Everything about my breast cancer diagnosis, from my presentation to diagnosis, was strange. In the spring of 2006, I was performing my monthly breast self-exam when I felt a hard lump in the upper left quadrant of my left breast. Having lost a good friend to breast cancer 4 years earlier, I was hyperaware of what this could mean and could feel panic setting in. I asked my husband, John L. Marshall, MD [Chief, Division of Hematology/Oncology, MedStar Georgetown University Hospital and Director, Otto J. Ruesch Center for the Cure of Gastrointestinal Cancer in Washington, DC], what he thought I should do—I wanted to make sure I wasn’t overreacting—and he said to “get it checked out.”
I first saw my gynecologist, who advised me to see an oncology breast surgeon for an additional examination but reassured me that the mass was unlikely to be serious. Her words were comforting but did little to assuage my growing sense of concern. Although the surgeon agreed that the mass didn’t appear to be serious, she referred me for an ultrasound and mammogram screening. The radiology report concluded that I had “an ovoid solid lesion measuring approximately 1.3 cm” and recommended I have an ultrasound-guided core needle biopsy.
Here’s where it gets interesting. A few days later, I received a call from the breast surgeon with the good news. The pathology report found that my “benign breast tissue [is] consistent with fibroadenoma.” Finally, I thought, I could relax. I was wrong.
A few months later, I noticed that my right breast was swollen. It didn’t hurt or feel different, but I made another appointment with the breast surgeon just to be sure the swelling wasn’t a sign of something ominous. Although both the ultrasound and mammogram had been negative for suspicious masses, the surgeon recommended I have a core needle biopsy performed.
During the procedure, a research nurse came into the room and asked if I would consent to donating some of my breast tissue for biobanking for a study they were launching on normal breast tissue. As the wife of an oncologist and someone who believes strongly in improving the lives of patients through research, I consented immediately and went home.
The following Monday morning, I was on the phone with John discussing our schedule for the coming week, when he suddenly blurted out, “You’ve got cancer.” He had accidentally been sent a copy of the pathology results from the tissue retrieved for biobanking, which showed malignant cells in my breast.
After removal of my right breast and examination of the tissue, it was determined that I had stage IIIA triple-negative breast cancer. I was 43 and the mother of two young children, Charlie, 13, and Emma, 10. I knew several women my age who had died of breast cancer and wondered if I would be next.
In 2006, not much was known about triple-negative breast cancer, and the diagnosis was overwhelming. I worried that members of my oncology team—and even John—weren’t telling me everything they knew about my diagnosis. I think the dilemma many physicians face is balancing wanting to be truthful with patients while not overburdening them with information that might not be helpful. The same is true for caregivers, especially those with a medical background, and both John and I struggled with maintaining our roles as patient, caregiver, and oncologist. Years later, we were able to confront our conflicting roles and document the impact a life-threatening disease had on our family in the book Off Our Chests: A Candid Tour Through the World of Cancer (Ideapress Publishing, May 2021; see the April 10, 2021, issue of The ASCO Post for a review of this book).
Accessing the Best Medical Care
I’m incredibly fortunate. I have both the financial means and access to the best medical care, and I’m sure this advantage contributed to my success in overcoming this cancer. After the surgical removal of my breast, I enrolled in a dose-dense clinical study investigating the benefit of six cycles of combination doxorubicin and cyclophosphamide compared with the four-cycle standard of care. Although the side effects after four cycles were debilitating, I was able to complete the treatment regimen after a reduction in doxorubicin for the last two cycles.
As I came to the end of the first part of the study, a former colleague of John’s, Marc E. Lippman, MD, MACP, FRCP, suggested I try platinum chemotherapy. This treatment had been shown to be effective in metastatic triple-negative breast cancer but had not been tested in the adjuvant setting.
I continued therapy with the paclitaxel portion of the standard-of-care treatment plus carboplatin. However, 2 weeks into the second cycle of treatment, my neutrophil counts dropped dangerously low, and I switched to cisplatin, in the hope it would be less toxic; it was. Following the chemotherapy regimen, I had 6 weeks of radiation therapy, and, today, I remain cancer-free.
Living Life After Cancer
Although I wish I never had cancer, the diagnosis has had a positive impact on my life. For one, it led to my becoming an author. Most importantly, it solidified my marriage. Prior to my diagnosis, I had quit my legal career to concentrate on raising our family while John built his oncology practice and, frankly, we had hit a rut in our marriage. Cancer made it possible for us to recognize how committed we are to our marriage and family. We didn’t know how much longer we had to be together, and that fear and sense of urgency made us appreciate what we had built over our years together.
I’m very aware that every day I’m alive is a blessing. That is not to say I don’t have the occasional bad day, but I am grateful to be alive. I’m grateful that I’ve lived long enough to see my children grow into wonderful adults. I’m grateful for what we lovingly refer to as “the breast cancer industrial complex” that has kept me alive. And I’m grateful that cancer has brought John and me closer together.
Cancer has taught me to celebrate the day-to-day ordinariness of life and not to take anything for granted. I don’t know what’s around the corner, but I am embracing life and all of its uncertainties.
Ms. Marshall and her husband, John L. Marshall, MD, live in Arlington, Virginia.
Editor’s Note: Columns that appear in the Patient’s Corner are based solely on information The ASCO Post receives from patients and should be considered anecdotal.