Breast Cancer Awareness Month

At age 30, I had a long conversation with my primary care physician about my risk for developing breast cancer. My mother had survived ovarian cancer; both my maternal and paternal grandmothers had survived breast cancer.  Genetic testing showed that none of us had evidence of the BRCA mutation, but my doctors still determined that I was high-risk based on my family history. “The BRCA1 (Breast Cancer gene 1) and BRCA2 (Breast Cancer gene 2) are genes that produce proteins that help repair damaged DNA. Everyone has two copies of each of these genes – one copy inherited from each parent. BRCA1 and BRCA2 are sometimes called tumor suppressor genes because when they have certain changes, called harmful (or pathogenic) variants (or mutations), cancer can develop. 55%–72% of women who inherit a harmful BRCA1 variant and 45%–69% of women who inherit a harmful BRCA2 variant will develop breast cancer by 70–80 years of age.” In late October of 2018, I went in for my regular annual physical and mammogram, as I had done every year since I was 30. On the drive home was when I received the first call asking me to come back for a quick follow up test – a biopsy for a small “shadow” that showed up in the scans. Two weeks later, I received the call informing me I had ductal carcinoma in situ (DCIS) stage 0 breast cancer. That was perhaps the most terrifying call I had ever received. Immediately my mind was flooded with a million questions – does this mean I am going to die? What kind of treatment do I need? Will insurance cover everything? Will I be able to continue working? Will my job be secure? Can I handle this? And what exactly is stage 0 – is that even a thing? Of course, I did exactly what all doctors tell you not to do – and started scouring every inch of the internet for more “data”. I wanted answers to all my questions so I could develop my “project plan”, and instead, overwhelmed myself with too much information, a headache, and a strong desire to drink myself silly. Fortunately, I had sense enough to schedule an appointment with my oncologist to discuss a real plan. Each of my family members had chosen to go with a lumpectomy and chemotherapy/radiation treatment, but they each had a recurrence of the cancer within 5 years, so I opted for a bilateral mastectomy with reconstruction. That is not the easiest or even the best choice for everyone, but I felt it was the right one for me if I wanted to increase my chance of long-term survival. I knew I was one of the lucky ones because we caught it so early. Like most things in life, despite my best efforts, very little went according to “plan”. I knew I wasn’t going to have to do multiple cycles of chemo or radiation, but I honestly had no idea about the other complications you could have when you are also a type 2 diabetic.  I didn’t know anything about the potential for necrosis or the infections you could get after surgery.  I had no idea that what originally was going to be 2 or 3 surgeries would turn into 7 over the course of 3 years. But what I did have was Fritz Wetschnig, an amazing boss, who told me many times along the way to focus on my healing and to stop worrying about job security. The same boss who still promoted me in the middle of this ordeal, even though we weren’t sure what the outcome would be. The same boss who came to the hospital to bring my wife breakfast and coffee while she waited for me to come out of surgery. The same boss who saw me on the first day that I returned to the office after my mastectomy and instead of greeting me like a normal human being, pulled out his cell phone and called my wife to see if I was really supposed to be there.  The same boss who grew increasingly worried as the COVID-19 cases were spreading across Asia and Europe and kicked me out of the office almost two weeks before our lockdown in California, because he was concerned about my safety. I am eternally grateful for all of the people who stood beside me and lifted me up when I thought I had no fight left in me to give. It’s been a long 3-year journey, but I am in remission and ready to write this next chapter. ———————————————- “According to the World Health Organization, in 2020, there were 2.3 million women diagnosed with breast cancer and 685 000 deaths globally. As of the end of 2020, there were 7.8 million women alive who were diagnosed with breast cancer in the past 5 years, making it the world’s most prevalent cancer. Breast cancer occurs in every country of the world in women at any age after puberty but with increasing rates in later life. Approximately half of breast cancers develop in women who have no identifiable breast cancer risk factor other than gender (female) and age (over 40 years). Certain factors increase the risk of breast cancer including increasing age, obesity, harmful use of alcohol, family history of breast cancer, history of radiation exposure, reproductive history, tobacco use and postmenopausal hormone therapy. Unfortunately, even if all of the potentially modifiable risk factors could be controlled, this would only reduce the risk of developing breast cancer by at most 30%.”