Breast Cancer—The “Lucky” One in Eight

Prologue: Famous Last Words

Is breast cancer even a big deal anymore? I remember thinking not long ago. I’m not sure why. I was probably reading an article about breast cancer and just thought the world had bigger problems, like pandemics and Trump. One in eight odds didn’t sound so terrible. I knew at least three women who’d had breast cancer. Maybe that’s why I felt my risk was lower, as if being part of their eight-woman cohorts rendered me immune.

Rosh Hashana 2019 I prayed for one of them, a mother of four. I prayed hard. Repeating the brief prayer Moses uttered after his sister, Miriam, was stricken with leprosy. He apparently cured her immediately. Later I found this video of the same prayer:

https://www.youtube.com/watch?v=Ha2iRU9TrXo

I can’t say I was responsible for my friend’s recovery, but being diagnosed myself in November 2021 felt like a delayed ironic cosmic slap.

Sure, I’ll heal your friend, purred the universe. Tag, you’re It!

Part 1: A “Lucky” Finding

I almost didn’t get a mammogram in 2021.

Like many, I skipped my annual pelvic exam and mammogram in 2020. I regretted that after I left a work-from-home gig for an in-person position in Gowanus, a part of Brooklyn that isn’t close to anything, including where I live on the Upper West Side of Manhattan. It’s a former industrial wasteland of factories, wholesalers, and bus garages that is slowly being gentrified into hip sandwich stores, java bars, and Pilates garages. I have to take two subways and walk 7-10 minutes to get to the office. On a good day it’s 45 minutes, and on a bad day it’s an eternity.

Going to the doctor or dentist now requires a great deal of coordination, rescheduling, and requested time off. I called my gynecologist in May 2021 and was given an appointment for mid-October. A few weeks before the exam, I started calling imaging facilities in Manhattan. But I couldn’t schedule a morning mammogram that month to save my life. (Literally.) I didn’t want to have to take off most of the day for 20 minutes of intense discomfort. I decided to try a women’s health practice in Flatbush; it’s not exactly close to my office, nothing is, but it’s closer than Manhattan, and it’s affiliated with the same medical system as my gynecologist, Dr. Stratton.

I never expected them to find anything in my left breast. I knew I had a big fibroadenoma in the right. According to the Mayo Clinic,

A fibroadenoma (fy-broe-ad-uh-NO-muh) is a solid breast lump. This breast lump is not cancer. A fibroadenoma happens most often between ages 15 and 35. But it can be found at any age in anyone who has periods.

A fibroadenoma often causes no pain. It can feel firm, smooth and rubbery. It has a round shape. It might feel like a pea in the breast. Or it may feel flat like a coin. When touched, it moves easily within the breast tissue.

Fibroadenomas are common; about 200,000 are discovered every year in the US. I didn’t notice the lump until my startled gynecologist guided my fingers to it during my annual 2015 exam. We hadn’t detected anything in 2014. At 45, I was a bit old for one, but since I was still menstruating and releasing hormones, I wasn't a complete outlier.

In sonogram stills, the fibroadenoma looks like the end of a tobacco plug. One side flat, one curved. Discrete edges. Hasn’t changed much in six years, when it was biopsied. Every year after the biopsy, along with my annual mammogram, the right breast has been ultrasounded to make sure the growth hasn’t expanded or turned malignant.

A few days after I made the appointment for my 2021 mammogram, the Brooklyn clinic called and said the ultrasound tech was out and wouldn’t be back in time. They rescheduled me for the following week. Then, just before I went in, they called with more apologies: they didn’t know when the tech would come back, so I would only receive a mammogram.

One breast ultrasound tech in the whole borough of Brooklyn? I wondered. Damn bridge and tunnel crowd. I almost canceled the mammogram out of spite, since I’d have to go for an ultrasound later anyway. But I’d already changed my work schedule for a later shift and rescheduled a bunch of meetings. I decided that if the mammogram didn’t show much of anything, I wouldn’t rush to get an ultrasound.

I had no idea how many ultrasounds, mammograms, MRIs and biopsies I would endure in November, December, and January. How many needles—small, large and ginormous—would pierce and bruise me. How many strangers would palpate, poke, or position my breasts. How many thousands of dollars I’d put on my credit card. More than $8,500, my yearly out-of-pocket maximum, plus $3,000, my annual deductible.

All of this led up to a partial mastectomy on February 14, 2022, a day of overwhelming pain and excruciating tedium. Another oddly karmic coincidence; instead of giving me my heart’s desire, on Valentine’s Day the universe took a little piece of my heart.

Part 2: A Spiculated Mass

“Cancer” is named after a crab, but it’s more like a spider. Actually, it’s like a spider and web in one, expanding through your flesh with deadly filaments and tendrils.

In contrast, benign growths tend to be solid. My right-side fibroadenoma was comfortably compact and opaque. Clean lines. “It doesn’t look like cancer,” the radiologist had reassured me in 2015 before taking the biopsy sample, and she was proven right. Every year, the ultrasound and mammogram reports confirmed that the fibroadenoma wasn’t spreading. Dr. Stratton would contact me to let me know, and I also started reading the reports myself for reassurance.

