A Delayed Screening, a Breast Cancer Diagnosis, and Membership in a New Club
Maura Fritz was diagnosed with DCIS, ductal carcinoma in situ, and chose radiation treatment.(PRISCILLA DE CASTRO)I hate mammograms probably as much as you hate mammograms. But I will never skip one again, because a mammogram may have saved my life. And a mammogram may save yours.
Heres the backstory: About 15 years ago, I had benign lumps removed from both my breasts, and I was supposed to be diligent about following up with my doctor. Certainly I was, for a while. But clean scan followed clean scan, and I got careless.
In April 2007, though, I was about to be out of a job. I was an editor at Time Inc. (also the parent company of this Web site), which offered low-cost mammograms once a year to employees, but the magazine where I was working—Life—had shut down. We were days away from shutting out the lights. So just before 2 p.m. on a Monday, I was debating how best to use my time: finish packing up or keep my mammogram appointment. It was a money thing, in the end. I'd barely started looking for another job, and the scan was basically free. I went for the scan.
Two days later someone from the diagnostic service called: The mammogram had picked up an irregularity in my left breast. I needed a follow-up. “OK,” I said. A day later, I got a letter that reiterated the message: I had to have another mammogram. But I remained unconcerned; Id been through this fire drill before. Someone from the service started phoning weekly to ask if I had scheduled the test. I took to ducking the calls.
I didn't get around to the appointment until July. Since April, in quick succession, I had lost a job, an uncle to a stroke, a cousin to cancer, and someone I love dearly to rehab—a secret crack user. I was reeling.
More about breast cancer
The heat was stifling as I walked the 15 blocks from my apartment to the radiology practice where I'd gone sporadically over the years. As usual, its waiting room was packed, and close to an hour passed before a technician ushered me to an exam room. She was large and German and reassuring as she told me, minutes after doing my mammogram, that the radiologist wanted to talk about what she saw: microcalcifications.
I sat in a darkened room, looking up at my X-rays on a light wall, as the radiologist pointed out the tiny calcium deposits that might mean something or nothing at all. The spots looked suspicious enough that she wanted to schedule a biopsy. I could choose a full-blown surgical excision or something called a Mammotome, a minimally invasive procedure.
I stared at her for about five seconds before I burst into tears. I couldnt stop crying—not when she detailed my options, not when she walked me to the scheduling room, not when the two women who juggle the practice's multitude of appointments stared at me in alarm. They offered Kleenex and a pat on the arm. I couldn't begin to explain that I wasn't crying for myself: I was crying for everyone and everything I'd lost in the past few weeks.
Next Page: The news [ pagebreak ] The news, part 1
Twelve days later, I was back for the Mammotome. In this relatively new procedure, a probe is inserted into your breast through a small incision and guided to the suspicious area. Tissue samples are vacuumed out and sent for analysis. Its as much fun as it sounds, which is to say not much.
I lay facedown on an elevated table, my breast positioned through an opening and held immobile by mammogram-like paddles. The radiologist had told me that I would adjust to the pressure within minutes, and sure enough I did. But the effort of holding still for 20 minutes or more as the probe snaked precisely through my tissue left me weary. Even so, I went to my freelance job, and that's where I was the next morning, when my radiologist called to say that she'd found LCIS in the sample.
Lobular carcinoma in situ, or LCIS, she explained, is an indicator that I was at high risk to develop an invasive breast cancer. Though at one time the condition was usually treated aggressively with mastectomy, the current wisdom holds that, for most patients, the better course is to monitor the disease with mammograms and to reduce the chances of developing cancer with a hormone drug therapy.
“You'll probably need to be on tamoxifen, she said. “But in the meantime, you definitely need a surgical biopsy. We have to make sure that there isn't anything more to this.” She had already scheduled an appointment for me with the surgeon who'd removed the lumps from my breasts 15 years ago.
