Kris Holladay

"I'm too young not to think about living another 30 years. I have too much to live for."

Kris and Hal Holladay are no strangers to what most folks would call "bad news."

Their trials began when their second child, Kari, was born with trisomy 18, a genetic disorder that would take her life. Doctors gave her weeks. Kris and Hal were blessed to have 10 years with her.

Kris carries with her a carefully laminated 5x7 photograph of Kari. She touches the photo gently, a motherly stroke. "We were in our early 20s when she was diagnosed ... that was shocking." Before Kari died, Hal and Kris founded S.O.F.T., an international support organization for parents and families of children with trisomy and related disorders.

They also tried for another baby, but Kris miscarried.

Then their fourth child, Devin — "Devin from heaven," they call him — was diagnosed at age 12 with a painful kidney disorder. Treatment involved surgery to remove part of his ureter. Now he's a healthy young man.

The Holladay family grew to include seven children, including an adopted daughter with special needs and a young man they took in as their own. Hal's elderly parents, who needed care, also moved in.

No matter what the challenge, Kris and Hal faced it head-on, together. "We laugh about the things that are great, and we cry about the things that are hard," Kris says. "You learn to think, 'Okay, regroup, stand tall, move on.'"

And then they learned Kris had breast cancer.

"This Can Never Happen To Me"

In the fall of 2002, a small lump appeared in Kris' left breast. Doctors removed it during an excisional biopsy at a Phoenix hospital. Kris spent October at home, recovering from surgery.

October is National Breast Cancer Awareness Month. But it never occurred to Kris that she could be in danger. "I was watching TV, and I thought, 'Wow, that is so tough for some people. That must be horrendous,'" Kris recalls. "But I have no risk factors. My family is absolutely clean. I breast-fed my babies. I didn't smoke."

So Kris expected an easy appointment when she sandwiched her surgical biopsy review into a 15-minute window between other errands, including taking Devin to the urologist for his kidney problems. Hal had offered to accompany her, but she'd sent him off to work. "No, no," she had said. "It's a busy day. I'll call you at lunch."

Little did Kris know she'd face an hour-long consult that began with the words: "Your biopsy came back: Cancer."

When a breast tumor is removed, surgeons also remove some surrounding tissue. A pathologist checks the tissue under a microscope to verify that the cancer cells haven't spread to the margins, or edge, of the site. Kris' margins weren't clean, which meant additional cancer surgery was needed. "When you hear cancer, it's everything," Kris says. "Because you don't know where you fit in that whole scale, from A to Z."

Kris had a relatively small tumor with a good prognosis. Doctors gave her 90 percent odds of surviving at least 10 years.

"And I said, 'Not good enough.' I've picked out percentages before [with Kari]. Ten percent is a little high for me. I want 1 percent. I'm too young not to think about living another 30 years. That's why we looked to Mayo Clinic as the place to go for treatment. I didn't want to take chances with this. I had too much to live for. I have children that are young. I want to be a grandmother, a great-grandmother."

Role Reversal

"We had made an agreement: I won't die if you won't die."

Kris and Hal had always faced challenges together. "We had made an agreement: 'I won't die if you won't die.' But now was the first time we couldn't laugh about it."

For the first time, Kris was the person receiving care instead of providing it. "It's easier to be the caretaker ... the mom of the child that's sick ... the one to offer assistance. To finally be the one who had to take it — when my own mortality was on the edge — that's a whole different place," she says.

Kris also had concerns about driving 45 minutes each way to Mayo Clinic for treatment.

Hal drove her to Mayo Clinic often, as did sons Bryce, Nick, and surrogate son Joe. In fact, Kris never came to Mayo Clinic alone. "They never left me alone. ... I always assumed they were coming for the drive, or to go out to lunch afterward. I never realized they were coming so I wouldn't be alone." Hal takes her hand and squeezes it tight.

Beating Breast Cancer — On Her Terms

At Mayo Clinic, Kris and Hal met with Barbara Pockaj, M.D., to discuss surgical options: breast conservation therapy, involving lumpectomy and radiation, or mastectomy. Kris wanted to save her breast, a process that typically involves surgery followed by three weeks of healing and six weeks of external radiation treatment.

"It was a little amazing to me when I found out [with standard radiation therapy] you go six weeks, five days a week," Kris says. "That's a big commitment. That means putting everything else on hold."

"You learn to think, 'Okay, regroup, stand tall, move on.'"

Hal adds, "No matter who you are, it's not that easy to put your life on hold for six weeks."

Moreover, their first grandchild was to be born just about the time Kris would be wrapping up therapy. And Kris wanted to be there. "We had a grandbaby coming. I didn't have time to take [traditional] radiation."

Fortunately, Dr. Pockaj thought Kris would benefit from a new clinical trial that shortens the course of postoperative radiation: Intraoperative radiation therapy for breast cancer. She sent Kris to see William Wong, M.D., the Mayo Clinic radiation oncologist leading the study.

Intraoperative radiation therapy (IOERT) is a special form of cancer treatment that delivers a powerful, concentrated beam of radiation directly to tumor sites while they are exposed during surgery. The IOERT machine, called the Mobetron, is brought into the patient's operating room. "With standard therapies, radiation oncologists see patients after surgery to discuss treatment," explains Dr. Wong. "But in the case of IOERT, we work with the surgeon to make sure the patient is a good candidate, and we administer therapy with the surgeon in the operating room. It's really done as a team effort."

IOERT has been used by teams of surgeons and radiation oncologists at Mayo Clinic in Arizona since January 2002 to treat locally advanced cancers, such as colorectal, pancreas, biliary, gynecologic and renal cancers and sarcomas. In the past year, a new clinical study began using IOERT in the treatment of early stage breast cancer.

"This was the treatment that let me be there when my grandbaby was born."

Mayo Clinic Hospital has one of only nine FDA-approved mobile IOERT machines in the world, and is the only medical center in the Southwest with this treatment option. In the case of breast cancer, IOERT adds only about 20 minutes to the surgery. And as Kris says, "What do I know? I'm asleep."

This initial high dose of radiation drastically reduces external radiation treatment time following surgery. For Kris, external treatment was reduced from six weeks to four weeks plus four days. Future IOERT studies may shorten the course of external radiation even further.

"This approach is more convenient for our patients and reduces the total time and cost of treatment," says Dr. Wong. "Most importantly, though, it also allows us to be more accurate because we are right there radiating the tumor itself. We're able to focus more on the tumor and less on the surrounding tissue."

For Kris, the benefit was much more profound. "This was the treatment that let me be there when my grandbaby was born."

"How Long?"

In summer 2003, Kris and her eldest daughter Tricia participated in the Walk for the Cure in Washington, D.C.

"[During registration], they were handing out information packets, hats and T-shirts to the participants, and they were asking, 'How long?' And as they came down the line, I could hear people answering, 'Ten years.' 'Twelve years.' 'Seventeen years.' It took a moment before I realized they meant, how long since your diagnosis of breast cancer?

"They got to me, and I sort of ducked my head and whispered, 'Eight months.' And the woman turned and held my arm up high and yelled, 'Eight months!' And a great cheer went up from the crowd.

"And that's when I knew I had won."