Breast Cancer Awareness Month is actually international. When I look back at the evolution of the diagnosis and treatment of breast cancer, I can see the achievements that have been made to date, but I also know that we have a long way to go.
I remember when I was in nursing school at age 17 and heard a patient crying in the recovery room when she awakened and touched her chest, and learned that her breast was gone. She was one of those patients who had had an excisional biopsy under general anesthesia. The tissue was sent out for an immediate examination, which revealed cancer, and the surgeon proceeded to do a total radical mastectomy (the old radical procedure developed by Dr. William Halsted at Johns Hopkins a century ago). She was devastated.
It’s My Story
When I was in my thirties, I was diagnosed with breast cancer. I fell into the majority of women who are diagnosed with this disease—having no risk factors and no family history. As a result of having multicentric disease, I needed a modified radical mastectomy. And because of other medical issues, I was not a candidate for reconstruction, so I wore a breast prosthesis, which I named Betty Boob.
At age 40, I was diagnosed with breast cancer in my contralateral side. Again, I received a modified radical mastectomy, without reconstruction. Rather than telling my friends and family that I was diagnosed again with a new primary tumor, we called everyone and said, “We found out today that Betty Boob is getting a roommate, and we want you to help us select her name.” It became an effective way to neutralize the discussion about breast cancer and its treatment. People called asking how Betty and I were doing, when really they were asking how I was doing with my new diagnosis and continued treatments.
A decade after my second mastectomy, with the improvements in medicine and science, I finally became a candidate for breast reconstruction. I chose deep inferior epigastric perforator flap surgery. Guilt set in, though. Who would navigate my patients while I was home recovering, which I anticipated would be probably 4 weeks. I went to church alone and prayed about it—“God, you give me a sign that it is okay with you that I pursue reconstruction, and if I never get a sign, that is okay. I have been doing just fine with my breast prostheses.”
I left the church planning to never tell anyone what I had just done. I didn’t expect to see a burning bush or to be hit by lightning. I already resolved that reconstruction would not be in the cards for me. Just then I reached my car, put the key in the ignition, and playing on my car radio was the song “Sexual Healing,” by Marvin Gaye. The first full verse I heard him sing was, “I can’t wait for you to operate. I’m your medicine, let me in.”
I hurried home and told my husband, “God just sang ‘Sexual Healing’ to me on my car radio. I am going to proceed with getting the reconstruction done.” And I did. I went to sleep in the operating room with headphones on, listening to that song. I went home a few days later with “the girls,” and later had the final touches done— the creation of nipples and areolas that looked 3D, courtesy of an amazing tattoo artist.
I am Impressed
Today I look at what we are able to offer women for breast cancer treatment, and I am impressed. We can do skin-sparing and nipple-/areola-sparing mastectomies, with immediate reconstruction, and it would take a very close look and feel to figure out that any surgery was done at all. Sentinel node biopsies are done instead of the full axillary node dissections. Radiation is shorter. Chemo is kinder. Targeted therapies are available, and research is even being done on the perfection of vaccines.
We have learned more about the biology of this type of cancer, and we now realize that there are not just a few different types of breast cancer; there are hundreds, which also explains why this disease has been so hard to prevent and to cure.
Although it is good news that fewer women (and men) are dying of metastatic breast cancer, we still need to acknowledge the more than 39,000 patients who do lose their lives each year from this disease. They feel isolated. They don’t fit into a regular support group. They are surrounded by pink ribbons this month, which doesn’t make them happy, because there is such a strong focus on overcoming this disease, and very little focus on those forced to live with their cancer.
For those of you who are breast cancer navigators, I know you will agree with me that it is a privilege to be in our patients’ lives during this vulnerable time. We guide them through decision-making about surgical options, chemotherapy, radiation therapy, targeted therapy, hormonal therapy, and more. We also support patients who need guidance for deciding when to stop treatment in favor of preservation of quality of life for the remaining time they have, which is quite profound.
So during Breast Cancer Awareness Month, think about the 300,000 individuals who will be diagnosed this year, the more than 39,000 who will succumb to this disease, and the loved ones who are impacted. But also reflect on how far we have come, especially in the past 3 decades.
Promote clinical trials, so that we can further improve treatment options for new patients. As someone whose granddaughter turns 7 this October, I have hope that her generation will see breast cancer listed in medical books in the same chapter as polio—the chapter that is titled “Cured Diseases.”