My cancer journey...the diagnosis

 Setting the stage...

When I was nursing my second child, I would often get "lumps" in my breasts.  I'd dutifully report it to my OB/GYN and we would decide that they were cysts and I'd move on with my life.  So, when I reported a new lump in my breast during an annual exam in July, despite the fact that it had been sixteen years or so since I was last nursing, we weren't too worried about it.  We identified that I was due for a mammogram anyway, and so I kind of just forgot about it.  

I have been getting mammograms since I turned 40, since there is a history of breast cancer in my family.  Each year, after the scans, I get the same notice, something akin to "you have very dense and lumpy breasts, we can't see shit". Despite this, I still went, and even upgraded to the 3D version (excerpted to the left). Then, in 2020 (yay! COVID!) the radiologist "saw something" on the scan of my left breast and so I was sent for biopsy, which ended up being surgical because they couldn't get a good enough view/angle for a core biopsy.  Thankfully, what they found was benign, attributed to something like calcifications. Since then, all of my scans were negative, accompanied by notes such as (in my best Mr. Mackey impression) "It'd be great if you could just iron out all of those lumps and pump some air into those suckers to make our lives easier, mkay?".

Fast forward to 2023 after said REAL lump inspection. I went for my mammogram in early August and got a prompt message from my radiologist that I needed to return for a diagnostic ultrasound to confirm an unusual finding, this time in my right breast. It took a few weeks to schedule, and given my last scare that ended up as nothing, I was much less concerned. That day, however, after the scans, it was apparent that something was wrong. This was different than the last time. There was a sense of urgency in the radiologist when they reported to me that I need to have a biopsy, and that they had scheduled me an appointment with the surgeon the following afternoon.  I sat in my car and cried, and called my husband who is currently living over 2000 miles away.  But, both of us being scientists, we decided it wasn't worth freaking out until we had facts that would warrant it...at this point we only had the suspicion.   

My biopsy was scheduled for the following week.  It was an ultrasound guided core biopsy of two separate lumps, which ultimately come to be affectionately known as 11:30 and 3 o'clock, based on where they're located in my breast. They also insert and leave little metal clips in there so that the radiologist/surgeon can identify them on subsequent scans.   A few days later, in early September, we got the news that I was dreading...I do indeed have cancer. And, because I'm such an overachiever, I have not ONE but TWO different cancer types. Thankfully I was visiting my husband when I got the news and so had support there with me when I heard.

And now the details...

From https://www.cancer.org

Meet my friend 11:30

This one is an invasive lobular carcinoma, grade 2, N+3 cm. Invasive means that it has spread into surrounding breast tissues, lobular means that it started in the glands that make milk. 3 cm is the size of a grape. In my case, grade 2 means that it's over 2cm but it hasn't yet spread to local lymph nodes (they think). It is accompanied by lobular carcinoma in situ with atypical lobular hyperplasia, meaning that abnormal cells are remaining in the lobule, or milk gland.  11:30 is both estrogen and progesterone receptor positive (so, hormone receptor positive), HER-2/neu negative (this is a protein that helps cancer cells grow more quickly...it's good that mine is negative).  It's Ki67 score is 5%...this means that among the total number of cancer cells in the section, only 5% of them are actively dividing, or making copies of themselves.  A score of 5% or less is good, it means it's slow-growing.  It's also E-cadherin negative, which is how they are able to discriminate it from ductal carcinoma.

Don't forget 3 o'clock

This one is an invasive ductal carcinoma, grade 1, N+2cm.  Again, invasive means that it has spread into the surrounding breast tissues, ductal means that it started in the milk ducts - the tubes that carry milk from the lobules to the nipple.  2 cm is the size of a peanut.  Grade 1 means that it's slow growing (yay!).  I also have ductal carcinoma in situ, grade 2.  It means that the cancer is also in it's original place and hasn't escaped some ducts.  Grade 2 means that it has an intermediate risk of returning after treatment.  Like 11:30, 3:00 is hormone receptor positive and HER-2/neu negative.  It's Ki67 score is a little higher, 5-10% (which I think it still considered low.  It's E-cadherin positive which is how they know it's ductal.  

So what's the plan?

It's hurry up and wait.  Get blood tests to make sure I'm otherwise healthy, do genetic testing to see if I have the BRCA mutation or other genes that would be predictive of a more severe/aggressive cancer (or higher additional cancer risk), have an MRI to see if there was additional cancer that the ultrasound couldn't see, and talk with the surgeon, the plastic surgeon, the medical oncologist and the radiation oncologist to define my course of action.  Then decide if I can (or should) save the ta-tas.