It is estimated that 182,460 women in the US will be diagnosed with invasive breast cancer in 2008, and that 40,480 will die of the disease (20,080 and 4150, respectively, in California alone). That’s better odds than the rest of the world, where 1.1 million new cases and 420,000 deaths are predicted this year. Chances are that 1 in 8 American women will have the disease during their lifetime. In addition, 62,480 Americans are <a href="expected to be diagnosed with melanoma in 2008, with 8420 deaths attributed to that disease. The set of Americans that are diagnosed in 2008 with both breast cancer and melanoma, as two separate primary cancers, is not a null set. It contains at least one person: me. When you are sitting in the doctor’s office and being told that you have cancer, time really does stop. The remainder of that doctor’s appointment occurred in slow motion, with words being drawn out and motions distorted, as if I were walking through a haunted house display. I instantly turned numb. My doctor explained the pathology from the biopsy and the treatment options. Intelligent questions were out of the question – I had yet to learn the breast cancer dictionary – so all I could muster to ask was whether I was going to lose my hair. Two months later, after the main surgery, the final pathology revealed that the situation was more serious than previously thought. At that point, I was in a combined state of total, sheer panic and determination to seek the best, aggressive treatment available today. Three weeks ago, I was diagnosed with the melanoma. By this time, it seemed old hat. I peppered the poor doctor with questions about the pathology and the treatment, and there was a new cancer dictionary to learn. I would much rather have a new primary than a distant recurrence of the breast cancer. I never asked "why me" as apparently many women do. I’m the fourth woman in my family to have breast cancer, so it’s more of an "oh shit, me too" than a "why me" moment. Out of 4 aunts, Aunt Helen is a 20 year survivor. She has had one instance of a local recurrence that was treated. Out of 9 female first cousins, 3 of us have/had breast cancer. And we are not an old group. Cousin Margie, born six weeks after me, was diagnosed in 2003 and died in 2004. Cousin Carol was diagnosed in 2007. Me in 2008. The rest of the family is now on high alert. One of the more interesting stories about my cancer, is how it was diagnosed. I’ve been good about getting mammograms on the recommended schedule, particularly after Margie’s death. However, it is often the case that younger pre-menopausal women have dense breast tissue, rendering mammograms less effective. My doctor was concerned for years whether I was being adequately screened. So the last time around, he casually mentioned that perhaps, just maybe, I should have an MRI as well. Just for screening. I wasn’t keen on it – didn’t wanna be locked up in a tube. Doc was leaning 60-40 in favor. I left for a 4 week trip to Europe the next day and didn’t think about it for awhile. I returned to find that the ever efficient staff in my doctor’s office had moved forward, scheduling a mammogram and sending in an insurance request for the MRI. And that my insurance company, wasting no time, had immediately turned down the request. (I have the most expensive, hot-shot insurance that Stanford offers.) The service denial letter stated
The MRI is an investigative and experimental procedure.
That is a direct quote. My doctor was livid. In the meantime, the mammogram revealed a harmless cyst that we already knew was there and was of no concern. But the insurance company didn’t know that. So my doctor sent in an appeal, using the cyst to demonstrate medical necessity. I left for Europe for a week and thought about this every minute. Upon my return, the hot-shot insurance folks had decided that medical necessity had been met, afterall, and my MRI was already scheduled by the ever efficient staff. They gave me a pill to make me ditzy and stuffed me into the tube. And here is the result:
On the left, is the mammogram image of my breast. Nothing (except the harmless cyst) shows up. On the right, is the MRI image. Bammo, there it is. Clear as day in the twelve to one o’clock position. You don’t need an advanced degree in radiology to see it. Given the size, it’s been growing for about 4 years. I had it in me when I attended my cousin Margie’s funeral. It never showed up on a mammogram. My doctor’s hunch that I should have an MRI saved my life. Now I have something in common with Christina Applegate (well this, and my comic wit ;) ). Turns out that none of the 4 breast cancers in my family were discovered by a mammogram. Aunt Helen felt the lump. Cousin Carol had an MRI (without protest from her insurance). And cousin Margie felt the lump, only 6 months after her last mammogram. Indirectly, that MRI also led to the early detection of the melanoma. My breast cancer oncologist was diagnosed with a serious melanoma over the summer and at my last appointment, suddenly being very aware of such things, she took my arm and said `you are going to have this looked at’. She didn’t give me a choice and wrote up the paperwork then and there. The breast cancer consisted of a multi-focal ductal carcinoma in situ, a 1.2 cm invasive ductal carcinoma with moderately aggressive cell structure, and a 1 mm micrometastasis in one out of 12 lymph nodes removed. The official staging is 2a. The prognosis for a micrometastasis is under medical debate – leave it to me to be on the cutting edge of science in everything I do. The melanoma was only 0.3mm deep, Clark’s level II and is stage 1a. This year, I’ve had 3 biopsies, 5 surgeries and counting (at least 2 more to go), 4 months of the most aggressive chemo they do for breast cancer (without a distant metastasis), and I now take endocrine therapy for 5 yrs. I think I had every side effect in the book during the chemo (was even hospitalized for awhile) and I’m amassing enough scars to resemble Frankenstein. And yes, I lost my hair. Throughout, I have been fortunate to receive some of the best medical care in the world. And, most importantly, I’m alive! I’ve made it through the journey and am on the other side of the ordeal. I am learning to cope with the ever present anxiety of recurrence. I am getting stronger everyday and am starting to live life fully again. I am looking forward to the opportunity of growing old, no longer being frightened as body parts start to display their age. And, most of all, I am thankful for that MRI, because otherwise....
