From screening mammogram to cancer diagnosis in a global pandemic.
In 2015, I received a lovely letter from the NZ government, wishing me a happy 45th birthday, and would I please attend a free screening mammogram. So I dutifully took myself off to the offered appointment, and got my free boob squishing. And every year since, I’ve had the same invitation. Last year, I dodged my appointment, but once we got out of lockdown, I figured I had better go. I was able to schedule it for a school day, so it was efficiently achieved, and promptly forgotten about.
Until about a week later, when I got a call from a nurse, asking me to come back for a second look. They had spotted a “something” that warranted closer inspection, and it needed to be done soon. On the 14th of July, I left Inigo with a friend, and went off for my appointment. Thanks Phillipa!
One more go in the sandwich press, this time on a machine that did slightly higher resolution, and multiple angles. Then an ultrasound and a check of my lymph nodes.
At that stage I was told that my imaging results indicated about a 3/5, where 1 = “go home and don’t bother us till next year”, and 5 = “that’s no moon”. Mine was a 3 = “we are going to poke you a lot more before we tell you to go away, or invoke the death star”.
Next up on the 5th August was a biopsy, which was honestly the thing I was most afraid of. I’ve never been great at medical things, but my pregnancy with the twins forced me to develop a callus over a lot of those fears. But it also left me with some medical related trauma (mostly because of the dehumanising way I was treated, not completely because of of the procedures themselves). I opted to take the offered mild sedation, but I think I really needed a much higher dose.
I won’t go into the procedure here, because I don’t want to frighten people, but if you’ve got to have one, and you’re like me and need to know what to expect beforehand, I will be very happy to chat. The way it was described to me, and what actually happened, were two very, very different things. Like describing borg assimilation as strapping on a wristwatch.
And during a pandemic, you don’t get to have a support person with you.
I was expecting to get my results the following week, during which Auckland went back up to level 3. I was offered the option of getting my results by phone, which I preferred. My surgeon rang to let me know that my cells had been identified as “Atypical Ductal Hyperplasia” – the centre diagram in the image below. This is not cancer, but it can become cancer in some women.
Sometimes, when a biopsy indicates ADH, a surgical sample will reveal “Ductal Carcinoma In Situ”, the next image, second from right. With this in mind, I was scheduled to have surgery on the 25th of August to remove more of the affected tissue and have a better look.
Because my boobs are big, and the cancer is small (and invisible to the naked eye), the procedure was preceded by a another procedure to place wires into the breast to guide the surgeon to the right spot. This meant quite an early start, getting to the first appointment, having the wires placed, and then being driven to the hospital – because you can’t have both procedures done in one place, of course.
And during lockdown, no support person. Or childcare. So all three of us trooped off to Newmarket, and Mark and Inigo waited in the car while I had the wires placed. They then dropped me at the hospital, then thankfully, Inigo was able to go to school for the day. Thanks Andrea, for planting the idea, making it possible (schools are only open for kids whose parents are essential workers), and for loving my little guy. And thanks Julie, for turning back after picking up your own kids, and going back for Squid, who got slightly forgotten in all the drama of my surgery being delayed.
Surgery was uneventful, except for the fact that my weird skin allergy/reaction to the surgical dressings hadn’t been communicated at all, so I had to have my wound completely redressed while in recovery, and I still ended up with a nasty rash from that and the cannula. The pain wasn’t that bad afterwards, and I only really needed pain relief for the first 2 days after surgery. I’m still sore now, but the extra bonus mammogram I had yesterday wasn’t intolerable.
On Wednesday afternoon I went in for my results, and to have the dressing changed. At level 2, I could have taken a support person with me. I should have. I didn’t.
Friends, if you ever have to attend an appointment where a possible outcome is being told you have cancer, take a friend. Thanks Alia, for bringing Squid home from school – that meant I had a little time to process things before I had to tell him what was going on.
Ductal Carcinoma In Situ is like winning the jackpot when it comes to a cancer diagnosis. Once you’ve processed “my boob is trying to kill me, I always knew those fuckers were suspicious”, the next thing you want to think about is treatment, and survival. With most cancers, they don’t use the word “cure”. With most cancers, they talk about how many patients with the same diagnosis are still alive 5 years after diagnosis. But with DCIS, they use the word CURE.
It’s not invasive, so while there are some cells that have gone rogue, they haven’t broken out of their prison yet, and it hasn’t spread.
Yesterday I had a second appointment to chat with the surgeon in detail, and I took Mark. And Inigo too, because he slept in, so he got to sit in the waiting room with his mask reading a book while we went in. One more surgery to get the extra bits they missed last time, and if the margins are clear, the only follow up treatment will be my regular yearly mammogram with minimal extra scrutiny, and slightly higher risk of recurrence – 10-15%. And because this is a relatively slow growing cancer, even if it had been discovered last year, the treatment would have been exactly the same. How lucky am I!?
If they aren’t able to get clear margins, then we talk about radiation, full mastectomy, etc. But for now, the prognosis is extremely good, and while the medical stuff is hell on my anxiety, I have no reason for self pity or catastrophising. One great blessing from having lived through carrying and then losing the twins, then nearly dying myself, is that I have already lived through one of the worst things a human can experience. Losing a child feels like the end of the world. Like nothing will ever be ok again.
This just feels like the next checkbox on my 2020 bullshit bingo card.
*Postscript. If you are reading this in a country that doesn’t have a socialised medical system, you might be alarmed at the financial cost of all my treatment. So far, my out of pocket expenses for all this are NZD$23.19 for the Uber I took home after the biopsy when Mark forgot to pick me up, and $10 for the beer I had with lunch immediately after the diagnosis.
At the point of diagnosis I was offered the choice of being referred to the public hospital system for the remainder of my treatment, or going into the private system. Since I have private health insurance, I have opted to go private because the sandwiches are better, and hopefully a woman without private cover will get treated slightly sooner because I am not using those resources. The standard of care I would receive in both systems is identical, though my treatment will be slightly quicker in private over public (2-3 weeks for surgery instead of 4-6 weeks in public. My case is not urgent – if it were urgent, it would be treated sooner in public. With private insurance, the projected cost to me = $0 out of pocket. In the public system, the cost would be the same. Free.
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