Belinda Phillips of DeLand will be forever thankful that she is one of few women examining their breasts each month.

Even though she has benefited from a great deal of ultra-sound, mammogram and MRI (magnetic resonance imaging)-related technology over the past few weeks, what may have ultimately saved her life is her own hand.

Phillips, now 54, has received a mammogram every year since she turned 40, and she also does a breast self-exam every month.

Her last mammogram in November revealed nothing abnormal. But her last breast self-exam was July 14, standing in the shower during a vacation with her husband, Denny, in the mountains of North Carolina.

She felt a lump. Phillips recalls lying down on the bed, and feeling the same spot. This time, she could not feel the lump, though she did feel a small indentation in her breast.

"It made the difference for me," Phillips says, adding, "I really did not think that it would be malignant."

Ironically, the DeLand resident has been education coordinator of Radiologic Technology Education at Halifax Medical Center for 24 years. Her students enter the field of radiation oncology, something she will become more intimately familiar with in the coming months.

EXAMS BEGIN

While she was optimistic that her lump was benign, Phillips also is perennially practical. She knows that time means everything in cancer treatment, so she called her family physician, Dr. Roxy Marrese, the next day and had an exam in Daytona Beach on July 19.

Marrese could not feel a lump while Phillips was prone, but did find one -- with her guidance -- when she sat upright. He ordered a diagnostic mammogram that confirmed an abnormality a day later.

Two days later, on July 21, Dr. Charles Burkett, chief of mammography and ultrasound at Radiology Associates, performed an ultrasound-guided biopsy of Phillips' right breast. In biopsy, a surgeon removes a small piece of the tumor to evaluate for cancer, and inserts a small, metal clip that marks the spot for follow-up.

That day, Phillips also had a post-biopsy mammogram. And on July 23, Marrese informed Belinda that she had breast cancer.

Phillips then saw a surgeon, Dr. Michael Fabian, who ordered breast MRIs to determine the extent of her cancer. On Aug. 2, she had an MRI of her right breast, which detected additional spots that the recent mammogram missed. An MRI two days later of her left breast also revealed spots.

At this point, Phillips knows she has breast cancer, but does not know how it can best be treated. One option is a lumpectomy followed by radiation therapy, where the surgeon cuts out the tumor but leaves the breast intact; the other is a mastectomy or removal of one or both breasts.

Either way, she will soon become one of over two million women in the U.S. treated for breast cancer.

The next biopsy will be MRI-guided, as Phillips now has known cancer.

"Ultrasound can see some things, but not everything," says Dr. Roger Shifrin, chief of MRI, CT and 3-D scanning at Radiology Associates. "MRI has a much greater sensitivity. It can find more and smaller things."

At 8 a.m. on Aug. 5, Belinda and Denny, who have been married for 30 years, arrive at Halifax Professional Center for the MRI-guided biopsies of both her left and right breasts.

She fills out paperwork while Denny looks on. Occasionally, when Belinda's seems tense, he asks her questions.

"I have a wonderful husband. He's been with me for every appointment and every test," she says.

Phillips also credits her physicians and their medical staffs as being invaluable in her diagnosis and care.

"I am so thankful that we have the technology in Daytona Beach that will allow me to have the newest, the latest, and the greatest," Phillips says. "I want women to know that the system works. It really does. When we need to be seen fast, we're seen fast."

By 8:15 a.m., Phillips sits upstairs in a rocking chair, while a medical technician inserts an IV in her arm. Her husband excuses himself to avoid seeing the needle. The technician informs Phillips of the risks of MRI biopsy, which are bleeding and swelling. But the treatment is low-tech.

Phillips is instructed to use a package of frozen peas on her breast to sooth minor swelling and Band-aids for minor bleeding.

IT'S DRAINING

After Shifrin arrives, Phillips lays facedown on the MRI bed under a white blanket, still outside of the giant machine. She has been given Xanax to calm her nerves.

The female medical technicians speak quietly to her, rubbing her back until she slides inside the machine. A chemical that will show contrast enters her body through a catheter inserted in her arm. Images of her right breast appear on the computer screen in an adjoining room, where Shifrin determines where to insert the biopsy needle based on a grid system.

The radiologist, now gloved, enters the MRI room and bends to talk to Phillips. He numbs the biopsy spot by inserting a needle through the grid that is lined up against her breast.

"That's the worst part," a technician tells the patient.

After the anesthetic takes effect, Shifrin inserts a large biopsy needle through the grid that extracts a part of her tumor and sucks it through a vacuum device for later lab work. The actual biopsy only takes a few minutes.

He removes the sample from the machine and places the fleshy strands in a Petri dish. Shifrin later determines that her left breast will not require a biopsy.

Phillips and her physicians will determine her treatment based on the pathology report.

There is no doubt that MRI technology has helped Phillips and many other women. However, one downside as a screening tool is cost. An MRI costs around $1,700, compared with $120 to $150 for a mammogram, according to a spokesperson for Radiology Associates.

"Most people, including myself, would not recommend MRI screening for the general population," Shifrin says.

On Sunday, while Phillips still waits for her results, she will spend the day reading about her condition, so that she is prepared for the results on Monday.

She will not spend the day wallowing in medical literature, however. Denny and she will get out of the house, she said. "Today, we'll go for a long walk if the rain lets up."

MONDAY'S NEWS

The couple didn't get to walk on Sunday, because the rain never let up. On Monday, her doctor informed her the biopsy revealed abnormal cells. She will now have a lumpectomy, in addition to more biopsies.

After that, Phillips is told, she may require more extensive surgery to remove the cancer.

She remains upbeat, knowing that she has the support of a strong medical team and her husband, who remains resolute against the disease with her.

"We'll get through it together," Phillips says.

MRI better tool to detect tumors

Magnetic resonance imaging (MRI) appears to detect breast tumors better than clinical breast exams and mammograms in women at high genetic risk for breast cancer. So says a study in the July 29 New England Journal of Medicine.
The study followed 1,909 women for 2.9 years, and determined that the MRIs detected breast abnormalities 79.5 percent of the time, compared with 33.3 percent for mammogram. The study, however, does not recommend MRI screening for most women.

According to estimates from the American Cancer Society, mammograms will save many of the 215,990 women in the U.S., who will find out they have breast cancer this year. The bad news is that some of those 40,110 who will die in 2004 from the disease might have benefited from the more sensitive MRI screening.

Women who find tumors early have the best chance of surviving breast cancer. The American Cancer Society recommends all women age 40 and older have a mammogram and clinical exam yearly.

From their 20s, women should have a clinical exam every three years, and should perform a breast self-exam monthly.

Next phase: Facing surgery. Correspondent Lynn Koller will follow Brenda Phillips' next stage of defense in her battle against breast cancer. Watch for her follow-up story in an upcoming Monday Accent section.