Beyond Polarity

Donna’s Cancer Journey Post #3

Within 18 hours of being home from Peru, I’m sitting in the waiting room of the Breast Clinic.

The clinic is housed at the Women’s Health Centre, one of the smaller buildings tucked within the vast Foothills hospital complex in Calgary. I’m grateful to my daughter-in-law, Renee, a pediatrician; she’s come with me to meet the oncological surgeon. 

First, we meet the resident, a surgeon-in-training. She does a history of my family’s experience with cancer, a quick physical exam of my breasts, and then, very gingerly, asks open-ended questions about my expectations for treatment. Based on what I’ve heard from others, I’m prepared for a double mastectomy if that’s what’s required. My declarations sound bold, even to me. 

My official diagnosis? Ductal carcinoma in situ (DCIS). “Some people don’t even call it cancer,” says the resident. But does she really expect any diagnosis that includes the word “carcinoma” to not make me wince? Sketching an image of a breast duct on a white board with a marker, she explains how the cells have grown in an unusual way but based on the biopsy, remain within the duct itself. If I did nothing, there’s a 70% likelihood that nothing would happen and there’s a 30% risk that the cells would become invasive and I would then be at risk of dying from metastatic breast cancer. 

Dr. Quan, the oncological surgeon, joins us in the examination room; in spite of her youthful appearance, I’ve done my research and know she’s incredibly experienced. The surgeon’s manner is direct; I like that. Her aim is not to have me trust her judgment; she wants me to comprehend my options and make an informed choice. What’s she recommending? A lumpectomy (remove the compromised cells plus a buffer zone of healthy cells) followed up with radiation at the Tom Baker Cancer Centre. Radiation decreases the risk of reoccurrence of DCIS by 50%. 

Reflexively, people think more (a mastectomy, removal of the entire breast) is better, Dr. Quan explains. And there’s a lot of conflicting information in the zeitgeist about DCIS treatment, she continues. But a mastectomy is not what she’s recommending. A mastectomy is not benign; there’s an emotional toll, a risk of chronic pain and it’s far more radical surgery. Angelina Jolie may have unwittingly romanticized the lopping of one’s breasts—and plastic surgeons can work wonders—but you don’t get your breasts back once they are gone. 

In the surgeon’s opinion, DCIS is a “disease of screening”. Mammograms are a good thing, of course, but one in eight women will have some abnormality show up on screening. 

What about genetic testing for the breast cancer gene (the testing that precipitated Angelina Jolie’s prophylactic double mastectomy)? Both of my grandmothers had breasts removed, decades ago. There’s a spit test I can purchase (the cost for testing is $350); if that’s something I want to do, please do it as part of a screening project not randomly, the surgeon advises.

Moving along, I accept the recommended treatment strategy and sign on the dotted line.  I’m now officially in the queue for a surgery time, expected to happen sometime in the next six weeks. Radiation timelines are getting stretched in Alberta; I’m warned that step in the treatment plan may not happen until November or December. 

The surgeon and her protege exit and a nurse navigator joins us in the examination room to explain the surgical logistics; it’s day surgery, in-and-out. Armed with heaps of information, documents and a plan, Renee and I depart the clinic after nearly two hours of intense conversations. 

As I exit the clinic, I shudder; feeling waves of relief and even a sweet moment of glee. I had entered this place believing that a double mastectomy would be the best pathway forward and depart the place feeling confident in the surgeon’s far less radical plan. 

Both of my Grandmothers Survived Breast Cancer

Filling out the stacks of forms at the oncological surgeon’s office—including a family history of cancer—I am struck by two things. First, the preponderance of cancer faced by the females in my family. And second, just how little I actually know of my grandmothers’ breast cancer journeys. 

In their time, social culture was different. Nobody spoke openly of cancer. And while my proper British grandmas (like Queen Elizabeth II, they shared a fondness for robin’s egg blue dresses & pearls) would have been very familiar with the realities of farm life (including massaging the tender udders of milk cows), they wouldn’t be caught dead speaking of their own breasts.  

In 1962—when I was still in diapers—my paternal grandmother, Grace, had a radical mastectomy.  Written sideways in very small handwriting in the margins of a now fragile notebook (where Grandma recorded recipes, as well as the dates of births, marriages and deaths), my Aunt Joyce recently discovered Grandma’s brief record of her experience with breast cancer:

1962 Jan. 30th Radical Mastectomy.  In hospital 1 month, then to London for 3 weeks of Cobalt A treatments.  Sept 16 back in hospital 6 1/2 weeks, treatment on arm.

Removal of Grandma’s lymph nodes–all part of the radical mastectomy–was botched. As long as I knew her, one of her forearms was much larger than the other and from time to time leaked clear fluid.

As a young girl, I recall Grandma deftly tucking a hand into her corset (she always wore a bra that went down to her waist), to jiggle and reposition her fake breast. Her prosthesis was a  bra cup filled with tiny bird seed—that moved more naturally than the foam cups then on offer. And when she became engrossed in sewing or mending, she would, much to everyone’s amusement (including her own), use her prosthesis breast as a pin cushion. 

My maternal grandmother—Kathleen—was diagnosed with breast cancer when she was in her early 70s. One breast was removed and decades later, when I reach out to my aunts to ask about Grandma’s experience, I’m surprised to learn no one remembers much. Grandma shielded her own family from her cancer experience; it’s what people did then. 

For both of my grandmothers, the discovery of a lump on their breasts must have been terrifying. The surgery was radical and disfiguring; reconstructive surgery wasn’t on offer. In that era, doctors were gods; the patient wasn’t likely to be presented with options for treatment. 

But both of my grandmothers survived breast cancer and went on to live long lives. Neither died of cancer. These facts give me hope. In an age of intensive screening and a range of treatment options, I still feel anxious. But I have a voice in the treatment plan.

And as a grandmother now myself, I have some understanding of why my these matriarchs hid cancer, and the fear of cancer, from innocent children.  As a young girl, I don’t recall being afraid of cancer—I didn’t see cancer as the defining plague of my grandparents’ generation. But I do, now.