Hold on. Wait. LCIS? Another biopsy? As my brain slowly worked through this information, my cell phone rang. On my office phone, the radiologist was explaining that a wider sampling was needed to be sure that no cancer cells had begun to develop. On my cell, the surgeon's office was asking for a fax number to send some paperwork that was needed back immediately. I thought my head would explode.
As I scurried around looking for a fax machine, I got frantic. No, not frantic, angry. I was pissed. Was this some sort of cosmic joke? How much was I supposed to handle? My heart still ached from the buffeting it had recently taken, and now this assault on my breast?
It already bore a faint scar from my 1993 procedure, plus the new wound from the Mammotome, as small as that was. I didn't want to mar it again. I love my breasts. Frankly, theyre among my best assets. The idea of slashing open one of them made me nauseated, especially since I was convinced it would be for nothing. It was nothing in 1993; it would be nothing now.
Next Page: The chip [ pagebreak ]The chip in my breast
Before I actually got in to see Deborah Axelrod, MD, I had to get through the organized but unhurried intake process at the NYU Clinical Cancer Center in New York City, and then bide my time in a crowded waiting area. Cancer does depressingly brisk business.
In the decade and a half since Id last seen her, my surgeon had burnished an already fine reputation. I felt lucky to have her on my case—at least until she agreed with the radiologists recommendation. “I know this is not what you want to hear,” she told me, “but were going to have to do a surgical excision. We need to see whats in there.” She was right: It wasnt what I wanted to hear. Nevertheless, my procedure was scheduled for August 9.
The advantage to having had the Mammotome was that a small chip had been left behind as a precise marker of the microcalcifications. Early on the morning of the 9th, I was back at the radiology practice for phase one of what is technically called a “surgical excision with wire localization.” Translation: A wire would be inserted into my breast to guide the surgeon to the chip.
The tiny area of insertion was cleaned and numbed. And a few mammograms were taken to check the positioning. I seem to have scoured from my memory exactly how the wire got in my breast, though I remember the surreal experience of walking the couple of blocks to the hospital afterward, bare-breasted under my thin sweater, with a length of hairline-fine wire protruding from my skin.
As I settled under a warm blanket on the operating table at NYU Medical Center, I was remarkably at ease—even more so after the anesthesiologist released Demerol into my veins. His was the last face I saw before I slipped into oblivion, and the first I saw when I came out of it, an hour later, in recovery. Dr. Axelrod appeared at my bedside with a bit of good news: She had every reason to believe I was dealing only with LCIS. She would see me back in her office in a week.
The news, part 2
I walked into the NYU Clinical Cancer Center at 10:40 on the morning of August 15. When I walked out, I had cancer.
When a nurse handed my pathology report to Dr. Axelrod, she was seeing it for the first time; it was fresh from the lab. “OK,” she said quietly. “This is not what I thought it would be.” She handed the report to me. I scanned it quickly; popping up from the page were the letters DCIS—ductal carcinoma in situ.
Heres what flashed through my brain: No husband, no kids, no job, and I have cancer? “This is not a good time for this,” I said to my surgeon. And then I sobbed.
“Youre looking at this as the glass half-empty,” she said, not unkindly. “You need to look at this as the glass half-full.” DCIS, she told me, was cancer at its earliest stages—often called stage 0 because it is noninvasive. “Youre lucky you caught this now. If you caught it a year or two years or five years from now, we would be having a different conversation.” It would be a few days before I saw her point.
Back out on the street, I felt purposeless. What was the protocol here? Do I head home, hit a bar, go to work? I slowly wandered uptown before I settled on the last option. My head was filled with thoughts of an old friend who had battled myeloma a few years before. I had thought then that he was incredibly brave for picking up the phone himself to let those in his life know what he was up against. I wasnt sure I had that strength in me. What I would shortly find out is that you just do what you have to do.
