I Had Zero Risk Factors — And I Still Got Breast Cancer
I'm a breast cancer survivor. And while I have uttered those words numerous times over the past four years, it is still shocking to hear myself say it. I had no risk factors. I was young, I was active, I had no family history of breast cancer, I did not carry a genetic mutation, I was not overweight, and I had delivered and breastfed two children. In fact, I had all the "protective" factors and a "normal" mammogram only six months before the diagnosis. Nonetheless, it happened to me. And because I was a seemingly unexpected bystander, I have chosen to share my story with all of you.
One day I felt a very discreet pea-size lump just under the surface of the skin on my right breast. I didn't remember it being there before; it immediately caught my attention. I waited it out for a menstrual cycle to see if it would go away (as a GYN, I knew that some lumps and bumps come and go with our hormones). But a month later, it was still there—no change. I went immediately for a mammogram followed by a biopsy. And what I heard changed my life forever. "This is not normal; you have poorly differentiated invasive breast cancer."
It's hard to put into words exactly how I felt at that minute, for the next several minutes, and for the next few days. There was so much that was unknown to me, even as a physician, and it was these unknowns that made it so incredibly frightening. How bad was it? How far had it spread? Would I recover? And through all the unknown and unanswerable questions, the pervading thought running through my head was, I have two young children who need me and who I want to see grow up.
That evening, my support team came to my apartment and we mobilized. We got names of breast surgeons, we made appointments, and together, we moved forward. A few days later, I had an MRI that suggested the tumor was localized to the breast. I found out that my receptor status was positive. (Breast cancers that are positive for estrogen and progesterone receptors have a better prognosis and respond to a medication called Tamoxifen, which can be used to lower recurrence.) I was scheduled to undergo surgery with an excellent physician at Memorial Sloan Kettering. I opted for a full double mastectomy but still had to await the surgery to understand the extent of my disease and need for additional treatment.
I got lucky. My news was good. There had been no spread to the lymph nodes. The invasive lesion was only 7 millimeters, exactly the pimple-size mass I had felt. I was cured surgically and am taking Tamoxifen for 10 years to lower my recurrence risk.
According to the current guidelines and recommendations, I would not have had a mammogram for several years. I was not yet 40, I had no family history, and I was not a BRCA carrier. The American College of Obstetrics and Gynecology recommends that yearly mammograms start at age 40; a breast exam is performed by a health care provider every one to three years (from ages 20 to 39) and yearly after 40. Furthermore, while there have also been advances in mammography (digital mammography vs. traditional film mammography), MRIs for high-risk cases and ultrasounds for women with dense breasts are not routinely used on the "regular" no-risk patient. I was that totally "random" patient who would have been missed.
That is why I am an advocate of breast self-awareness and self-breast exams. Without them, I am not sure when I would have found the lesion, how big it would have been, or where I would be now.
And I am not alone. One in eight women will get breast cancer, and many of us are going to be the "randoms." We won't be BRCA (genetic mutation increasing risk of breast cancer) carriers, we may not have a family history, and there is a chance we will have no real, identifiable risk factors.
So what are those risk factors? Risk factors for breast cancer include obesity, high alcohol use, and a sedentary lifestyle. Additionally, having your first child before age 30 and breastfeeding are protective. And while I still got breast cancer despite NOT having these risk factors, having protective factors—like being lean, athletic (a marathon runner, in fact!), and healthy—really helped me in my recovery. And while my healthy living may not have prevented my breast cancer, it most certainly helped me cope with my diagnosis, recover from the surgeries, and currently reduces my recurrence risk. One of my first questions when diagnosed with breast cancer was "How long will it be before I can exercise?"
Truthfully, it was really only a couple of weeks that I was not out pounding the pavement or on a spin bike. Being fit helped me heal quickly and with no complications. As a doctor, I knew that being mobile as soon as possible after surgery was critical to healing. I took very long walks as early as four days after my mastectomy (yes—with my drains under my shirt!). The mental endurance that I gained over the years marathon training also helped me deal with my postoperative course. In the four years since my diagnosis, I have continued my avid exercise. My oncologist encourages me by citing data that intense exercise is associated with lower recurrences. I'm in my final weeks prepping for the NYC Marathon and hoping to have my best time since my diagnosis.
I have also done an overhaul of products throughout my household, changing to organic and "natural" wherever possible. I can't erase the years of aerosol products I used (I was a child of the '80s!), but I can make that intervention for my children. I've also adopted an "anti-inflammatory" diet as much as possible. Not only can this possibly lower recurrence risk, but it also helps my aging joints and muscles.
Only 5 percent of breast cancer occurs in women under age 40. Be your own health advocate and routinely feel your breasts, go for your annual check-ups, and please please please exercise and maintain healthy habits (most days of the week!). I share my story in hopes that maybe one woman or more will be prompted to do her own breast exam, go in for her long-overdue GYN appointment, or get her first mammogram. Hearing my story could really make the difference between life and death for someone else.
I often say I was dealt the "good cancer card." I caught it early, and it was treatable. I was lucky. However, not everyone is as lucky. To my sisters out there battling more extensive disease—I send you my love and support. Together, we fight and raise awareness. No cancer diagnosis is in vain. We love, live, and learn more with each life affected. #BreastCancerAwarenessMonth
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