Tuesday, October 10, 2017

Breast Cancer Awareness Month: A Personal Perspective, Part 1

October is National Breast Cancer Awareness month, and just like I did with my SMA series in August (which you can read here, here, here, here, and here), I wanted to share the story of someone who has been personally affected by breast cancer. So every Tuesday from now until the end of October, I'm going to turn this space over to one of my best friends, Katie (whose art you have seen here before!), so that she can tell her story.


For years, I have done breast self exams out of habit. I didn't necessarily remember every single month, but I did try to make a habit of it. Last year, in April, I thought I felt something different. I remembered my gynecologist saying that your breast tissue changed during your period, so I waited about a month, but honestly I checked it pretty obsessively during that time. And a month later, it felt harder, seemed like it had grown a little bit, and was starting to become painful. I called my gynecologist on a Friday, who, after hearing why I wanted to make an appointment, fit me in on Monday.

She did feel the same lump that I did, but told me it was probably a fibroadenoma - a very common, benign tumor that a lot of younger women have. She did send me for an ultrasound just to be sure, which was scheduled for the following week. While she tried her best to reassure me, and told me not to worry about it, I instead obsessively Googled pictures of fibroadenomas and cancerous tumors and compared them, trying to figure out ahead of time what the ultrasound might show.

I went in for the ultrasound, which was a very short appointment. The tech barely said two words to me, which only made me panic more, and the radiologist came in at the end of appointment and told me that my tumor did not fit all the characteristics of a benign adenoma - which I already knew, thanks to my Googling. The next step was a biopsy, which the radiologist told me she would doing herself. I left the office in tears.


There was about a week between the ultrasound and the biopsy. I went to Jefferson Hospital's "Breast Center" for the biopsy, and was greeted there by a Nurse Navigator, who explained to me what the process would be. First, they would insert a needle and numb the tissue, and then the radiologist would capture some breast tissue in another hollow needle that would be inserted - five to seven different times. They'd then insert a tiny metal clip to mark where they took the samples, so that it would show up on future ultrasounds and mammograms. Even though she told me it would be numb, they can only numb some of the tumor, not the whole thing - and I definitely felt it. I could not have imagined how badly it would hurt - and then immediately after the biopsy, they did a mammogram, which did not make the pain any better. I went home, and because it was right before Memorial Day weekend, they weren't exactly sure what day the results would be available.

I tried to live normally over the holiday weekend, but I couldn't really stop thinking about the biopsy and spent a lot of time early in the week checking my phone, waiting for the call with my results. When the call did come, both the radiologist and the Nurse Navigator were on the call, and I knew immediately that it was bad news. They told me that my results were positive for breast cancer, and they were both shocked. I was a healthy, 28 year old woman, with no family history of breast cancer. I also learned it was Stage I Invasive Ductal Carcinoma, and that I would need both chemotherapy and surgery, and they gave me what was essentially "Breast Cancer 101." We set my first appointment with my new oncologist. 

Honestly, my oncologist made this whole experience bearable. One of the first things she told me was that we were going to fit cancer into my life, and not make my life revolve around cancer. Since I had a busy summer planned, full of art festivals all over the Eastern US, this was so important for me to hear. She really treated me like a person, and not just another case of breast cancer. She also asked if I had kids, and if I wanted them, because there were a lot of fertility concerns to discuss, which I'll talk about in next week's post. 

We spent some time discussing the kind of cancer that I had, and what that meant specifically for treatment. She explained that there are three main factors in breast cancer biology - estrogen receptive, progesterone receptive, and HER-2 receptive. They test the receptors of the cancer cells from the tumor to see if those three factors affect the growth of the tumor. Breast cancer can be positive or negative for each of those factors, and each combination might require a different kind of treatment. I was triple-negative, which is more aggressive, but also more responsive to chemotherapy, so my treatment would focus on that. I also had genetic testing, where I found out I was BRCA negative, which was unexpected because of my triple-negative status. BRCA is the most "famous" genetic mutation, but that mutation is actually only responsible less than 10% of all breast cancer cases. Someone who is BRCA positive is exponentially more likely to develop both breast and ovarian cancers. 

I also met with my surgeon. We talked about the chemotherapy port that I'd need to have surgically implanted, and about lumpectomy vs. mastectomy. While I could have been a candidate for lumpectomy because my tumor was relatively small, that would have meant radiation in addition to chemotherapy, which due to my age would have increased my risk for developing other cancers, so that was ruled out. We talked about my options for single or double mastectomy, as well as reconstruction, but nothing was decided yet.

 Before any treatment could begin, though, I had to go through fertility preservation treatments, which I'll talk about in next week's post.

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