Mother, Daughter Support Each Other Through Breast Cancer Diagnoses

By Susan Van Dusen

Little did they know that seven years later, both would proclaim themselves breast cancer survivors.

“We really didn’t have similar cases. My cancer was nothing compared to Debby’s,” said Anna “Dale” Linton, who was diagnosed with Stage 1 cancer in September 2018.

When a radiologist in Fayetteville discovered what Linton called “a speck” on her annual mammogram, she was surprised. Other than her daughter, who was diagnosed in 2011, there was no history of cancer in Linton’s family.

That wasn’t the case, however, for her husband. William Linton’s family carried an extensive cancer history, including his mother, who survived breast cancer and later died of natural causes, and his sister, who died of breast cancer.

William Linton also is a survivor, having been diagnosed with soft tissue sarcoma at age 40.

Soft tissue sarcomas develop in tissues like fat, muscle, nerves or fibrous tissues.

After initially undergoing successful treatment at UAMS in 1989, his cancer returned years later and spread to his lungs.

“They didn’t give him much of a chance to survive, but he’s strong. He came back to UAMS for treatment a second time. Now he’s 72 and cancer free,” said Dale Linton of Dover.

Since all of her family’s cancer history rested on her dad’s side, Ferguson thought she was not considered high risk for breast cancer – certainly not in her 30s before mammograms are even recommended.

“Everything I had ever seen about breast cancer talks about it being passed through your mom’s side of the family, so I thought I was OK,” Ferguson said.

When she found a lump during a self-exam in June 2011, she waited a couple of months to see if it changed. When it remained stable, she went to her OBGYN who referred her for a mammogram.

Although Ferguson, of Little Rock, was initially told that the mammogram didn’t show any irregularities, it did reveal that she had very dense breast tissue, which can make it more difficult to spot a tumor.

During a subsequent ultrasound, a technician asked about her family history, and after hearing about the cancer on her dad’s side, called in a physician who correctly recognized that breast cancer risk can come from either side of the family. After reviewing the scans, he confirmed she might have cancer.

“He told me that if it was cancer, all I would need was a lumpectomy and radiation. That didn’t feel right to me or my mom, so I pushed for an MRI,” Ferguson said.

She quickly got an appointment with her mom’s radiologist in Fayetteville, who also was a longtime family friend. After the MRI, he told a very different story than the first doctor described.

Ferguson’s cancer was diffuse, meaning that in addition to the 3-cm lump she felt, there were multiple small tumors throughout her left breast.

Precancerous spots also were found on her right side.

“There’s no way a lumpectomy would have worked. He told me I would likely need a double mastectomy, which was the last thing I wanted to hear,” she said.

The radiologist referred Ferguson to the UAMS Winthrop P. Rockefeller Cancer Institute on a Friday, and she was scheduled for an appointment the following Monday.

“Over the weekend, I researched whether I could get better treatment out of state. I found that I could get the best possible care right here at the UAMS,” she said.

James Yuen, M.D.

James Yuen, M.D.

As an active, athletic woman, Ferguson was very concerned about function and mobility following her mastectomy and reconstruction. She spoke to other athletes about loss of function due to reconstruction, which can involve cutting the pectoralis major muscle, commonly known as the pec muscle. She quickly decided that severing her pec muscle was not an acceptable option for her lifestyle.

“It was hard to make a decision about reconstruction options at my age. Most of the people I knew who were breast cancer survivors were in their 60s and 70s and weren’t as physically active as I was,” said Ferguson, who counted softball, water skiing and golf among her regular activities.

She also hoped to start a family someday and knew she would need the ability to lift and carry a baby with ease.

In consultation with UAMS plastic surgeon James Yuen, M.D., Ferguson discovered she could undergo reconstruction with a newer procedure where the tissue expander is placed above the muscle, rather than below.

