of her favorite means of support came from co-workers, Windmoeller said. They brought what they called the "blue basket" filled with small, wrapped gifts and an envelope. Each day, she was to draw a numbered slip of paper from the envelope and open the matching present.
Windmoeller, now 56, fully retired in January and said she does everything she wants to.
She's always been an avid exerciser and now spends most mornings at the gym. She prefers the aerobic dance and strength training classes that offer more intense workouts. On Wednesday mornings, she takes a jump rope class.
She also collects dolls and makes jewelry. As a survivor, she said she appreciates each day.
"Now I don't let little things bother me," she said. "There are so many things that are worse than what a lot of people get upset about."
Windmoeller started a local breast cancer support group in late 2000 after her battle with the disease. The group meets once a month, and some of the women who attended meetings over the years have branched out and launched support groups in smaller communities around Columbia.
Windmoeller also volunteers at the American Cancer Society as the coordinator for the Reach to Recovery program.
Although she stays busy, she still thinks about the cancer returning every day.
"Breast cancer is sneaky," she said. "It can crop back up whenever it wants to.
"It scares me, but I try not to think about it. I just know the possibility is there and try to live every day to the fullest."
Bonnie Shapero: "... I did change my view of life."
When Bonnie Shapero felt a lump in her breast during a self-examination in December 2004, she said she wasn't immediately alarmed.
Two months later, the lump was still there. She called her doctor and arranged for a mammogram and ultrasound. When she learned a biopsy was needed, a red flag went up.
"I assumed it wasn't good," she said.
The next day, she was told she had breast cancer. She was 53.
She immediately called an oncologist she knew and set up an appointment with a surgeon. The first surgeon suggested a mastectomy, but Shapero held out for a second opinion.
The second surgeon suggested chemotherapy to shrink the tumor so he could do a lumpectomy. She chose the second option.
Surgery followed eight chemotherapy treatments, in August 2005.. Following surgery, she did six weeks of radiation therapy, five days a week.
Shapero said each radiation treatment lasted five minutes, and she had few negative side effects. The chemo, however, left her exhausted and made her nauseated. Her appetite remained strong, however, and she said she craved comfort foods.
"The worst part was losing my hair," Shapero said. "(It's a) manifestation of your condition. It's disheartening."
Her daughter went with her to Jefferson City to pick out a wig.
When people ask her how she got through it, she tells them, "one day at a time." During her treatments, her family, friends and an online support group, called Living Beyond Breast Cancer, helped her stay positive.
"People came out of the woodwork," she said. They brought her food and drove her around town.
A friend from Chicago stayed with Shapero for a week during chemotherapy. Another traveled from Philadelphia to help her with chores and keep her company during the surgery.
She also strongly credits the Missouri Cancer Associates for their assistance, and she gets teary-eyed speaking of the staff's sense of humor, compassion and ability to comfort.
After surgery, Shapero said she expected to have a different outlook on life, but it didn't happen — at least not right away.
"I wasn't necessarily pessimistic," she said. " I was scared."
Everything turned upside down when she suspected a recurrence about 18 months after the surgery. She had a severe pain in her arm that would not go away.
"I was really scared," she said. "I didn't want to go through that again."
It ended up being harmless, and Shapero was so relieved, her attitude changed immediately.
"Now I appreciate everything. Family, friends, the sky, the clouds — everyday things," she said. "I wouldn't say it was a religious experience, but I did change my view of life. Now I celebrate every birthday to mark every year."
She's more patient now, especially with the little things, such as sitting in traffic.
Her family and friends are her priority, and she travels often to visit them.
When she's not traveling to visit family, she teaches American history and women's history at Moberly Community College. She volunteers for the Reach to Recovery program and The Shelter for Victims of Domestic Violence and Sexual Assault.
She also knits and takes care of her dog, Alice. Adopting Alice was a positive sign for Shapero. It meant she believed she was going to be around to care for her.
As a rule, Shapero tries not to think too far ahead and instead takes a deep breath and finds something to do.
But she still worries. She thinks of her children, who lost their father suddenly in 2002. She does not want them to be left without both parents.
"Almost every day I think of it coming back," she said. "But I just take it one day at a time."
Jan Lank: "... it's a waste of energy to worry."
Jan Lank was diagnosed with breast cancer six years ago at age 53. She always did monthly examinations, and that time, she found a lump in her left underarm.
She called her doctor and arranged a mammogram and ultrasound. She was told it was probably just a lymph node.
Two months later, the lump was still there. Her doctor sent her to a surgeon and a biopsy was performed Feb. 7.
The following Monday, she received a phone call at work that confirmed her fears.
"I was shocked," she said.
She played it cool, did not tell any of her co-workers and continued to work the remainder of the day.
The following day she met with a surgeon who explained her treatment options. The tumor was small but aggressive, and he suggested a mastectomy. Lank asked to have both breasts removed, "just to get it over with," she said.
Before telling her family, she wanted everything settled in her mind.
"It was harder to tell my family than hearing it for myself," she said, because she didn't want her family to suffer.
Lank had a bilateral mastectomy with reconstruction surgery, followed by four treatments of chemotherapy, each lasting four hours, every three weeks.
She had the option to participate in a study or follow the traditional chemotherapy route. She chose the former because "studies are what provides information for future treatments."
By participating in the study, Lank received all three chemicals used in chemotherapy at the same time, making the treatments more intense.
About two weeks after beginning chemo, her hair began falling out in clumps.
"Hairspray works wonders," she said, laughing.
Shortly after her hair started falling out, she shaved her head. To show support, her husband shaved his head, too.
Lank has always been active, and it was frustrating for her to not be able to take care of herself while she recovered. She was living in Omaha then and returned to work about three weeks after surgery. She could not drive, so co-workers provided transportation.
Her husband helped, too, changing her bandages and washing her hair.
When Lank was first diagnosed, she thought about how her family would remember her when she was gone; she wanted to leave good memories.
"I'm really organized and logical, so I went through my closet and got rid of lots of clothing," she said. "I didn't want to leave a mess for my sisters to pick through."
Lank tries not to fret about the cancer returning.
"It's easy to become a hypochondriac," she said. "But it's a waste of energy to worry."
She loves to be outside and bikes or hikes whenever she can. She and her husband love to take walks and are members of the Missouri Ramblers.
They also travel, taking two of their grandsons on a vacation every summer. The tradition began when the youngest was 3. They were going to wait until he was 5, but after Lank was diagnosed, she thought: "Why wait?
"Things can change overnight."
Breast cancer does not run in Lank's family. She doesn't drink or smoke; she exercises regularly and follows a healthy diet.
"And I still got sick," she said.
She encourages women to conduct monthly self-examinations. She is a volunteer with the Reach to Recovery program and hopes to become more involved in the community.
"I've always been a positive person," she said. "I didn't think it would turn out any other way."