A Year Later

Laura Zigman Health Guide October 19, 2007
  • Author Laura Zigman 

     

    Last year, about a week before I turned forty-four, I was diagnosed with breast cancer. Normal people would find this news shocking but I didn’t. I’d always known, deep down, due to my strong family history of breast cancer and my genetic predisposition for pervasive generalized ambient negativity (PGAN) that I would eventually get it. Which is why I started having yearly mammograms at thirty and dragging my breast films with me whenever I moved.


    For as long as I could remember I’d been catastrophizing various horrible scenarios about finding a lump so far gone that the remainder of my life would play like Debra Winger’s in Terms of Endearment and eventually after another clean mammogram the radiologist reading my film suggested that at some point I get a more definitive imaging test – specifically, an MRI.

     

    This sounded like a terrific idea, and completely in keeping with my pessimistic health forecasting but I promptly forgot about it – so busy was I in the early stages of my pre-publication self-promotion for my first book in four years – and several months went by before I remembered to ask my primary care physician about it. Oddly enough, despite the fact that this doctor practiced right in the middle of the Bermuda Triangle of Boston medical institutions – Harvard Medical School, Dana Farber Cancer Institute, and The Mass. General Hospital – and despite my oft-mentioned family history of the disease – and despite the fact that she was a woman – she tried to talk me out of having the test. But I persisted and my doctor relented and ordered a breast MRI for me. After scheduling it and rescheduling it twice, I finally kept my mid-summer appointment at the Sagoff Breast Centre at the Faulkner Hospital.


    A week after the MRI and follow up ultrasound and needle biopsy, a different radiologist gave me my diagnosis over the phone: I had Ductal Carcinoma in Situ, also known as DCIS, an early type of cancer that starts in the milk ducts. It was Stage 0, she said – a stage I’d never heard of but which meant that although the cancer was there, it hadn’t gone anywhere.

     

    Yet.


    Strangely, though, at some point during the radiologist’s explanation of the diagnosis, I’m certain I heard her say this: “Don’t let the word carcinoma fool you. It’s a type of pre-cancer condition routinely treated by lumpectomy and radiation.” Which was a huge relief: pre-cancer wasn’t cancer! I thought happily, and this important distinction made calling everyone I knew who was waiting to hear about my test results – including my husband and my catastrophizing parents – a whole lot easier.
    .

    *


    I was still under the impression that I had a pre-cancerous non-cancerous type of cancer that wasn’t really cancer when I met with the head surgeon of the hospital a week later.


    But just minutes into my two-hour consultation I suddenly noticed how often the surgeon was using the word “cancer” as opposed to “pre-cancer.” I felt like I was having a job interview with someone who was looking at the wrong resume and I kept waiting for a good time to cut in and make the correction.


  • “So, it’s cancer,” I finally said, half expecting her to look down at my file and notice her big mistake.


    “Yes. It’s cancer.”


    “Because, you see, the person – the radiologist – who explained it to me said it wasn’t actually cancer, it was pre-cancer.” I didn’t want to go into the fact that I’d already told everyone including my husband and my parents that it wasn’t actually cancer and that correcting myself was going to put me in a rather uncomfortable position – not just because I actually did have cancer but because I would feel incredibly stupid for not being clear on that very basic fact from the beginning.


    “Well, it’s definitely cancer.”


    I nodded, taking a minute to recalibrate my delicately balanced sense of catastrophe-thinking. But as soon as I had done that, another piece of news was lobbed at me like a little hand grenade: because there were two areas of this cancer that didn’t seem like cancer but actually in fact was cancer in my left breast, the surgical treatment would require a full mastectomy as opposed to a lumpectomy.


    “The good news is that once you have the surgery you don’t have to have chemotherapy or radiation. But, once you’ve had cancer in one breast you’re much more likely to get it in the second breast, which is why we recommend that you consider having the other breast removed as a precaution.”


    I stopped with the nodding. Here I’d come in thinking I had a small pre-cancerous condition that wasn’t cancer and was going to have a lumpectomy – and suddenly I was definitely having one mastectomy, and now probably two! My head was spinning. And while I was indeed leaning in the bilateral mastectomy direction – better safe than sorry and have both done at once with immediate reconstructive surgery than sit around waiting for it to show up in the second breast too late to be cured – the surgeon then suggested I have the blood test for the “breast cancer genes,” BRCA1 and BRCA2. That way, she said, if I tested positive for either of the genes, I’d feel better about opting for the preventative bilateral surgery.


    The problem with the genetic test was that if you tested positively for the breast cancer genes they recommended that you also have your ovaries removed since there’s an increased risk that you’ll develop ovarian cancer as well. Luckily, though, when the test results came back several weeks later I found out that I had neither BRCA gene: at least I wouldn’t be forced into full-blown menopause at the tender age of forty-four.


    (more to come from "Breast Brants" -- www.laurazigman.com)