I know first hand the exact location of the loneliest place on earth.
It is the hallway between mammography and sonography, where the minutes crawl by with interminable slowness as you wait to be worked in because the technician saw something on your films and went right then to fetch the radiologist to have a look, and he has ordered a stat sonogram of the breast. I also know how it gets even scarier and lonelier when the sonography tech gets a concerned look because he can’t pick up the mass, just the blood supply to it, and his jaw muscle grows tenser and tenser as he maneuvers the wand, hoping that if he hits it just right he will see what he wants to see, instead of what he is seeing.
The slowest week of my life was spent waiting for a stereotactic needle biopsy of the tiny but highly suspicious spot on my chest wall. The normal wait for a stereotactic biopsy in that facility is less than 48 hours, but the machine was down and the part to fix it was ordered but had not arrived. My doctor sent me for bloodwork. “Let’s get your antigen levels. If nothing is elevated you can relax in two days instead of two weeks. Besides, if it isn’t the news we want it to be, we will need baseline levels anyway.”
I went to the lab and had a coworker draw some blood and another friend personally ran the two that we could do in-house. Both of those, the CA 19-9 which is a tumor marker that is not indicative of cancer type and the CA 27.29, which is indicative of breast cancer, were elevated, but not dramatically. When the CA 15-3, a test that indicates a more aggressive and advanced disease came back two days later, it was normal.
I felt like my life was a coin toss and the quarter was just hanging in the air, as if gravity were suspended.
I was scared to death – there are too many instances of the disease in my family. I cried for a day, then I was numb for one more.
Then I got defiant, or what passes for defiant when you are a 40-something urbanite who has led a pretty staid existence.
I went shopping. With a vengeance. I went to the Plaza and bought things for my granddaughter that she was far too young for, and I bought a Kate Spade handbag on credit. It was my way of saying “I will be here for a while. I will be here long enough to see Zoe play with that dollhouse and wear that diamond necklace – and to actually own that purse.”
In my case, it turned out that I was about as lucky as I could be. The cluster of cells in question was extremely tiny, less than 2mm in size, and the lymph node that was removed at the same time showed no cancer cells. The diagnosis was ductal carcinoma in situ – literally a stage 0 cancer that was confined to a single mammary gland. It was so minor that some researchers exclude cases like mine from their statistics. My treatment was so uneventful that I never threw up once or lost a single hair off my head. My experience was not at all dramatic. I went into the hospital one fine fall morning at 6:00, was in the OR by 7:15 and in recovery by 8:00 with a tiny (three stitches) incision on the side of my right breast, near the chest wall, where they removed the mass and the lymph node. I was home before lunch with a couple of prescriptions and was talking my husband down, telling him to please relax, there was nothing wrong with me. I’m a medical professional. If there was I would be the one overreacting, and after over 20 years of marriage he should know that about me. He thought about this for a minute, realized the veracity of what I said, and calmed down.
Because my healthcare comes from the government, I don’t have to fight with an insurance company that insists one mammogram a year is adequate, and if it isn’t, I am too great a risk to insure. Because my doctor is free to treat and test me as he sees fit with no insurance company employee standing between him and his patient, he took one look at my family history and ordered an annual bilateral MRI of the breasts and a mammogram every six months. A tiny spot that had not been there six months before was picked up almost as soon as the first onco cell underwent mitosis, and long before it had a chance to permeated my chest wall and get to bone, or spread to my lymph system. Because my doctor, who works for a salary rather than fee-for-service, is allowed to make decisions that are in my best interest and not that of an insurance company, I had a very non-eventful experience with a very traumatic disease. I missed a grand total of two days of work and my treatment consisted of taking one pill a day for 36 months. I still get mammograms and antigen levels every six months, and will for the rest of my life. As of today I remain cancer free.
Because of my job – I was a supervisor working in a clinical lab that received a few million dollars in cancer research grants every year – I was aware of ongoing research into the effects of lifestyle on both prevention and recurrence. I knew that the preliminary results were encouraging because I had crunched some of the numbers myself. Besides that, who has ever seen their health deteriorate because they quit smoking, stopped drinking, started exercising and eating better and reduced their stress?
Now the data has been analyzed and the peer-reviewed studies on lifestyle changes and breast cancer are making their way into professional journals and the results are encouraging, especially for survivors who make lifestyle changes in an effort to prevent a recurrence of a second primary invasive contralateral breast cancer.
Breast cancer survivors might be able to reduce their risk for contralateral breast cancer by making lifestyle modifications. A new study published online September 8 in the Journal of Clinical Oncology has found that obesity, alcohol use, and smoking all significantly increase the risk for second primary invasive contralateral breast cancer among breast cancer survivors.
Researchers from the Fred Hutchinson Cancer Research Center in Seattle, Washington, found that obese women had a 50% increased risk for contralateral breast cancer, and those who consumed 7 or more alcoholic drinks per week had a 90% increased risk. Survivors who currently smoked had a 120% increased risk of developing a second breast cancer.
The risk was particularly high in women who were current smokers and who consumed at least 1 alcoholic beverage a day. The authors found that this subgroup of women had a 7.2-fold (95% confidence interval [CI], 1.9 – 26.5) elevated risk for contralateral breast cancer.
I have always lived a pretty healthy lifestyle. I don’t smoke, and I rarely drink (Netroots Nation doesn’t count!) I have always gotten adequate exercise and being able to stand to lose about twenty pounds that I had gained gradually as I went through a series of five knee surgeries in the four previous years didn’t exactly qualify me as obese. In other words, outside of reducing stress, there just wasn’t a lot for me to change…in my own life. But I could certainly make myself insufferable to friends, relatives, acquaintances and people stuck in an elevator or checkout line with me who dropped their guard and made eye contact or let their eyes linger on a pink ribbon for more than two seconds.
My mantra has always been “we aren’t helpless” because there are things we can do to be proactive and reduce our risk of both initial occurre
nce and secondary recurrence by making some lifestyle changes. If you smoke, stop. If you drink more than one alcoholic beverage per day, cut way back on that, too. If you aren’t getting enough exercise, make an honest effort to increase your activity levels. Eat a healthy diet that is low in fat, high in fiber and rich in fruits and vegetables – and if you do the last two things, weight issues tend to resolve themselves.
October is breast cancer awareness month. Make a vow to educate yourself and practice good breast health. Get regular screening mammograms, and do regular self exams. (If you don’t have a regular menstrual cycle to remind you to do your self exam, pick another monthly event to serve as your reminder. My usual suggestion to women who don’t have a period is to do it the day the phone bill comes in the mail.) Adjust your lifestyle to lower your risks. If you have a friend or a loved one who gets a diagnosis, be supportive and loving and positive and encouraging, because I can tell you this as a healthcare practitioner for over two decades: people with good, positive social networks always have the best outcomes. And the fact that we now have clinical proof that we aren’t helpless, well, there is something to be positive about – and that is as good a place to start as any.
This post originally appeared at Fire Dog Lake