Dr. Melissa Hulvat, surgeon and co-director of the Bass Breast Center, has a sobering message about the breast cancer cases here compared to those she treated in Chicago:

"I'm finding bigger tumors, more advanced cancer than I'm used to seeing."

She said some advanced cases are unavoidable, but others could have been caught earlier had the women been screened for breast cancer at an annual exam.

Flathead County continues to lag behind the national rate of 70 percent of women seeking yearly mammograms after 40.

"Here in this county, it's 42 percent, which is abysmal," Hulvat said.

With October as Breast Cancer Awareness Month, she wanted to add her voice to others promoting screening to catch breast cancer early when it's most treatable.

Hulvat arrived here from Chicago in July to serve as co-director with Dr. Debra Accord of the Bass Breast Center.

"I always knew I wanted to be somewhere smaller," she said.

Hulvat said she found the best of both worlds in the Flathead Valley - a rural lifestyle with a high-quality working environment.

"The medical staff is great and there's really nothing I'm used to having that I don't have here," she said.

It's high praise from a physician who trained and practiced for the last 10 years at the medical facilities of Loyola University, where she spent a five-year residency in general surgery, and at Northwestern, where she finished a one-year fellowship in breast disease.

At the Bass Breast Center, Hulvat treats breast diseases as part of a team that includes imaging specialists such as Accord, pathologists, plastic surgeons, oncologists and more.

"It's nice that we have a small medical community," Hulvat said. "We all work closely together."

She began the interview with a tour of the 2,750-square-foot facility made possible by $1 million given by philanthropists Harold and Annette Simmons in honor of their friend, investment banker Paul Bass.

Bass, a part-time Bigfork resident, has a passion for advancing health care.

Tucked between Kalispell Regional Medical Center and HealthCenter Northwest, the Bass Breast Center includes two exam rooms, a small procedures room, two office suites, a patient library and conference room. Hulvat particularly enjoys the cozy conference area.

"I like working with my patients and their families - the more human touch," she said.

Hulvat said it was that aspect of breast surgery that drew her to the field once she settled on medicine. Growing up in the Midwest, she first dreamed of a career in music.

"I wanted to play the French horn and be a music teacher," she said. "Then I realized I wasn't that good and I would never be in a symphony."

Enrolling in a Jesuit Catholic high school changed her life in two significant ways. Hulvat met her future husband, James, at school and worked as a candy striper to fulfill the school's community service requirement.

"That was my first medical job," she said. "I loved it."

As a candy striper, Hulvat recalled taking care of a child for a woman whose baby had been severely burned. She said it made her realize what people go through and she felt so good helping in a small way. She realized she wanted to help in a much larger way.

As an undergraduate at Cornell, Hulvat was a pre-med major who was planning a career as a family practice physician. A chance invitation to spend the summer working with a surgical team in Cleveland planted the seed for a career in surgery.

"I thought I would get coffee and do the filing," she said. "I just had just gotten there and they said 'Oh great - you can hold the retractors'" in surgery.

Even at medical school at Loyola, she still envisioned herself as a family practitioner. Hulvat's passion for surgery came flooding back during that rotation at school.

"Don't get me wrong - I have all the respect in the world for family practitioners," she said. "But I really like taking hand A and hand B and fixing a problem."

Breast surgery offered her the human interaction of family practice with the hands-on-fixing of surgery. At the Bass Breast Center, she spends an hour with new patients mapping out every aspect of their cancer or other breast problem

"I treat all varieties of breast disease," she said. "That's why I chose the fellowship that I chose."

Hulvat said her field covers a broader spectrum than most people think. She recently saw two women with chronic breast pain. Other problems include breast abscesses and nipple discharge.

"I also have patients come in who are at high risk for cancer - they have a genetic syndrome in their family," she said.

At the Bass Breast Center, Hulvat has achieved her vision of offering full-service breast care, with breast-cancer patients still a significant portion of her cases.

By beating the drum for breast-cancer awareness this month, she hopes to meet patients early in the course of the disease. Hulvat encourages people to bring any changes they've noticed in their breasts to their provider's attention.

"Breast is not a bad word," she said.

For some women, embarrassment or fear may have deadly consequences if they prevent them from getting annual exams and screenings. Hulvat met one such woman at a recent presentation where she showed slides of a beautiful breast reconstruction performed by a plastic surgeon after a mastectomy.

Afterward, the woman confided that she never had a mammogram because she couldn't face the disfigurement of breast surgery, so she didn't want to know if she had cancer. After seeing the advances in reconstruction, the woman had a potentially life-saving change of heart.

"She said, 'Now I'm going to have a mammogram,'" Hulvat said with a smile.

From the first consultation, patients who opt for a mastectomy learn about reconstruction. In the process of removing the cancer, Hulvat uses the latest techniques to preserve as much skin as possible for the plastic surgeon to achieve a natural-looking result.

"Reconstruction after breast cancer has gotten so good," Hulvat said.

She said some patients are shy about addressing the issue of breast appearance after a mastectomy. Hulvat assures them they should not feel any hesitation about wanting to look whole.

"There's nothing vain about wanting to look as healthy as you feel," she said.

Reporter Candace Chase may be reached at 758-4436 or by e-mail at cchase@dailyinterlake.com.