Breast Cancer Survivor Advocates for Screening and Early Detection
When 53-year-old photographer and single mom Pia Navales went to the Berkeley Outpatient Center for her annual mammogram in December 2021, she had no reason to suspect any problems. "I felt completely healthy. I'd lost weight. I had more energy than ever before," Navales said. "Suddenly, my life changed on a dime." The mammogram identified three masses on her left breast, which Navales would later refer to as her triplet Loch Ness monsters.
After a follow-up mammogram and ultrasound with UCSF Professor of Clinical Radiology Rita Freimanis, MD, Navales drove from Berkeley across the Bay Bridge to get a core biopsy and fine needle aspiration done at the UCSF Breast Imaging Clinic at Mission Bay. She arrived for the procedure feeling optimistic, but nervous. After filling out paperwork and changing into a gown, Medical Assistant Sandy Champa offered her a choice of lavender or ylang ylang essential oil for aromatherapy and a choice of spa music. The lights were dimmed, and there was a photograph of a nature scene on display. "I said, 'Sandy, I feel like I'm about to get a massage at a spa rather than a biopsy at a hospital.'"
As a result of both the soothing environment and the excellent care team, Navales said she felt calm throughout the procedure. "I was given a play-by-play of everything happening," Navales said. "They checked in with me throughout the entire process." Champa held her hand whenever she got scared or nervous. "Sandy made me feel that my comfort was her number-one priority during the procedure." She felt a strong human connection with everyone at the clinic. "I felt so seen, so heard, and I never felt invisible."
Bonnie N. Joe, MD, PhD, the chief radiologist for UCSF Breast Imaging, said the Mission Bay and Berkeley Outpatient Center breast imaging clinics were designed to create a comfortable, calming experience for patients. "The idea is to alleviate anxiety and provide a nurturing, safe environment and build patients' confidence in the expert level of care," Dr. Joe said. "I think this is the best way to provide breast imaging services."
Despite the calming environment, the biopsy confirmed what Navales feared: She had breast cancer. While a devastating diagnosis, she was heartened by the confidence she had in her doctors and the knowledge that it was caught early and was treatable.
She received a call from a nurse navigator two days later confirming that she had three malignant growths that would need to be removed. She had invasive ductal carcinoma, non-aggressive Stage 1 breast cancer, that was HR-positive/HER2-negative, with a Ki-67 score of 2-3%. The nurse navigator walked Navales through her diagnosis, and a plan of action, with a next step of selecting a breast surgeon. Depending on the pathology and surgery results, she would either need chemotherapy or radiation. Navales selected Associate Clinical Professor of Surgery Karen Goodwin, DO, FACS, as her surgeon, and hasn't regretted her choice. "Dr. Goodwin is warm, caring and provides exceptional patient care."
At this point, Navales had to make another difficult decision: When would she tell her teenage kids? Her diagnosis arrived just before the holidays. Her son was coming home from college for winter break. "On the one hand, I felt an urgency to share the news and thought it would be a huge release for me, but on the other hand, I didn't want them to look back on Christmas 2021 as something really sad and worrisome. I ultimately waited until the new year to share the news." Both kids understood and thanked her for waiting — they appreciated being able to experience a more joyous and worry-free season, Navales said.
Meanwhile, as a precaution, Dr. Goodwin had ordered a bilateral breast MRI, which revealed that the cancer was larger than originally suspected.
In February 2022, Dr. Goodwin performed a lumpectomy on Navales' left breast. She worked in tandem with Navales' plastic surgeon, Dr. Christian Kirman, who performed a bilateral mastopexy (breast lift) and breast reduction on the right breast to make her symmetrical. She also removed three lymph nodes. The surgery went well, and her results came back with clean margins.
After six weeks of recovery, her next step was five weeks of daily radiation treatment overseen by Assistant Professor in Radiation Oncology Lisa Singer, MD, PhD. Navales chose to undergo treatment at the UCSF Breast Imaging Clinic at Mission Bay because she says the patient care protocols are the best of the best. "I felt at ease starting radiation treatment because of the calm demeanor and level of expertise of the UCSF doctors."
If Navales had not gotten her mammogram in 2021, she suspects that the cancer might have begun to grow more aggressively, leading to a worse prognosis and more intense treatment. "These triplet Loch Ness masses would have continued to grow in stealth mode in my left breast," Navales said. "By the time I would've found out, I would've been at a later stage.
"Breast cancer doesn't mean a death sentence, especially if it's detected early," Navales said. "Schedule your mammogram, show up and follow up if you need to — do not procrastinate!"
Dr. Joe recommends that women start annual mammograms at age 40. "Early screening can make the difference between a tiny tumor or metastatic disease," Dr. Joe said. Peak breast cancer incidence occurs for women of color in their 40s and screening at this age gives all women the opportunity to detect breast cancer early.
"It can be so personal and so devastating to hear the words 'you have cancer,'" Dr. Joe said. "Knowing that we help patients through this difficult time is really an honor."
By sharing her story, Navales hopes to destigmatize breast cancer and empower other women to take charge of their health. "How many other women out there might also have breast cancer growing inside them unbeknownst to them because they have no symptoms and they've put off their mammograms?" As a domestic violence survivor and now as a breast cancer survivor, she has experienced the love and support of her community by sharing her story publicly. "I have breast cancer and that's ok because it can be treated," Navales said. "I'm not going to let it bring me down. I'm not going to let it stop me. I'm going to keep fighting it."