Second opinion leads to life-changing care for patient with breast cancer

Madison, Wis. – When Sarah Smith was diagnosed with metastatic breast cancer, she was only 39 years old.

In April 2017, she discovered a lump in her breast during a self-examination and asked her sister, a nurse, what she should do. Smith set up an appointment to see a physician in Wausau, where she learned the news.

“It was straight to stage four, meaning it had spread to other places like my bones,” she said. “I was shocked because I wasn’t even old enough to schedule a standard mammogram screening at that time.”

Smith asked her physician if this meant she only had six months or so to live.

“He said, ‘yes, it could be that fast,’” she said. “I thought I needed to go home and start getting my affairs in order.”

Smith’s husband and sister pushed her to seek a second opinion. They knew the diagnosis was unlikely to change, but after reflecting on her initial prognosis she wanted to know if there were any other treatment options. This led her to make an appointment with Dr. Kari Braun Wisinski, a medical oncologist and co-leader of the UW Carbone Cancer Center breast center disease-oriented team.

“She made me feel better almost right away,” Smith said. “She did a great job explaining the diagnosis to me and she provided me with several treatment options.”

Smith has hormone receptor-positive, HER2- breast cancer, as well as a mutation of the BRCA gene which can makes people more susceptible to early-age breast cancer, according to Wisinski, who is also a professor of medicine and the chief of the hematology, oncology and palliative care division at the University of Wisconsin School of Medicine and Public Health.

Smith, who lives in Rothschild, near Wausau, decided to receive her care from Wisinski at UW Carbone.

Her first treatment regimen, according to Wisinski, was a standard therapy for patients with breast cancer. It included aromatase inhibitors – anti-estrogen medication – as well as a class of medicines called CDK4/6 inhibitors, which are used to treat certain metastatic breast cancers by interrupting the process through which breast cancer cells divide and multiply.

This treatment plan worked for three years before the cancer started resisting the therapeutics. This is when Wisinski started looking at clinical trials that could benefit Smith.

Clinical trials are research studies performed in phases to evaluate a medical, surgical or behavioral intervention. When people participate in clinical trials, researchers are investigating if a new drug or device, for example, is safe and effective.

In Sept. 2020, Smith joined a clinical trial led by Wisinski that is targeting the BRCA gene mutation using a drug already approved to treat breast cancer – talazoparib – in combination with gedatolisib, an investigational medication that may increase how well tumors respond to talazoparib. This clinical trial is a shared effort across five universities in the Big Ten Cancer Research Consortium and is for patients with metastatic triple negative breast cancer or those with BRCA mutations.

In May 2022, Smith and her family celebrated her reaching the five-year milestone post-diagnosis. The five-year survival rate for patients with metastatic breast cancer is only 29%, according to the American Society for Clinical Oncology.

Smith credits this milestone with getting a second opinion and joining clinical trials.

“I think everyone should get a second opinion if you can,” she said. “It might be exactly what you need to find the right doctor and the right treatments for you.”

Wisinski also strongly encourages second opinions.

“It can be about confirming a diagnosis, but it’s much more than that,” she said. “We physicians learn from each other through second opinions, and patients can learn more about the options they can access, including clinical trials.”

Smith is proud to participate in clinical trials.

“When I first learned about my cancer, I wasn’t very interested in being part of the research,” she said. “Since I’ve worked with Dr. Wisinski and met so many other women going through breast cancer, I’m glad to be part of these trials. They don’t just have the potential to help me, they pave the way to help women who are diagnosed with breast cancer after me.”
As a result of the second opinion and success of her treatments, Smith spends her time enjoying summer in Wisconsin and traveling.

“We’ve traveled a lot in the last five years,” she said. “I’m happy to not only have this time but to spend it with family and see the places I might have waited longer to see before.”