The first few days, I spilled the news selectively; telling my family was the hardest. But talking about the DCIS had a positive effect—it became more real. And more real seemed more manageable. Of course, Id also come to realize what a huge safety net I had under me: My cancer was not life-threatening, for one thing. Everything I was going to do would keep it from becoming life-threatening. And then there was this: As word leaked out, I got phone calls, emails. An ex-boss—hard shell, soft chewy center—called to say, “Were going to beat this.” Were. Another ex-boss scrambled to arrange an extension of my health coverage; I was a week away from my severance running out. And then my very temporary freelance assignment was extended by six months. No husband, no kids? I had a community. In fact, I was overwhelmed by the number of people who reached out a hand to me, personally or professionally.
Next Page: The radiation [ pagebreak ]Beam me up
In mid-September, after a follow-up mammogram, consultations with oncologists, an MRI, and an ultrasound, I got “mapped”—my breast was tattooed with four tiny blue dots that marked the path that the beam of radiation would take. As tattoos go, they were a complete disappointment; I had imagined something a little more butch.
Five mornings a week, for almost seven weeks, I went to the office of John Rescigno, MD, a caring man with an equally caring staff, to get my radiation treatment. The routine rarely varied: Check in with Marie, who asked my birthday every last time to be sure I was the right Maura Fritz (what are the chances?); say hi to Jasmine, who handles all the insurance; change, then wait for one of the technicians—David, Jose, or Toni—to wave me in; hop up on the table, get precisely positioned, and lie still while the radiation beam tracked across me, painlessly and soundlessly. Generally, I was in and out in about 15 minutes.
Most mornings I went to work afterward. By the end of each week, my energy was sapped. I knew exactly when it was 10:15 every night—for some reason, my body seemed programmed to crash then. I had random bouts of nausea. And my breast bloomed with radiation burn, the redness spreading up under my arm, the skin sore and cracking by my last treatments. But in the scheme of things, all of that was minor. I had come around to Deborah Axelrod's thinking: I considered myself lucky.
Getting my last treatment on November 5 was surprisingly emotional. I made cookies for the staff—not something I do casually. After I got off the table (for what I hope will be the last time ever), I exchanged hugs with David and Toni. These were good people; Id seen more of them in the past weeks than I had seen my family, friends, or colleagues.
A few days later, on the recommendation of Amy Tiersten, MD, my medical oncologist, I started on tamoxifen. The drug blocks the action of estrogen, the hormone that can promote the growth of cancer cells in the breast. The one-two punch of radiation and tamoxifen would squelch the DCIS, my team thought; the drug would also reduce the likelihood that cancer would either come back in my left breast or develop in my right one.
It has potential side effects, ranging from headaches to an increased risk of developing certain kinds of uterine cancer, and I seemed to work my way through some of the lesser ones (headaches, hot flashes) as my body adapted to the medication. But none was so awful that it outweighed the benefits.
Almost 10 months after I finished radiation, my breast still does not look quite the same. Its a little brown, a little pink, in places it wouldnt be naturally.
In April I went for my follow-up mammogram. The news was good (my left breast is clean) and not quite so good (I now have calcifications in my right one). I had a pelvic ultrasound, too, which showed a thickening of my uterine lining that made my doctor unhappy; at its most extreme, this sort of thickening—an adverse effect of tamoxifen—can indicate hyperplasia, a precancerous condition. Erring on the side of caution, Dr. Tiersten has pulled me off of tamoxifen and put me on Evista, though its the runner-up of treatment choices when it comes to DCIS.
In the coming weeks Ill do another round of tests to help sort out whats happening in my body. Are the drugs holding the line against DCIS in my right breast? Will the change in medication stop the thickening of my uterine lining? What it all means long-term, in truth, I dont know. What has finally sunk in (no one ever called me fast on the uptake) is this: Once youre in the club, youre in it. This is my life now. Im grateful for it.
Maura Fritz is a senior editor at RealSimple.com