How am I going to get through this?
This was the first thought that flew through my head as I hung up the phone and burst into tears.
Some say that when you’re confronted with the possibility of death, your life flashes before your eyes. In my case, the potential future of my life did — I wanted to get a job, to have a family, to grow old. I didn’t want to be going through this: There was a chance I might have breast cancer, the most common cancer and second deadliest among women.
Last Christmas break, I flew home to California and was greeted with the usual family gatherings and reunions with friends. In the midst of the revelry, I had to complete the usual annual checkups at the doctor, dentist and optometrist. My eyes and teeth checked out fine, but when my physician asked if I had been performing regular breast self-examinations, I shrugged and said that everything felt normal — after all, if something was painful or terribly wrong then I would be able to sense it, right? Instead, I was told that starting in your 20s, women should begin doing self-exams in order to determine what feels normal for their body. Self-breast exams can be helpful for noticing changes such as swelling, discoloration and the development of lumps — the National Breast Cancer Foundation states that nearly 70 percent of cancerous lumps are found with these at-home exams.
As I was lying on the examination table, my physician frowned a bit when she pressed her fingers against a certain area. She informed me that the tissue was denser than normal and that there could be something underneath the surface. I was scheduled for an ultrasound the next week, but she reassured me that my age was on my side and that it could just be dense fibrous tissue. I was concerned, but not overly so, and the radiology appointment seemed to go smoothly. In just a few days, I was back at Cornell to start off my second rotation in lab. Then the call came.
“There were some abnormalities in your films,” my physician reported. My heart pounded. She told me there were two masses in my right breast and that they appeared to be solid. In contrast, fluid-filled lesions (i.e. cysts) are almost always non-cancerous. Ultimately, I was in New York and my physician was in California, so she left me with the words, “You should really get a second opinion.”
In shock and in tears, I immediately dialed the number of the professor I had worked for during my first rotation, knowing that she was an M.D./Ph.D. In a matter of hours, she had referred me to the chief of breast surgery at Memorial Sloan-Kettering, and I booked an appointment for the following week.
That day was such a blur — there was the consult with the surgeon, who sent me down to radiology to have more films taken, and then I had to go back up to the physician’s office to discuss the results and determine a plan of action.
The radiologist thought that the suspicious lumps were fibroadenomas, benign tumors in the breast that have the ability to grow or shrink as time progresses. The surgeon told me that I had three options — to wait it out, which she did not recommend because it involved monitoring the masses every half-year with radiology; to have a core needle biopsy which would take out four to five samples to send to a pathologist; or an excisional biopsy to remove the masses completely. There was no sure way to ascertain what the tumors truly were, she told me, without doing a biopsy of some sort.
Since the beginning of this ordeal, I had been researching breast cancer and its contributing risks as well as diagnosis and treatment options. The lumps were classified as BI-RADS 3 and 4, based on a breast imaging reporting and data system. From a scale of 0-6 with 0-1 being no abnormalities identified to 5-6 being almost certainly cancerous and biopsy-proven cancer, respectively, a 4 was more uncertain but required diagnostic intervention. Even benign fibroadenomas larger than 2-3 centimeters are usually removed, and the two I had were already 1-2 cm larger than that.
After discussing the options with my parents, who were (needless to say) extremely concerned, I decided that I would have the surgery. The lumps aren’t supposed to be there in the first place, I thought, and most doctors recommend excision for women older than 30. Alternatively, a core needle biopsy would leave residual tissue that would require careful monitoring for the foreseeable future.
My surgery date was booked quickly and the day came sooner than I had anticipated. First, an ultrasound was used to find the lumps. Once they were localized, a hollow needle was then inserted into the mass and a wire threaded through to help the surgeon find the mass later. The first mass was nearer to the surface and easier to locate, but the second one was deep and I needed a second shot of local anesthetic to get through the pressure and pulling of the needle.
When I was escorted into the operating room, I was introduced to the staff and then climbed onto the operating table where an I.V. was inserted in my arm and other sensors placed on my body for monitoring vital signs. I was put under twilight anesthesia, which is lighter than general anesthesia, but I only remember waking up afterward in the recovery wing. In the following days, I took prescription painkillers and spent most of my time in bed because I couldn’t lift my right arm without some pain. Climbing stairs was difficult, and short walks became both an escape from my prison of a room and a nuisance because of the aches. My pathology reports came back identifying the masses as benign fibroadenomas, which was a huge sigh of relief.
The whole ordeal has been a roller coaster of emotions and physical pain, but I have gained so much from the past few months — an appreciation for life and an even deeper respect for the women battling breast cancer. It takes much strength, courage, and support to walk through such a difficult road. With the smallest scratch on the surface that I’ve experienced, I’ve learned to be more conscious and actively involved in maintaining my health as well as reminding others to do the same. The Avon Walk for Breast Cancer is in New York City late October of this year — come and join or raise support for the ones dedicated to fighting this fight. We’ll be in it together.
Debbie Tseng is a first-year Ph.D. candidate at Weill Cornell Medical College. She may be reached at email@example.com. What’s Up, Doc? appears alternate Fridays this semester.