The first report from my Brooklyn mammogram was not reassuring.

IN THE UPPER, OUTER LEFT BREAST AT MIDDLE TO POSTERIOR DEPTH, THERE IS AN INDETERMINATE MASS WHICH APPEARS SPICULATED.

Immediately I Googled “spiculated.” It is medical-speak for “spiky.” Something that grows quickly and unevenly. Cancer.

I palpated my left breast but couldn’t find any lump. I don’t do regular breast self-exams, but I liked to think I knew my breasts fairly well from settling them into underwire bras, bathing them, and occasionally allowing other people to touch them for fun. Every now and again I would poke around in the right one to feel the fibroadenoma, but I’d never felt anything solid in the left. Then again, I hadn’t noticed the sizable right-side growth until my doctor put my fingers on it.

I was quickly referred for a bilateral ultrasound, which, after a series of anxious phone calls and a bit of pleading, I was able to schedule and undergo in early November. The Brooklyn ultrasound tech was still out of the office, so I had to go in Manhattan.

When undergoing a bilateral ultrasound, you might think you’d lie down on the table topless and just let the tech take turns with your breasts, but they never expose both at the same time. After they examine one, they gently pull and arrange the gown to cover it, and, more gently, ease the gown off the other breast for its time in the spotlight.

The ultrasound report had a bit of good news:

At the right 6:00 axis, retroareolar location there is a 1.6 x 1 x 1.2 cm lobulated hypoechoic mass which is smaller in size when compared with prior ultrasounds dating back to 10/1/2015.

The right breast is trying to keep me alive, shrinking its fibroadenoma. The left breast, however, is not a team player.

At the left 1:00 axis, 8 cm from the nipple, there is a 0.9 x 0.9 x 0.8 cm irregular hypoechoic mass which likely correlates with the spiculated mass seen in the upper outer left breast on mammography. An ultrasound-guided core biopsy is recommended. No sonographic abnormality is seen to account for the architectural distortion in the anterior lateral left breast on mammography.

Translation: In addition to the spiky mass (“hypoechoic” means it made itself known to the ultrasound waves) threading its way through my left breast, there was an “architectural distortion.” That seemed to be something the radiologist couldn’t figure out. Was it a benign tumor? A malignancy? A piece of shrapnel? Nobody knew. I took it to mean that my breast was erecting a hostile edifice, a fortress in its war against me.

But it’s not just my breasts. All of my reproductive organs have taken up arms against me. The rebellion isn’t random. Research indicates that as a childless woman and survivor of childhood sexual abuse , I’m much more vulnerable to gynecological woes and cancers than women who’ve had children and/or less traumatic lives . Apparently Nature or the universe thinks I deserve to suffer for never suffering through pregnancy, childbirth, and raising a family.

Along with the right-side fibroadenoma, I suffered from monstrous uterine fibroids for many years. They caused horrifically heavy, 8- or 9-day menstrual flows that drenched boxes of tampons and pads—think “The Shining”—and nasty bloating. In 2016, I underwent surgery to excise about 7 pounds of their densely vascular flesh.

Five years later, Dr. Stratton palpated my abdomen and informed me that the fibroids had struck back, including one perched atop my bladder—a likely cause of some recently emerging incontinence. I had attributed that to menopause, which brings with it so many delightful harbingers of deterioration; lower estrogen levels mean weaker pelvic floor and sphincter muscle tone. It cheered me to learn that the occasional damp spurt was due to resurgent fibroids, not advancing decrepitude.

My uterus and ovaries weren’t as lethal as my left breast, but they were almost as industrious. In the busy month of November, between biopsies and three types of breast imaging, I managed to fit in a pelvic ultrasound. Instead of stroking the wand along your abdomen, the tech coats it with lubricant and slides it up inside you. This revealed three fibroids I’ve grown since 2016, accompanied by a sizable “paraovarian” (which I Googled and learned means “near the ovary”) cyst nestled among my fallopian tubes.

Dr. Stratton’s hospital system uses a website to communicate with patients. You can email with your doctors, review test results and reports, and even look at your MRIs, X-rays, and other scans. I checked out my pelvic ultrasound images and saw the beautiful, symmetrical paraovarian cyst, glowing like a pearl amid the dark fleshy background. I tried to read the Brooklyn mammogram, marbled in shades of white, gray, and black, but despite the helpful little arrow someone had drawn on it, I couldn’t see any spiculation. It just looked like a streaky white blob within a breast-shaped shadow. My respect for the Brooklyn radiologist increased.

Dr. Stratton did a heroic job saving my uterus in 2016, when I still had hopes of using it, although she had to punch five laparoscopic holes in my abdomen to carve out all the fibroids. Now she alerted me to the ultrasound results and suggested a pelvic MRI as the next step if I wanted to consider harvesting the fresh crop.

“Right now I'm more worried about the spiculated mass in my left breast,” I responded. “Is there a chance any of the abdominal growths could be malignant?” Dr. Stratton found that very unlikely and reassured me that a pelvic MRI could wait.

To be continued...