‘Sweeping up the breadcrumbs’

Retired elementary school teacher Janet Fuller was stunned when a routine mammogram showed a lump in her right breast in October 2024. She was 68 years old with no known family history of cancer. A follow-up diagnostic mammogram indicated lymph node involvement and a biopsy confirmed stage 3C (locally advanced) breast cancer.

Shortly after her diagnosis, Fuller, from Arlington, Washington, received another blow. Her son died suddenly due to a heart attack. Even though the two events were devastating, she focused on being there for the rest of her family, which gave her the will to fight.

Her local oncologist fast-tracked her for surgery and chemotherapy, but Fuller didn’t want chemotherapy, worried it might exacerbate her osteoporosis. She looked for other options.

Fuller had heard about Fred Hutch Cancer Center’s reputation and learned they had proton therapy — a radiation option that could precisely target the tumors but avoid healthy tissue. After her first call to Fred Hutch, she felt confident about her choice.

“I felt listened to from the very first call,” Fuller said.

She opted to have a mastectomy of her right breast at her local hospital, followed by radiation at Fred Hutch.

 An ‘integrated boost’ of proton therapy

Fuller met with radiation oncologist Janice Kim, MD, MS, in March 2025, after she had time to recover from surgery.

“Janet was diagnosed with a more advanced breast cancer that had spread to lymph nodes located deep inside the chest, near the sternum and heart,” Kim said. “These lymph nodes are called the internal mammary nodes and are an important area to treat because they can sometimes contain residual cancer cells. Unlike lymph nodes in the armpit, these nodes are difficult and risky to remove surgically because of their location near critical structures such as the heart and lungs. Fortunately, radiation therapy can effectively treat this area without the need for additional surgery.”

In Fuller’s case, Kim opted for proton therapy with an “integrated boost,” which delivered extra radiation to the lymph nodes at highest risk. Emerging research suggests that this strategy may improve outcomes for select patients, and Kim has recently received funding to study it in a clinical trial.

“She called it ‘sweeping up the breadcrumbs,’” said Fuller. “Her way of simplifying the scientific information was very helpful.”

Fuller had 16 sessions of proton therapy and finished treatment in April 2025.

“I was scared the first time,” she said. “I’d been told what to expect but it was a brand-new experience. It turned out it was a piece of cake. I felt like I’d made the right decision. And the team there made the experience as nice as it could be. They were so compassionate.”

Fuller’s husband came with her to treatment every day, and she had lots of support from family and church members to help her through the emotionally difficult times. Physically, she said everything was manageable. She had some minor skin burns for which she used prescribed creams, and she suffered from fatigue. Other than lingering tiredness, she feels good now, and she remains cancer-free. She will continue to be monitored once a year.

Despite the lack of cancer in her family history, Fuller and her daughter opted for genetic testing. Neither of them has the BRCA mutations that are associated with breast — and other — cancers but both will be monitored more closely than average given Fuller’s diagnosis.

Fuller is now back to enjoying her well-deserved retirement: taking walks with her husband, having lunch with her daughter and playing with her granddaughter. They love doing puzzles. She is very grateful to have a calm life and for the good quality of life she attributes to having chosen proton therapy as part of her treatment.