Breast cancer is no stranger to Aberdeen physician

As a physician in Aberdeen at the Sandford Clinic, Shirlene Smook deals with hundreds of patients each year, practicing family medicine since 1994. A disease turned the tables as Smook learned she had a diagnosis of a risky breast cancer and she needed surgery and treatment.

“It’s been three years now, which is awesome,” Smook, 61, said in a phone interview. “The C word is bad for everyone. Knowing what I know, when I heard those words it scared the bejeebers out of me. I cried when they told me it was triple negative. I cried when I told my husband and I cried when we did a Facebook conference call with our kids.”

Smook shared that she has very dense breasts and so her yearly mammograms are at the Edith Sanford Breast Center in Sioux Falls. In 2017, she had her mammogram and they called her back for a second mammogram with diagnostic extra film, special magnification, and compression views. After an ultrasound was completed, the mammography radiologist said they really should do a biopsy.

After that test, like any patient, “I waited on pins and needles for a week,” Smook said. “The results went to my PA Lynn Meyers who came to tell me the news that it was intraductal cancer, but they were still waiting for information. I waited a week for special staining and immunochemistry testing for receptor types (which guide treatment options), which showed receptors were triple negative. I got the diagnosis on Sept. 21, 2017 that it was Stage 1, later reclassified to Stage 2.”

Smook explained, “There was the initial shock and then dread. Knowing what I knew about breast cancers, 98 percent are very treatable. The kind I had would not respond to the suppressive hormonal treatments post initial interventions; to which many patients respond favorably. There are several types (i.e., inflammatory, triple-negative and HER2/neu + cancers) which are not so favorably treatable, and I had one of them. Mine was triple negative, which has more of a catch-22. The survival rate at 5 to 10 years, is not the 98 percent; in about one-third there is a reoccurrence. If you get a reoccurrence within a 3-year-time period, it’s not as good of a diagnosis. If you get past the window of 3 to 5 years, then the good thing is that triple negative generally does not come back after that time period. So, for me, it’s a waiting game for a couple more years, but otherwise things are going well.”

Smook met her specialists all on the same day at the monthly Breast Institute in Sioux Falls. Included were Medical Oncologist Keely Hack, M.D., Radiation Oncologist Michele Lohr, M.D., and surgeon Jesse Dirksen, M.D., to plan for treatment and care. At the end of the day, Dr. Heather Karu, plastic surgeon, kindly added her into the schedule. All that then was needed was for the tumor board to meet. They agreed with the plan.

Smook shared that the imaging was very important as the cancer is one that did not show up as a lump. None of the doctors in Sioux Falls felt anything when the area was palpated (felt with the fingers).

Initially, Smook decided with her husband Dennis that she wanted to have a bilateral mastectomy and reconstruction so she would get it all done at once and not need a second procedure. “I went through a good learning curve as the Sioux Falls doctors suggested having a partial mastectomy on the affected side and a reduction on the other side. The doctors gave me the statistics and showed studies which indicated that they could achieve a better outcome than what I had proposed.”

Her surgery was on Halloween. “I think we made the right decision to go with their plan.”

After surgery, Smook focused on healing, then chemo and dealing with the side effects. “I had eythroderma/erythrodyesthesia (hand-foot syndrome) in my hands due to the cyclophosphamide chemotherapy. My hands swelled and the skin peeled off the tips of my fingers. It was like someone had dipped them in Elmer’s glue and let the glue drip off. It had to blister and peel away. I quit working for a while as I couldn’t type on a keyboard and wanted to minimize the risk of infection.”

Chemotherapy started the weekend after Thanksgiving and was completed at the end of January 2018.

In April, Smook opted to complete her 6 weeks of irradiation at Avera St. Luke’s with Radiation Oncology Specialist Kathleen Schneekloth, M.D., working closely with the Sioux Falls Sanford team. That way she worked in the morning, got her treatment in the afternoon, and she didn’t have to travel.

“It was good for me to be at work and I needed to keep my mind busy and occupied with other things. It really benefited me to do my radiation in Aberdeen with Dr. Schneekloth.”

With her treatment planned, she worried. “The biggest thing, mind wise, was what did I do wrong to get cancer?” Smook said. “I am just like other cancer patients. I completed a genetic panel and the BRCA test and others were negative. (The BRCA gene test is a blood test that’s done to determine if you have mutations in your DNA that increase the risk of breast cancer.) I had a paternal aunt who went through treatment and eventually died with a totally different type of breast cancer.”

Mentally, your anxiety increases. “You wonder, when will it come back? Will it come back? And I worry that I had it and my aunt had it. Will my daughter get it and/or my son? Guys can get it, too. I currently am working with a young male patient even though the prevalence in males is not common.”

Other than that, “I believe I tolerated treatment well. The fatigue persists. Even though it’s been more than two years, I aim to get my 8 to 9 hours of sleep a night. And some nights I need more than others. I hope it gets better. I’m back at work at the clinic full time.”

There are really great treatment options for breast cancer. Newer agents have come on the market. If those are not responsive, it’s possible to design a medication customized to particular cancers.

Smook said the experience enhanced her career and she’s able to better understand her patients. “Since my treatment, I listen a little more and I am more in tune with what they say. I’ve worked with multiple patients with breast cancer, both female and male. They appreciate the fact that they know I have walked in their shoes and I pay close attention to what they describe.”

Is it still safe during this pandemic to keep routine appointments?

“Statistics show people are avoiding care, resulting in eventually needing more extreme treatment,” Smook said. “I believe that people need to be back on their regular schedule. If they have concerns about their breast health, don’t avoid clinics and the hospital. Everyone there wants to keep you safe. You wear your mask in. All of us are wearing masks and cleaning rooms for patients. There is very little risk in going in for an appointment. If you were to miss something resulting in a delay in diagnosis, that would not be good. The biggest issue in healthcare is when we find things too late.”

Because of that, Smook believes all her patients, of the appropriate age, should get a breast exam, both men and women. At first men will raise their eyebrows at that, but “I'd rather catch one than miss one.” For women, they should get a screening starting at age 40 and a yearly mammogram after age 50.

As a breast cancer survivor, Smook encouraged people to be diligent in taking care of their health.

“I try to be very thorough in my breast exams. I provide a lot of education to my patients and encourage them to let me know if they notice any change in their breast tissue. If they do have a particular concern, they need to bring that up and we will check it out. Don’t delay.”