BREAST CANCER 101

After I chose the title for this post, I noticed that the Susan G. Komen Foundation website has a section called "Breast Cancer 101," but I don't think they'll mind. I know there's an abundance of information about breast cancer out there, including a lot of misinformation. As a newly diagnosed breast cancer patient, one of the things that is most helpful and encouraging to me is hearing about the experiences of women I know and trust who've been down their own variation of this road.

Since the possibility of breast cancer seems to be on every woman's radar, I thought I'd share some of my experience as it unfolds, in hopes that the information might be helpful to someone else someday. I decided I'd talk about diagnosis and risk factors first, since that's as far as I've gone down this road and what I've been asked about most. 

I know breast self examination is important and a lot of women find their own breast cancers that way. Honestly I haven't been very regular about self exams and never would have found my cancer that way, at least not until it was pretty far advanced. For one thing my tumor is fairly deep under the skin. My gynecologist had done a manual exam at my annual checkup a few weeks before my biopsy and didn't find it. My breast tissue is fibrocystic and extremely dense as I've been told by every doctor, nurse and radiology technician who's ever encountered it.

My diagnosis began with my annual screening mammogram. The radiology practice called me back in for additional views as well as an ultrasound, because there was "an area of concern." I'd had this part of the experience before. The radiologist reviewed the images while I waited and then I was asked into her office, where she showed them to me and pointed out the area of concern. She explained that the tissue in that small area appeared to be pulling down, sort of puckering, which was not a good sign, so they wanted to do a needle biopsy. That was going to be a first for me.

About a week later I had a core needle biopsy under local anesthetic. The radiologist injected the anesthetic, the only part of the procedure that hurt a little, and then made a small incision. He inserted the biopsy needle into the incision, and, guided by ultrasound, took three "core samples." The instrument made a sound like a staple gun with each sample he took, but I didn't feel anything. I came out of that with a dressing and some steri-strips over the incision, very little pain and a little bruising. Not bad at all. I went home knowing my gynecologist would get the report and would contact me with the results.

A few days later, his nurse called and said that he'd like me to come to the office that day or the next. I knew he wouldn't ask me to come in person just to tell me everything was fine, so I arranged to go in that afternoon. I was probably more nervous and emotional after that phone call than I have been since.  

My doctor sat down close to me in his office, looked me in the eyes and told me that the biopsy showed cancer, but that it was curable and had been caught very early. He explained that the next step would be to consult with a surgeon, who would go over the images and pathology report. He gave me a copy of the pathology report to keep and gave me a list of surgeons he recommended. He said I'd know more after talking with the surgeon, but that he thought the most likely scenario would be lumpectomy followed by radiation.

 My tumor is small, but it is not DCIS (Ductal Carcinoma In Situ), which would mean it hadn't invaded any tissue outside the duct. It is invasive, ductal carcinoma, grade 1, just under 2 centimeters. As I understand it, DCIS is the best diagnosis I could have received, but the one I got is pretty much second best and the prognosis is good. I'll be seeing the surgeon next week.

(Edit added 3 months later: I would come to learn that my tumor was actually 3.3 centimeters and stage 2, grade 2.)

As for risk factors, I did have a few, like onset of menstruation before age 12 and starting menopause after age 55, not a good combination. Simply being over age 55 increased my risk; I am 57.

Another risk factor is alcohol use, but probably not at the level that I consume alcohol, although I will definitely be cutting back. I've gone most of my life without drinking more than a glass of wine or a margarita once a month or so. About ten years ago I began having a glass of wine, occasionally two, most evenings. 

Having very dense breast tissue is also a risk factor, aside from the fact that it makes detection more difficult. Dense breasts have more glandular  tissue and less fatty tissue than is the norm. Breast cancer develops in the glandular tissue. 

Several people have asked me if there's a history of breast cancer in my family, because that's the biggest known risk factor. There isn't much of one. The only relative I know of who had breast cancer was my aunt, my mom's only sister. She died of it in her seventies, but her cancer may have been spreading for years while she lived undiagnosed, untreated and in awful pain. Sadly, that was her choice. 

It isn't mine. I hope and pray that neither of my daughters nor any of my nieces or granddaughters are ever diagnosed with breast cancer, but if they are and I'm the only female relative whose story they have, I want mine to be more encouraging to them than my aunt's is to me.