How breast cancer affected me
I never expected to see my own malignant breast cancer cells under the microscope. As a pathologist who specializes in breast cancer diagnosis, I am trained to detect cellular misbehavior that characterizes the invasive disease. But my own breast cancer? At age 33, still breast-feeding my 7-month-old son and with no family history of the disease, this was not something I thought was in my life plan.
But who does, really?
Clearly, the firmness over my left breast was abnormal. But it didn’t really feel like a lump and for a few months I assumed it was related to breast-feeding changes. However, at my husband’s urging, I visited my ob-gyn. Breast imaging found an 8 centimeter mass. Still convinced it couldn’t possibly be cancer, I carried my own biopsy to the laboratory for analysis by one of my colleagues.
The instant my colleague came into my office with tears in her eyes, I knew I was about to receive a terrifying education about life on the other side of the microscope.
After the shock waves of this new reality ran through me, the next thing I wanted to know was the details of my pathology report. Why? Because I knew my treatment plan depended on it.
Every cancer has unique biological characteristics. What a cancer looks like under the microscope will reveal clues to not only how aggressive it will behave but how best to treat it. A pathologist translates information about the biology of your cancer into a personalized report, acting as a sort of “diagnostic oncologist.” In fact, if there is a single second opinion you should consider after a cancer diagnosis, it is an expert opinion on your pathology, because all the other treatment opinions will be based off of it. Look to major academic centers in your area or nationally recognized experts for a pathology second opinion. The cost for a standard case may average $250 to $500 and often insurance will pay for it.
My cancer had all the features of a very bad biology: poorly differentiated cells, dividing rapidly. While most breast cancers express high levels of hormones like estrogen, mine tested hormone negative. This meant I was not a candidate for hormonally targeted therapies like tamoxifen. The stage 3 cancer had also spread beyond my breast to at least one lymph node. This was all bad news.
My best shot at survival was aggressive chemotherapy, followed by radiation. But even then, doctors quoted my prognosis at 40 percent survival in five years. I thought often about my two young kids being raised without me.
However, one result gave me hope: My cancer over-produced the protein HER2, making me a candidate for a new antibody therapy, Herceptin, that was adding to survival rates. This pathology test result likely saved my life. My cancer responded to Herceptin and chemotherapy. I am now, four years later, still free of cancer.
I’m grateful to my entire treatment team, and thankful for accurate pathology results that personalized my treatment for the best chance of success. Today, I study breast cancer diagnostic standards and issues in HER2 testing because I know how important the accuracy of these results can be. Every patient deserves the best shot at survival. And every once in a while, I take out the slides of my own cancer to remind me of this.
Dr. Kimberly Allison is director of breast pathology at highly rated University of Washington Medical Center in Seattle. She also is the author of “Red Sunshine”, which chronicles her battle with breast cancer.