ALLENTOWN, Pa. — Wearing pink shoes every day in October isn't just a seasonal ritual for Dr. Lori Alfonse.
“It’s a tribute to my patients who have walked this walk,” said Alfonse, deputy physician in chief at Lehigh Valley Topper Cancer Institute, part of Jefferson Health.
Alfonse, who also wears pink camo boots in honor of the 20 male patients she’s cared for, said the shoes are part of her daily promise to each patient walking through the doors.
The Power of Seven Minutes
Catching cancer in its earliest stages significantly improves treatment options, success rates and long-term survival. That’s why a major part of Alfonse’s mission is encouraging people not to delay routine imaging.
“I just want to encourage every woman to get a mammogram. Try not to be fearful. Is it fun? No. But let’s catch it early,” Alfonse said. “It’s seven minutes that can save your life.”
Alfonse follows her own advice. She had her annual mammogram the same day she was interviewed for this story.
According to guidelines from the American Cancer Society, women at average risk have the option to begin annual mammograms between ages 40 and 44 and are strongly recommended to start yearly screenings at age 45. The guidelines say women can transition to screening every one or two years at age 55.
However, for individuals with a family history of breast cancer, the timeline shifts. A standard benchmark recommended by Alfonse is to begin screening 10 years earlier than the age at which the youngest first-degree relative, such as a mother, sister or daughter, was diagnosed. For example, if a woman's mother was diagnosed at age 42, screening for that individual would typically begin at age 32.
In high-risk cases or for younger women with dense breast tissue, standard mammograms are often paired with breast MRIs to ensure higher detection sensitivity.
“If you have an increased risk, getting an MRI may be able to help detect cancer earlier,” Alfonse said.
Alfonse explained that routine mammograms can provide unexpected insights into a patient’s vascular health by revealing breast arterial calcification, a noncancerous calcium buildup in the blood vessels of the breast that correlates with broader cardiovascular risk.
“So, a mammogram can help predict early warning signs of a heart condition,” Alfonse said, “and heart disease is the leading cause of death for women.”
Minimizing Risk
Alfonse encourages women to build healthy habits starting early in life to minimize cancer risk. When discussing physical activity, however, she deliberately avoids specific terminology.
“I tell my patients, movement is important. I don’t use the word exercise, that can be a dirty word, I just say, ‘Keep moving,’” Alfonse said.
Beyond physical movement, Alfonse emphasizes that non-genetic influences play a massive role in cancer development.
“Ninety percent of all breast cancers are environmental,” Alfonse said. “The water we drink, the food we eat, the stress we’re under.”
Her perspective aligns with the National Institute of Environmental Health Sciences, which reports that most women diagnosed with breast cancer have no family history of the disease, pointing to the role of environmental factors.
Managing those everyday burdens, however, is easier said than done.
“Reducing stress is different for everyone,” Alfonse said. “If I could do a stress-ectomy on everyone, I’d be very rich.”
Personal history also shapes her understanding of how surroundings impact health.
“My mother, grandmother and aunt all had breast cancer,” Alfonse said. “They’re all from the Coal Region. So, they were subjected to an environment that could have played a role in cancer development.”
Personal Journeys
Because cancer manifests differently in every body, Alfonse emphasizes personalized care over a one-size-fits-all approach.
“Are there cancers with more favorable personalities? Yes. Breast cancer is two words, but it can mean a different cancer personality for each patient. I treat each person individually,” Alfonse said.
That individualized reality was felt deeply by Julie Bailey, one of Alfonse’s patients.
When a breast cancer diagnosis hit in the middle of a workday, everything stopped.
“I made the mistake of reading the news that I had cancer in my health portal,” said Bailey, senior director at the Northampton Community College Foundation. “I finished my meeting and I said I need to go home. I just remember my boss giving me a hug and my vice president saying, ‘Whatever you need.’”
From that first moment, Bailey chose to share her experience openly to raise awareness.
“Day 1 of diagnosis I was transparent with anyone that was around,” Bailey said. “I wanted to get the message out that mammograms are so important.”
Navigating the diagnosis also meant confronting common public misconceptions about the disease.
“Somebody actually said to me, ‘Oh, you’ve got breast cancer, that’s an easy one,’” said Bailey, who is now on hormone therapy after six surgeries, including a double mastectomy.
“You really don’t know, until you know,” Bailey said.
For others, a diagnosis comes entirely out of nowhere at a young age. Jenny Klan, restaurant manager for Hampton Winds, Northampton Community College’s culinary program restaurant, was diagnosed at 32 after tissue from her breast reduction surgery was tested. Her cancer was hormonal, and she has since completed radiation.
“Being diagnosed with breast cancer at 32 means facing a sobering truth, I likely wouldn't have known I was sick until my first routine mammogram at 40,” Klan said. “I think something I wish more young women realize is that cancer does not care about your age.”
When asked if working in oncology takes an emotional toll, Alfonse turns the focus back to her passion for her patients.
“I love my job,” Alfonse said. “I meet the most inspiring and amazing people and their families. I can’t un-diagnose a patient who has breast cancer, but what I can do is help with their experience now and give them the best care possible.”
For more on life after a diagnosis, listen to Julie Bailey on our women’s issues podcast, “Common Threads,” read our Q&A with Jenny Klan here, and sign up for the Common Threads newsletter.