COEUR d’ALENE — Since starting her work at Kootenai Health, Dr. Michalina Kupsik has been worried about breast health in North Idaho. 

Idaho is 48th for women ages 40-74 who reported receiving a mammogram in the past two years, according to 2022 data from the United Health Foundation. 

Only about 63% of eligible women had received mammograms. 

Surgical oncologists like Kupsik have found an increasing value in imaging over patients or doctors happening upon suspicious lumps.  

With more and more refined technology helping catch breast cancer earlier,  Kupsik said getting people in the room for annual testing has become a barrier. 

“Better cancer care happens when we catch it really early. The best thing you can do is to do your screening,” Kupsik said. “We have so many advances, but where we fall short is access.” 

She said that in the breast cancer field, about 9 out of 10 women with breast cancer will be survivors. 

Kootenai Health has offered about 17,000 breast cancer screenings so far this year. Out of those screenings, about 155 have resulted in positive breast cancer results.

Her work exclusively focuses on breast cases and Kupsik has been able to share her specialization with patients so that they know there are more options than just a basic lumpectomy or mastectomy if they receive a breast cancer diagnosis. 

“I like to emphasize different options. We can rearrange breast tissue for lumpectomy so you don’t have a divot and partner with plastic surgeons for flat aesthetic closure or a mastectomy with reconstruction,” Kupsik said. 

Many advancements have been made when it comes to breast cancer and dealing with underarm lymph nodes. 

“Historically, all of those lymph nodes used to come out,” Kupsik said. “When you do that big surgery that used to be the standard of care, it would damage the lymphatic flow of the arm.”  

The lymphatic system collects excess fluid from your body’s tissues and returns it to the bloodstream. 

Lymph nodes also help fight infections if we get them and recycle the fluid in the soft tissue. 

When lymph nodes in the underarms are removed as part of a mastectomy, fluid is more likely to back up and cause swelling of the hand or arm. 

Kusik calls the result a “life-long problem” that can be reversed to some extent with extensive therapy and precautionary measures. 

“We've deescalated that big surgery, very few people need it now and we keep finding more and more ways to deescalate it,” Kupsik said.  “Now when we have a positive lymph node, we have some options.” 

Kupsik said about one in 100 breast cancer cases involve men.   

“It is rare, but it does happen,” Kupsik said. “Breast cancer in men tends to be caught at a much later stage.” 

Because there is less awareness about the risks of men getting breast cancer, when cancer presents in men, a lump may not be caught until later on. 

Having a close family member get breast cancer at a young age can rate someone more likely to get breast cancer and other genetic factors may also play a part. 

Kupsik recommends people consulting their doctors to see if they are considered high-risk and potentially get a referral to her clinic or find another one locally that can do an enhanced screening if it’s needed. 

Kootenai Health is part of the National Accreditation Program for Breast Centers and Kupsik is starting a new high-risk clinic to host enhanced screenings for breast cancer. 

By just getting regular imaging and check-ups should be enough for most patients to catch something early on. 

“Don’t stress out,” Kupsik said. “The most important thing is just to be aware of how your breasts feel and look and if there is a change, go see your doctor. Breasts are supposed to be lumpy and bumpy.”   

    Dr. Michalina Kupsik and mammalogy technologist Jessica May talk about different presentations of breasts cancer at Kootenai Health.