Betty Dicker, RN, MSN
Cancer has stalked my family for generations. My mother, brother, and maternal uncle were diagnosed with melanoma. Fortunately, all survived. When my sister was diagnosed with early-stage invasive ductal carcinoma in 2010, she underwent genetic testing, which showed she was positive for the BRCA2 gene mutation. With this information, my mother, other siblings, and I also decided to have genetic testing to determine whether we, too, are carriers of this mutation. One brother and I tested positive for the BRCA2 mutation, but my mother did not, so we suspect we inherited our genetic risk from my father, who died suddenly at the age of 60, before genetic screening was available.
Although my sister was successfully treated for breast cancer a decade earlier, in 2020—during the height of the COVID-19 pandemic—she died from stage IV adenocarcinoma of unknown primary, just months after her husband also died of cancer. Soon, I would get my own cancer diagnosis.
After learning I was a BRCA2 mutation carrier at age 45, I underwent risk-reducing surgery and had my ovaries removed. My plan all along was to also have a bilateral prophylactic mastectomy. However, life kept getting in the way, and pulling the trigger on the breast surgery was harder than I thought.
While I decided on the right time to have the surgery, I was enrolled in a BRCA2 breast screening surveillance program and was carefully monitored for the early signs of breast cancer. I had alternating mammograms and breast contrast-enhanced magnetic resonance imaging (MRI) scans every 6 months. For 12 years everything was fine, and I got into a routine of surveillance screenings.
I had a mammogram in early winter of 2020, and it was clear of any suspicious masses, but in March 2021, while undergoing my regularly scheduled MRI, a mass was detected in my right breast. It was later diagnosed as ductal carcinoma in situ. Although it wasn’t a shock—I had expected that shoe to drop—I was disappointed that I hadn’t gone through with the surgery before the cancer could develop.
Saving My Life
I had decided long before I went through with the breast surgery that I would have deep inferior epigastric perforator reconstruction surgery after removal of my breasts. That decision likely saved my life from another life-threatening disease, pancreatic cancer.
While undergoing a preoperative computed tomography angiogram of my abdomen to determine the location, morphology, and size of the perforating arteries to use for my flap reconstruction surgery, the test found the head of my pancreas was bright, indicating normal blood flow, but the body and tail of my pancreas were smooth and dark. Although my surgeons were not initially alarmed, they suggested I meet with Diane M. Simeone, MD, Director of the Pancreatic Cancer Center at NYU Langone Health in New York, as a precaution. An endoscopic ultrasound found a 3-cm malignant mass on the body and tail of my pancreas, halting my plans for the breast surgery.
Although I was a candidate for pancreatic resection, Dr. Simeone, and Paul Oberstein, MD [Assistant Director of the Pancreatic Cancer Center], recommended 12 rounds of a “sandwich approach” of neoadjuvant FOLFIRINOX (leucovorin, fluorouracil, irinotecan, and oxaliplatin), surgery, and adjuvant FOLFIRINOX therapy. In August 2021, after seven rounds of chemotherapy, I had a partial pancreatectomy and splenectomy, during which one lymph node was determined to be malignant, and the cancer was staged as IIB. I completed chemotherapy in 2021.
Interestingly, the chemotherapy not only helped to shrink the pancreas tumor, it also eradicated the malignancy in my breast, giving me time to recover from the pancreas surgery and treatment before moving forward with my decision to undergo the bilateral mastectomy and breast reconstruction surgeries. In early 2022, I had a successful bilateral mastectomy and the breast reconstruction surgery and breathed a sigh of relief that I had gotten that ticking bomb out of my body.
Today, there is no evidence of cancer and I remain in remission. I am so grateful to my oncology medical and surgical teams for getting me through this ordeal, but I know I will always be looking over my shoulder for the next cancer to appear. My goal now is to raise awareness on cancer prevention and the benefit of early detection, which saved my life twice. I’m paying my good fortune forward through patient advocacy and spreading the word that a diagnosis of breast or pancreatic cancer is not a death sentence when diagnosed in early stages. I’m especially advocating for health insurance reforms to pay for pancreatic cancer surveillance for people with an increased genetic risk of this cancer.
These past few years have meant devastating personal loss for me and my family and have been emotionally and physically trying, but I finally feel that the broken pieces are being put back together. In the book Nobody Will Tell You This But Me, by Bess Kalb (Knopf, 2020), the author quotes what her grandmother Barbara “Bobby” Otis Bell used to say whenever she confronted an obstacle: “When the Earth is cracking behind your feet, and it feels like the whole world is going to swallow you up, you put one foot in front of the other and you keep going. You go forward.”
I’m better prepared now to face the future with all its uncertainties and just appreciate every day. I’m going forward.
Ms. Dicker lives in River Vale, New Jersey.
Editor’s Note: Columns in the Patient’s Corner are based solely on information The ASCO Post received from patients and should be considered anecdotal.