“My Voice” by Marcia Hahnfeld Deitrick

Marcia Hahnfeld Deitrick - 'Survivor'

I began surviving breast cancer the day I was diagnosed with invasive ductal carcinoma, on September 17, 2007.   In the past 22 months, I have underwent seven surgeries, four rounds of chemotherapy, endocrine therapy, and endured multiple treatment related complications and side effects.

A month after I turned 40, I found a lump in my right breast while showering.  Ten years of screening mammograms had failed to detect my 2.9-cm tumor.   The day it was visible on ultrasound, it was still not visible on a mammogram.  Shortly after diagnosis, I picked up copies of all my mammograms and the corresponding radiology reports, and saw that the first report from 1997 stated that my breast tissue was so dense it could easily obscure a malignancy.   Premenopausal women typically have dense breast tissue , but no one had told me that my tissue was so dense that mammography alone was inadequate.  Based upon my family history, I now know that I should have received additional screening with ultrasound or MRI.  Although initially angry, being a survivor meant moving forward, and not looking back.  If I dwelt on the past, I would potentially lose both the present and the hope of the future.

Being a survivor also meant choosing treatments that would hopefully not only keep me alive, but with which I could live comfortably.   In order to make these choices, educating myself on breast cancer was of the utmost importance.   I spent the month between diagnosis and surgery devouring breast cancer books and websites, educating myself about this potentially fatal disease which had taken up residence in my right breast.  Those weeks were filled with fear and uncertainty, revolving around questions of whether the cancer had spread to my lymph nodes, or metastasized.  Being a survivor meant dealing with these fears, while at the same time staying calm enough to continue putting one foot in front of the other as I planned my treatment.  Although my medical team consisted of a breast surgeon, plastic surgeon, oncologist, and gynecologist, I needed to be in control of what happened to my body.  In order to survive the decision making process along with the fear and uncertainty, I decided to look at my treatment as a series of stages.  I would only worry about one portion of my treatment at a time, thereby making my fear more manageable.

The first stage of treatment was surgery.  I chose to have both breasts removed so that I would never again be dependent upon mammography.   I embraced this decision knowing that breast reconstruction was available and would soften the blow of losing an integral part of my identity.  Unfortunately due to conflicting surgeon’s schedules, I was not able to have immediate reconstruction.  This would be a psychological stumbling block for me for months to come, and a source of much mental anguish.

My bilateral mastectomies were performed on 10/15/07, along with a sentinel node biopsy.  The next morning, I learned that what was originally believed to be a 1.1-cm stage 1 breast cancer, was actually a 2.9-cm stage 2 cancer.  Fortunately, the three sentinel lymph nodes  were free of cancer.  Even with negative lymph nodes, breast cancer can metastasize through the bloodstream.  Therefore, even with the great news that the lymph nodes were clean, I was not home free.  Due to the size of my tumor, the chemotherapy that I was originally told I could likely avoid would now be a necessity.   The larger the tumor, the more likely the chance of distant metastasis.  Now I was not only going to be breastless, but bald too.

The second stage of my treatment began on 11/14/07 with the administration of the first dose of chemotherapy.  I had a total of four treatments of Taxotere and Cytoxan, with three weeks between each treatment.  Taxotere requires the use of steroids to prevent allergic reactions.  By the second treatment, I had gained 20 pounds from steroids and a steady diet of starchy comfort foods.
Thirteen days after my first chemo, my hair began falling out.   Being a survivor meant taking charge of my life, even when it felt out of control.  My hair was leaving my head on my terms, and my terms did not involve watching it come out a handful at a time.  That evening my husband gave me a buzz cut.  A few days later the buzz cut stubble was gone, along with my eyebrows .  The world could now tell I was a cancer patient.

I became severely neutropenic after chemos 2 through 4, ending up with a fever and respiratory infection each time.   Chemo also put me into menopause and depression.  My final chemo took place on January 17, 2008.

The third stage of my treatment, endocrine therapy,  began a month after chemo ended.    Not all breast cancers shares the same pathology.  For those that are hormone receptor positive, endocrine therapy to suppress estrogen can be more important than chemotherapy.  My tumor was 93% estrogen receptor positive, meaning that hormone suppression was critical.   Chemo had made me menopausal, but that alone was not enough.   In February 2008, endocrine therapy began with the addition of a daily Tamoxifen pill.  The risk of recurrence of hormone positive breast cancer never goes away, and can occur years or even decades after the original diagnosis.  For this reason, endocrine therapy lasts for years.  Tamoxifen would be a part of my daily diet for 5 years, followed by 5 additional years on Arimidex.  Tamoxifen blocks estrogen receptors on cancer cells preventing the cancer from using the estrogen to grow.  Arimidex prevents the body’s adrenal glands from producing estrogen.

The next stage of treatment  was breast reconstruction.  I began reconstruction in August 2008, after 10 months without breasts, with the placement of tissue expanders under the pectoral muscles.  Over the next several weeks, the expanders were slowly filled with saline.  In December 2008, the temporary expanders were removed and replaced with silicone implants.  Nipples and areolas were created in two separate procedures in early 2009.

After a year of chemo induced menopause, my ovaries woke up and began spewing estrogen in December 2008.  In January 2009, I began monthly Lupron shots to chemically suppress them.  After five months of shots and associated unpleasant side effects, I decided to have my ovaries permanently removed.  Removing the ovaries would take away the long term worries over whether the Lupron was working, as well as the hormonal ups and downs caused by the shot.  The best part though was that I would be able to go back to a 3 month schedule of oncology appointments, rather than the monthly schedule Lupron involved.  For me this was freedom, and the most important part of survivorship for me is living my life on my terms.

On June 23, 2009, I had a total hysterectomy to remove both ovaries, fallopian tubes, the uterus and cervix.  This was my grand finale surgery designed to give me freedom and peace of mind.  I will continue to take Tamoxifen pills daily until 2013 at which time I will begin Arimidex for an additional five years.  Even without ovaries, the female body continues to produce small amounts of estrogen.  Therefore, Tamoxifen and Arimidex are still an important part of treatment.

Breast cancer has no one treatment.  There are choices to be made along the way, and treatment is not the same for each person.  Choices involve doubt, fear and second guessing.   Being a survivor means knowing I made the best choices for me at the time I made them, based upon the best knowledge available at the time.  Breast cancer has no cure.  Being a survivor means living each day knowing there is no guarantee the cancer is gone.  Most importantly, being a survivor means living my life to the fullest and without giving in to the cancer or it’s treatment, or the fear of recurrence.  Throughout my treatment, I refused to let cancer disrupt my life.  I worked full time, participated actively in my childrens’ lives, and kept as normal of a routine as possible.  The harder treatment knocked me down, the harder I fought to reclaim my life.  I am now in better shape than I was pre-diagnosis thanks to major diet and exercise changes.  Being a survivor also means occasionally giving in to the anguish of a cancer diagnosis, and raging against what has been thrust upon me.  As long as I don’t stay in that place, it is okay to acknowledge it’s existence and make brief visits to mourn the innocence that was lost.  Being a survivor taught me to take life one day at a time, to look for the beauty in the simple things, to savor each moment, and to celebrate whenever possible.   For that I am grateful.

I am a survivor, and I am strong.