Breast Cancer Again???

 Again? This was the question a lot of us were asking as poll numbers started drifting in late last Tuesday night. Earlier that evening, I had received a call from oncology surgeon Dr. Nuradeen. The biopsy DID show breast cancer. Breast cancer again? This was not truly surprising by this point. Biopsies of that same area had dated back to May of 2023 and June of this year. I then had started feeling a painful lump in September. A painful lump is exactly how my first breast cancer appeared early in 2009. Back then, I called a surgeon friend, had a biopsy the next day, and by the following day I knew that I had breast cancer. Nowadays, surgeons don't do breast biopsies, only radiologists. 

Between August and September, I found myself in the midst of health crises of other family members leading right up to the time that I was leaving for Spain for a wedding. I am the only doctor in my family, and our family has had a lot this year. I finally sat down to call the radiology company for an ultrasound. When the scheduler refused to schedule the ultrasound, I used my doctor card, "But I am an internal medicine doctor. This is the test I need. You'll get the order, please just put me on the schedule." I confess to irritation. The scheduler was taking far too long blocking the way, so after awhile I just asked for an MRI and the callback mammogram, a part of my usual care. The MRI was scheduled for as soon as possible after my return from Spain. 

The MRI result was far worse than I expected, showing highly suspicious findings with broader-than-expected dimensions. The recommendation was for any of several options to pursue another biopsy. Through a comedy of process errors, I was left to look at this report with no outside input, no call from the radiologist nor anyone else for an entire week until I was able to get in for a Televisit for the first time with Dr. Nuradeen. She effectively talked me off the ledge, yet a biopsy would still be needed. This biopsy took a very long three weeks to accomplish but only one day to interpret: breast cancer. Thus, Election Day was a tough day all around. 

Things then started moving quickly. Because of the aggressive and possibly large size of this cancer, the surgeon met with her team on Tuesday. When I met with her on Wednesdady, the plan was to operate first. That seemed great to me. Get the cancer out! Of course, as an internal medicine doctor, I had also done a lot of weekend reading. This cancer has a different biology than the first. I knew the medical oncologist might have a different opinion. Indeed, when I met with him yesterday, he recommended a chemotherapy plus 2 antibody treatment approach before surgery. He respected my leaning toward surgery but miraculously during that visit, the surgeon's office called with a surgery date that would not be until December 18th. Too long to wait! Right before Christmas? No. It took only a moment to change my mind. In less than 24 hours, the whole plan changed.

It turns out that in the case of this biology, having treatment before surgery (called neo-adjuvant therapy) not only produces better outcomes but gives a more clear picture of the prognosis for the future. I signed up yesterday. Treatment starts next Friday.  

I am grateful to at least have a plan mapped out for the next nearly 6 months. There may be schedule changes, but what we know is that there will be up to 12 weeks of medical treatment every week starting next Friday. During this time, I will likely work most of my regular hours. This honestly feels a little overwhelming right now, but the schedule is full through the end of the year. Our patients need to be seen. After the 12 weeks of treatment, there is a 3 week pause before going through a bilateral mastectomy with skin-sparing implant-based reconstruction. After surgery, I still have to finish out a year of antibody treatment. The intent of treatment is cure, and cure is reasonably likely. It will just take some doing.

I've had more than enough time to evaluate options since my sister's third breast cancer was found earlier this year. Enough is enough. Our BRCA1 gene mutation has come back to haunt us one too many times. She has made sure to be done with her breast cancer. Now it is my turn. 

On a positive note, having cancer can be like hearing your obituary before you die. I have been slowly leaking the information to avoid becoming emotionally overwhelmed. I have not wanted to talk about this a lot, especially without knowing the course. Now that the path ahead is a bit more clear, it is time to let everyone in on this. The 2009 breast cancer was the start of this blog. I had hit a dry spell of writing this year. Now the blog is back. I will try to keep everyone posted here so that the practice staff and close friends and family and I are not inundated with the questions.