Survivor Stories 2015:
1. How did you first find out you had cancer?
I found out about my breast cancer during a routine annual mammogram and ultrasound at the age of 43. Please note that I have no history of breast cancer in my family. I had my first baseline mammogram at the age of 40 which was unremarkable except for a “cyst” and a second, routine yearly mammogram at the age of 41. At the time of the second mammogram I was recalled because of abnormal findings in my left breast where the cancer was ultimately discovered more than a year later; however, a follow-up ultrasound following the second mammogram did not reveal any abnormalities. The radiologist at the time called the lesion a BI-RADS “2″ (BI-RADS is an acronym for “Breast Imaging Reporting and Data System,” a radiologic classification system for reporting lesions in the breast). The BI-RADS Assessment Categories are:
Besides the benign classification of the lesion by the radiologist, several things impeded the correct diagnosis at the time of my second mammogram and ultrasound: 1. I had switched breast imaging centers and did not have access to previous films. I want to stress here that continuity of care for patient is critical. Patients should have access to previous radiographic studies for comparison purposes. The “new” breast imaging center should help the patient locate and obtain the previous films; however, they rarely do. The patient has to be very proactive in order to obtain a copy of the films or a CD from the previous institution. 2. Fibrocystic changes/dense tissue in my breasts. My breasts felt like bags of marbles. While the architecture of the breast tissue can change with the menstrual cycle, any persistent, palpable lesion should be evaluated and probably biopsied. Looking back at my breast cancer, I had probably palpated it during self breast exams, and may even have accepted it as part of my normal architecture, especially in light of the BI-RADS 2 classification.
Fortunately, I followed the American College of Radiolgists’ recommendations for starting breast cancer screening by mammography at age 40. Other authorities have tried to move the start of screening to age 50. If I had waited that long, I would probably be dead by now.
At the age of 43 I had my third and diagnostic mammogram. I was a bit delayed in getting the screening done; approximately 18 months had passed since the second mammogram I described above with the BI-RADS 2 classification. The third mammogram looked abnormal, and an ultrasound was performed immediately. I will never forget that the ultrasound had the look of a “Christmas tree,” taller than wide and spiculated with irregular borders like the branches of a tree. A “Christmas tree” sign on a breast ultrasound is a menacing one. The radiologist biopsied the lesion, and I took the tissue back to my laboratory. I am a pathologist. I look at human tissues through the microscope. I make the diagnosis of breast cancer several times a day. I never imagined I would make the diagnosis of breast cancer on my own tissue. I did something unconventional to my breast biopsy. I removed the breast tissue from the formalin fixative, and I performed touch preps on it. That is when you touch the tissue onto a glass slide and stain it. You look at the cells that come off of the tissue. I am a cytopatholgist. I look at cells. I saw the cells of my breast cancer through the microscope. I lost my bearings. I felt disoriented, like the rug had been pulled out from under me.
2. How did you react when you heard the news?
After the initial shock, I felt strangely empowered—like I had to do everything in my power to stay alive for my childrens’ sake who were 5 and 8 years old at the time of my diagnosis. I diagnosed the cancer in November 2009, and before the beginning of Christmas break that year, I had all of the preoperative testing done including a PET scan to look for metastatic disease, an MRI of the opposite breast, and I had consulted with a plastic surgeon. I stayed busy with all of my appointments. On December 16, the Friday before Christmas break started, I underwent bilateral mastectomies with sentinel lymph node sampling and preliminary reconstructive surgery. I reduced my circle of friends and loved ones to those closest to me (at least temporarily), a phenomenon Dr. Atul Gawande describes in his book, Being Mortal. When faced with a deadly disease or advanced aging, people tend to limit their circle of friends and family to those who are closest to them.
3. What course of treatment were you prescribed?
Firstly, I do not like the notion that patients are prescribed a course of treatment. It implies that they have no say in their own treatment. It should probably state: “What course of treatment did you undertake?” I chose bilateral mastectomies. The reason is that on MRI and biopsy of my other breast, we found atypia bordering on DCIS (ductal carcinoma in-situ). That put me at a much higher risk of developing breast cancer in the other breast as well. I already needed a mastectomy on the left breast. I did not want to live with the uncertainty and required vigilance that monitoring the right breast would entail, so I opted for a mastectomy for both breasts. Upon sampling of some sentinel lymph nodes in my left underarm (axilla), one of the lymph nodes was found to have a small nest of metastatic cancer cells. Therefore, I opted to have chemotherapy to eradicate any potential remaining breast cancer cells elsewhere in my body.
Because my breast cancer was positive for estrogen receptors, I needed hormonal therapy to block the estrogen receptors on any potential remaining cancer cells. I took tamoxifen for a while; however, I took an extra step in order to remove the main source of estrogen in my body—my ovaries. I had a hysterectomy and bilateral ooporectomy. That made me menopausal at the age of 44. Now I take an aromatase inhibitor, which is a drug to block the formation of estrogen in my body. Depriving estrogen is a very effective means of preventing any residual breast tissue in the body from developing breast cancer.
The surgeries were followed by a number of reconstructive procedures, and I have had a good cosmetic outcome.
4. What surprised you most about your treatment?
What surprised me most was how effective the anti-emetics were in controlling nausea and vomiting during and after chemotherapy. I am not happy to report that I gained weight during my chemotherapy treatments, which is not at all uncommon. I was also surprised by the outpouring of support from family and friends, even the more distant ones who I rejected at the beginning of the process. They prepared and brought meals, took the kids for numerous playdates and outings, and sent flowers and cards.
5. What would your advice be to anyone who’s just received a cancer diagnosis?
It really depends on the type of cancer and on the stage. Breast cancer is highly treatable, especially that it is being caught earlier than ever before. It is very common, with an average lifetime risk of approximately 12%. With that comes a vast amount of knowledge and experience in its treatment. I tell people not to fret, to go out and get as much information as possible, and armed with that knowledge, to fight it head-on.
6. How long have you been cancer free?
I have been cancer free for almost 6 years.
7. What lessons did you learn from the experience?
I have changed my priorities. I put my children and family first. I listen intently to them and look them in the eye when they speak to me. I try to enjoy life to its fullest.
8. If you could send one message to all the Good Enough Mothers out there—what would it be?
Live and enjoy the present moment to its fullest potential. Don’t live in the past or in the future. Forgive and most importantly, be grateful for everyone and everything you have.
Enma Saiz, MD is a board-certified pathologist and cytopathologist at Vitro Molecular Laboratories www.