Discussing Breast Cancer

The morning of August 18th, my husband and I headed up to Yale first thing in the morning. The kids were at my mom’s so we didn’t have to worry about them, all we had to do was figure out what to listen to on the radio during the 1/2 hour car ride.

Our first stop at Yale was mammography; I know, I’d already been there, done that. But the surgery I was to have required one additional step: wire localization. Basically, the radiologist in mammography would insert a wire into my breast as a guide for my surgeon in the OR — he’d know exactly where the malignancy was and could be more precise in his surgical efforts.

Of course, I was awake for that, then had to be wheeled to the hospital OR with a wire sticking out of my body. Not very pleasant!

In the OR, I was given drugs to relax me … I was sort of asleep for the procedure but also sort of awake, and though I felt nothing, I was aware of what they were doing. I even heard the surgeon on the phone with pathology confirming that the margins looked good.

As I was coming out of that groggy place, I heard the doctor explaining the procedure to the nurse that was tending to me. I saw my husband, smiling, relieved it was over. Very little time passed and I was able to go home that day. The incision healed quickly, and though I was to baby it for a while, I hardly had any restrictions. It was nothing … kind of odd, actually. It sounded so much worse than it was.

When the pathology came back, it confirmed that I had Grade 2 DCIS but indeed, the margins looked clear, which meant I didn’t need a follow up surgery and wouldn’t require chemotherapy. It was a huge success, a huge relief. At that point, I was left with just one question: would I be starting radiation therapy before my son’s 4th birthday on September 15th or before I turned 36 on September 18th.

In previous posts I shared what led me to get my initial diagnosis of breast cancer … now I’ll share what led me to get a second opinion.

During that fateful phone call on Thursday, July 17, 2003, when I received my diagnosis, the surgeon explained she had booked an OR for the following week to perform a lumpectomy. The fact that she did this without consulting me first terrified me. If I was truly Stage 0, why the rush? Didn’t I have options? Besides, I had a vacation planned … if this wasn’t an emergency, couldn’t this wait until I returned from my vacation?

I called back the next day and questioned the receptionist; she recommended I do some research on my own over the weekend, starting with a quick read of the book, “The Breast Cancer Survival Manual,” by Dr. John Link, “a step by step guide for the woman with newly diagnosed breast cancer.”

Of course I got the book that night and started reading. After reading the acknowledgments and the introduction I read the most important chapter of the book. Chapter 1: Second Opinions.

At that point I recognized that the surgeon I’d scheduled the biopsy with was a general surgeon, not a breast surgeon, and the hospital she was affiliated with was not a renowned cancer hospital.

I needed and wanted a second opinion even if it would take time and money. And it needed to be with a cancer specialist. I owed that to my children.

On Monday, I consulted US News & World Report’s List of the best cancer hospitals. I’m only an hour North of New York City, so I visited the Memorial Sloan-Kettering Cancer Center website, the number one cancer hospital on the list, and found an 800 number. I called.

The woman on the phone from MSKCC recommended I make an appointment at the Yale Cancer Center, another one of 39 National Cancer Institute Designated Cancer Centers and the only one in Connecticut. She said they’d gladly see me at MSKCC and discuss my case, but since I had young children and was in close proximity to Yale, a hospital they regarded as excellent, I should start there. If I was unhappy with the service and attention I received at that consultation, however, thought they doubted I would be, I should call back and get an appointment at MSKCC.

I called Yale first thing the next morning. My surgery was scheduled for Thursday, remember, only two days away, and I wanted a second opinion immediately!

Amazingly, the oncology department had a cancellation for Wednesday afternoon. I snagged that appointment. I scrambled to the various offices to collect my mammogram films and biopsy report and headed up to New Haven.

The medical oncologist, Dr. Gina Chung, was surprised I entered their system through her. Usually with cases like mine, initial appointments were made with a breast surgeon, because that’s the ‘first step.’ But coincidentally, Dr. Donald Lannin, the Executive Director of the Yale Comprehensive Breast Center and Professor of Surgery for the Section of Oncologic and Endocrine Surgery happened to be on the floor.

Some things happen for a reason. If you’ve never believed that before you start to believe that after a cancer diagnosis.

Both doctors spoke with my husband and I that day. They both agreed with my previous surgeon’s recommendation to start with surgery — but explained it should be more of a partial mastectomy rather than a lumpectomy because there was no lump, just some milk ducts filled with cancer cells. They both agreed I should go there because of their credibility as a cancer treatment hospital.

Then they explained that Elspeth Knill-Selby, A.P.N., Affiliated, Surgery, would call me to schedule the partial mastectomy. After my surgery we’d meet again and go over the resulting plan for treatment based on the pathology results. He told me to rest assured that a few weeks wouldn’t make a difference, so since I already had vacation plans, it could wait until I got home.

I made the decision on the spot to switch to their care.

Before I left, they asked if I’d be willing to let them review my case in their Wednesday afternoon clinic — I jumped at that, immediately seeing the benefit of affiliating my case with a teaching hospital. I’d have the best and the brightest minds looking at my films, my biopsy report, and eventually … my pathology.

I went home, canceled the surgery that the original general surgeon had scheduled on my behalf. Elspeth called me to schedule a subsequent surgery with Dr. Lannin on August 18th.

I relaxed … having done my homework and taken control I felt far more empowered than I had expected.