“Traditionally, the tissue expander goes under the pectoralis major muscle, which can potentially weaken the muscle. By placing the tissue expander above the muscle, we don’t have to separate the muscle from its attachments. This helps retain mobility in your arms following surgery,” said Yuen, professor and chief of the Division of Plastic and Resconstructive Surgery in the UAMS College of Medicine.

Once the chest area is fully expanded, the tissue expander is removed and the implant is put in place.

One of the challenges of placing the tissue expander above the muscle is the lack of an ability to hide the implant. To remedy this, a procedure called fat grafting is used to build up a layer of fat to camouflage where the implant is placed.

Fat grafting involves removing fat tissue from another part of the body and injecting it in the upper part of the reconstructed breast to improve its appearance.

“It just so happens that I recently had training in fat grafting, which was relatively new at the time. By placing the tissue expander above the muscle and using fat grafting, we were able to achieve the results Mrs. Ferguson wanted,” Yuen said.


Linton’s Diagnosis

With Ferguson’s recovery safely in the rearview mirror, Dale Linton wasn’t concerned when she arrived for her annual mammogram seven years later.

However, the “speck” that was spotted on her mammogram that day, was indeed a very small tumor that required treatment.

And, just as Linton stood by her daughter’s side, Ferguson was there to support her mom through the entire process.

“Just like she did for me, I went to all of her appointments to ask questions, take notes and help her make decisions. I know how hard it is process all the information you’re getting when you’re the patient,” Ferguson said.

Like her daughter and husband, then-69-year-old Linton chose the UAMS Cancer Institute, where she was treated by breast surgical oncologist Daniela Ochoa, M.D.

“Dr. Ochoa was awesome. She did a lumpectomy to remove a small section of my breast tissue in November 2018. It’s hard to tell I even had surgery,” Linton said.

Because she chose a lumpectomy instead of a mastectomy, Linton also required radiation therapy, which she received at the UAMS Radiation Oncology Center.

Daniela Ochoa, M.D.

Daniela Ochoa, M.D.

“When we save the breast, it is done with the expectation that the patient will also undergo radiation therapy. This is used to decrease the risk of the cancer coming back in the same location,” said Ochoa, associate professor of surgery in the UAMS College of Medicine Division of Breast Surgical Oncology.

Linton’s radiation therapy concluded in January 2019, and she has experienced no complications since then.

“My experience was really nothing compared to Debby’s. Her cancer was much more serious than mine. Plus, you look at things differently when you are in your 60s than you do in your 30s. It wouldn’t have bothered me to have my breasts removed at 69, but in my 30s it probably would have been a different story. Debby was so strong and brave throughout her entire experience. She was truly amazing,” Linton said.


Surgical Options

In terms of choosing a breast cancer surgery, Ochoa sees women of different ages take many factors into consideration.

“With someone who is young and expected to live many more years, the risk of recurrence is an important consideration. These women may choose a mastectomy and reconstruction to reduce the risk of the cancer coming back over the course of their lifetime,” Ochoa said.

She added that mastectomy is also a desirable option for women don’t want to undergo the radiation therapy required with a lumpectomy.

Older women, who have fewer years for a recurrence to occur, might instead opt for a lumpectomy if possible. She also sees older women often forego reconstruction, either because they don’t want to undergo another surgery or because they simply don’t see the need for it.

“Women have lots of options, and everyone is unique. You have to examine your own situation and decide what is best for you,” she said.

As for their experience at UAMS, both Ferguson and Linton couldn’t be happier.

“The team approach that UAMS has is amazing. My doctors all sat down to discuss my case and created a unified plan. People who don’t go to UAMS may not get that type of team approach to their treatment. It really made a difference,” said Ferguson, who has married and become a new mom since her cancer diagnosis.

Linton agreed, adding that UAMS has played a unique and important role in her family’s life for more than 30 years.

“UAMS saved my husband’s life twice. They saved my daughter’s life, and I suppose they saved my life as well. We don’t think there’s any place better,” Linton said.