For years, I’ve followed a methodical cancer prevention regimen. Meet with a doctor regularly, review my family history, and flirt with the idea of BRCA testing. Nod pensively and affect a solemn expression while listening to medical recommendations. Return home with a sense of accomplishment and pride. Next, the key step: forget about the whole thing for a year, rinse, repeat. Because denial clearly makes you invulnerable to cancer, right? I’m positive that I saw that in a peer reviewed study.
When I met Dr. Smith, I could tell that this appointment would be different. He looked into my eyes with earnest intensity and said, “We are so glad you decided to come in,” in a way that was simultaneously terrifying and comforting. I knew my family history was significant, but Dr. Smith seemed impressed. My mother was diagnosed with metastatic breast cancer at 55 and died of it at 63. My great grandfather had also died from the disease, and my paternal grandmother had succumbed to ovarian cancer. All of that plus my Ashkenazi ancestry? I was winning the high risk lottery! We would do the BRCA test that day, with a breast exam thrown in for good measure.
I felt a stab of panic when Dr. Smith paused for further exploration not far from my left nipple. But when he said he felt a slight lump, I wasn’t surprised. I had imagined this scenario hundreds of times since my mother was diagnosed, but still I felt tears pouring down my cheeks. Dr. Smith reassured me. It was a small lump, probably nothing, and breast tissue is bumpy sometimes “like a cobblestone road.” Still, he recommended that I schedule an ultrasound for the lump, as well as a mammogram to establish a baseline reading. At 33, this would be my first of each.
The waiting room at the breast-imaging center had the vibe of a midrange spa. There were gossip mags and grey robes with teal accent stripes. Alas, there was no soothing pedicure in my future, just mammography. A woman walked me back to the exam room and used various buttons and pedals to help me settle into the machine. When the adjustments were right, she stepped back into her protective booth and the compression commenced. We took multiple x-rays from various angles. I had been worried about the pain, but found the embarrassment of having your breasts arranged by someone’s sweet-looking auntie far outweighed any physical discomfort, although there was that too. When it was over, she handed me a tissue and pointed out some clear discharge that had collected at the tip of my nipples. “That’s normal,” she said. Surprise! The human body is really gross!
Following the comparatively relaxing ultrasound, a doctor came in with my results. The lump was nothing, but the “just to establish a baseline” mammogram showed a cluster of micro-calcifications elsewhere in my left breast. Embarrassingly, I didn’t know what this meant. I remember thinking “Calcifications, like calcium? So that’s good, right?” The doctor explained that many women develop calcifications in their breasts as they age (way to add insult to injury, lady!) and that they’re often nothing… except for sometimes, when they are indicative of, you know, cancer. So I should schedule a stereotactic biopsy as soon as possible. Did I have any questions about that? Oh, only a million, but where to start? What were the chances that this was actually cancer? Would a biopsy disfigure my breast? How much would this cost? Was I going to die?
When my mom was diagnosed with cancer, it was already stage IV, in organs and bones. After the initial shock cleared, we were both surprised at how many things made us laugh, even in the midst of terminal illness. Her perpetually lopsided wigs. Intricate, mummy-like lymphedema wrappings. Her ongoing weight concerns: “Jesus, I have stage IV cancer, you’d think I’d at least get to be thin.”
Now, I was finding new things to laugh about, like the stereotactic biopsy set up. A nurse instructed me to climb onto a table and insert my breast into a hole towards one end. Then she cranked the table up, allowing the doctor space to work on me from beneath. It all was starting to feel a bit alien abduction. To enhance the extraterrestrial probing vibe, they compressed my breast throughout in order to find the suspicious area with a few x rays (like a mini-mammogram). The nurse urged me not to move, as not to throw off the precise measurements. Then, they numbed my breast with lidocaine and sucked up some samples with a hollow needle. As always, the doctor asked if I had any questions. I asked if he could tell anything from the x-rays. He explained that some patterns of micro-calcifications are pretty obviously malignant while others are almost always benign. Mine just didn’t fall into either category.
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