What are the chances!?

Thoughts about the diagnosis written last week before surgery...

Many people I've told about having cancer have had a stronger emotional reaction to the news than I have myself. Honestly, I felt more shocked about having an anaphylactic reaction to a bee sting and getting a flat tire the week of my mastectomy than I did when being diagnosed with breast cancer.  I've been preparing myself for this diagnosis since my mother died of metastatic breast cancer when I was 22. By the time I was 25, I had a mammogram, several ultrasounds, a biopsy, and visits with a breast specialist. This is not the beginning of my journey. I'm BRCA negative, so not the highest known risk, but my risk was still elevated to 20 or 30% chance in my lifetime, at least twice the average risk. So during this phase, one of my many feelings is a sense of relief. I'm dealing with it now, I don't have to keep watching and waiting. Because, it turns out that my risk was actually 100%. 

For the last several years, the beginning of the pandemic aside, I've been scheduled for mammograms alternating with breast MRIs every six months. I was a couple of months late this year as I followed the nurse practitioner I've been seeing for years to a new hospital. I had my MRI on Thursday evening, June 9. On Friday at 6pm, I got a call from my NP, also named Tracey, on her personal cell phone. 

As Tracey shared the results of the MRI, she (and everyone else) encouraged me to wait until the results of the biopsy to assume this was cancer, but I had no doubt in my mind. I knew it was cancer. For the past twenty years, I have read radiology reports, I have watched ultrasounds, I have had follow-up scans of questionable areas and I had biopsies. And from the first moment, this was different. Even, as I think back, the MRI technician making sure that I signed a release for my previous scans. I didn't think anything of it at the time, but now I realize that she knew too. 

On Wednesday, I went for follow up imaging and an ultrasound guided biopsy. First, I had a mammogram, then I was called back to have a second magnified mammogram. Then I had an ultrasound, where I first saw the cancer through ultrasound and MRI images. The radiologist doing the imaging also started to encourage me to wait for the biopsy results, but when it was obvious I could tell how different this image was, she acknowledged, "this is something that will need treatment." I met with a second radiologist for the biopsy. The biopsy itself felt different than I remembered. When I mentioned my family history, this radiologist also broke down the "wait and see" wall. "Given the timing, this is may be the result of a genetic mutation you share with your mother. But you will NOT have the same outcome."

On Thursday, one week after my MRI, I got the initial pathology results: invasive ductal carcinoma. If you like to know details like me...grade 2, suspicious for LVI, with a positive lymph node in the breast tissue. On Friday, my 44th birthday, I got the "good news," the cancer is strongly estrogen receptor positive and HER2 receptor negative. 

At 8am Monday morning, Dave and I were in the office of the breast surgeon who works with Tracey, my NP. By noon, I had also met with the plastic surgeon and the oncologist. Everyone agreed to the plan for a double mastectomy as soon as possible, but typically scheduling out about four weeks. There will be additional treatment - chemo as well as a hormonal treatment like tamoxifen - but details and official "staging" will not be known until after my surgery, when I would have a sentinel node biopsy to determine if the cancer spread to any lymph nodes outside the breast.  

I understand that for many people, waiting until the results are 100% definite and more is known than just "cancer" is better. But I appreciate the staff I met with who recognized that pretending it could be nothing was not helpful for me. For better or worse, I cope with information. The more details I know, the better, especially if I can Google it and read some medical journals myself.