Facing Breast Cancer: A Nurse's Story of Treatment, Surgery, and Advocacy

"You have invasive ductal carcinoma." Those five words changed my life on October 15, 2020.

There was no family history of cancer. A few months prior, I had found a lump in my right breast while showering. The lump felt irregular. It took my breath away. I cried in the shower for what felt like forever, because in my gut, I already knew. My mammogram would be due later that same month. Every year after my mammogram, I was used to getting recalled for breast ultrasounds, so I didn't really worry in years past.

This time, I knew it would be different. I received a call the same day with the ultrasound results, "There is a vascular component to the breast lump. You need to have a biopsy." I had the CD of the breast ultrasound made and began searching for a breast surgeon who could fit me in as soon as possible for the biopsy. The soonest one who could get me in was at least another month down the line.

Types of Breast Cancer and Treatment Options

Breast cancer is vastly different from person to person. There are so many variables: Which hormones (if any) feed it, the size of the tumor(s), whether it has spread locally or distally, whether chemotherapy is warranted, and whether radiation is needed. But wait, there's more!

Surgery is always part of the treatment plan for breast cancer, and surgery ranges from lumpectomy, single mastectomy, to double mastectomy. Lymph nodes are always removed with mastectomies. At minimum, only the sentinel lymph node is removed, or one may need a total lymph dissection, depending on how far advanced the breast cancer is. The good news is that there are imaging studies that can be done to determine lymph node involvement to avoid unnecessarily removing lymph nodes. The OncoType DX can determine if chemotherapy is beneficial or if chemotherapy is unnecessary. Each decision for treatment is personalized. I opted to have a double mastectomy. I still ended up needing both chemotherapy and radiation.

Breast Cancer Genetic Testing: BRCA, PALB2, and Other Genes

Since I was only 45 years old at the time of diagnosis, I was offered genetic testing to find out if I had any genetic predisposition to cancer. I was found to be positive for PALB2 (Partner and Localizer of BRCA2), which is a lesser-known gene compared to BRCA1 or BRCA2. As a result, I was referred to a genetic counselor for further evidence-based recommendations and screenings, as needed.

The cancer gene test that my insurance covered was the Myriad myRisk cancer gene panel. Another cancer gene panel is from Invitae. Both tests screen for multiple cancer genes. I caution people not to ask to be tested just for BRCA1 or BRCA2, but to ask for a cancer gene panel. So many more cancer genes have been discovered, and PALB2 was not discovered until 2016. I would not have known that I have the PALB2 gene, had I only been tested for BRCA1 or BRCA2!

Breast Reconstruction Surgery

Some will opt for reconstructive surgery, and others may prefer an aesthetic closure to remain flat. There is no age limit for reconstruction. Patients should be encouraged to do what helps them feel most comfortable in their own skin. I initially opted to be reconstructed with breast implants, but the implants made me ill after two years. I had the implants removed and instead had fat grafted to reconstruct breasts. I consulted with a few plastic surgeons in the local area who specialized in breast reconstruction, and unfortunately, none of them accepted my insurance. The closest plastic surgeon who accepted my insurance was over two hours away. I felt very comfortable with one local plastic surgeon, but since he did not accept my insurance, I wrote a letter of medical necessity (LOMN) that my primary physician signed and submitted to both my insurance and the plastic surgeon.

Thankfully, my insurance was willing to pay for most of my surgery, and the plastic surgeon whom I wanted accepted my case. However, after I needed the breast implants removed two years later, this plastic surgeon did not want to operate on me, because I had radiation. I dove into more research and found surgeons who would operate on patients who had previously had radiation. These surgeons had newer, microvascular surgical techniques, but they were even further away from my home, a few states away. I consider myself fortunate to be able to afford to travel to have my surgeries for the removal of the implants and subsequent reconstruction revisions.

Crash Course into Menopause

I was once told, Breast cancer is an easy cancer, by someone who meant well. It absolutely is not. No cancer is. There are so many physical and mental changes. It brings on anxiety, depression, fear, lack of libido, the list goes on!

I am still learning how to cope when certain feelings arise. The mental health piece is the toughest for me. My breast cancer was fed by estrogen and progesterone, two hormones that help sustain life during pregnancy and are crucial for many functions, especially for females. I was prescribed monthly Zoladex (goserelin) subcutaneous injections until I had my ovaries and tubes removed during a total hysterectomy. I opted to have this surgery to reduce my chances of developing ovarian cancer, because the PALB2 gene increases the risk of developing ovarian cancer, as well.

I was prescribed anastrozole, an aromatase inhibitor, to take daily by mouth to prevent breast cancer recurrence. I jokingly call it a-nasty-zole. It comes with many menopausal side effects. Most people prescribed aromatase inhibitors for cancer take them for anywhere from five to ten years. My medical oncologist recently ordered a test called the Breast Cancer Index (BCI) Test to determine if I'll need to continue anastrazole beyond the initial five years. Those results are still pending, as I'm writing this.

Advocacy

In the end, patients are their own best advocates, but not all are versed in health care, so this is where we come in as health care professionals. Advocate for your patients. Write those LOMNs and inform them of their options. They do not have to settle for providers in their local area if the necessary level of care is not available locally. Some insurances will cover travel.

Another option for military veterans who have a history of breast cancer is to file for compensation through the U.S. Department of Veterans Affairs (VA). A law called the PACT Act lists breast cancer as a presumptive condition for VA compensation for veterans who were exposed in combat zones and some other locations to known carcinogenic toxins, such as open burn pits and other occupational hazards.

A useful app to share with your patients who are facing cancer is Outcomes4Me. Outcomes4Me is a wealth of evidence-based information for patients. I found out about the BCI Test through that app and brought it up with my medical oncologist! Finally, look for stories of faith and hope and share them: I derived the most peace and comfort from those in my darkest times.

About the Author:

Catherine Hernandez began her career in healthcare 30 years ago as a patient care technician in a children's hospital. She went on to earn her Associate of Science in Registered Nursing, then went back for her Bachelor of Science in Nursing. She served six years in the United States Air Force, which included a tour in Iraq. Her specialties are pediatrics and labor & delivery/mother-baby and has experience with trauma nursing in the combat zone and ambulatory care settings. She earned her Doctor of Nursing Practice with a concentration in Pediatric Health from the University of South Florida (USF) in December 2020. She was diagnosed with breast cancer halfway through her last semester at USF and shares her story for the first time here.

Catherine is an independent contributor to CEUfast's Nursing Blog Program. Please note that the views, thoughts, and opinions expressed in this blog post are solely those of the independent contributor and do not necessarily represent those of CEUfast. This blog post is not medical advice. Always consult with your personal healthcare provider for any health-related questions or concerns.

If you want to learn more about CEUfast's Nursing Blog Program or would like to submit a blog post for consideration, please visit https://ceufast.com/blog/submissions.