Reflections of a 15-year Breast Cancer Survivor
15 years ago next month I was diagnosed with breast cancer at the age of 29.  I was a couple of months out from finishing my first (and only) Ironman and due to be married a few months later.  Over the course of the next 6 months, I learned I carry the BRCA1 mutation (the breast cancer gene), had a lumpectomy, 8 weeks of dose-dense chemotherapy in the middle of which we had a  ‘wigs optional wedding’, then completed 6.5 weeks of radiation. Six months later, 13 months from my original diagnosis, we learned we were pregnant.  Our son is now 13, our daughter 11 and I have a decade and a half of experiences and decisions to reflect on amidst the flurry of pink that is Breast Cancer Awareness Month.

Pregnancy after Breast Cancer
There are many parts of my story that people find surprising when I share – that I was 29, that I was in great physical condition, that I got married in the middle of it… but the one part of my story that has moved other young survivors to tears is that I had my children after treatment.  While this is not advisable for some, the pathology of my tumor was such that it did not eliminate my becoming pregnant from the realm of possibility.  Because the chemo regimen I would undergo had the possibility of affecting fertility, we went through an egg retrieval and fertilization prior to commencing chemo.  Thankfully, we were able to become pregnant naturally and a few years back were able to donate our embryos to the UCLA Broad Stem Cell Center.  In discussing the possibility of pregnancy, our medical team was supportive while also being vigilant.  I was able to carry both children to term and breastfeed them on the non-radiated side.  The only ‘limitation’ was that we breastfeed no longer than 6 months as all were anxious to resume screening via MRI which was impossible throughout pregnancy and nursing.  

Waiting for the Other Shoe to Drop
I think all cancers survivors suffer from this phenomenon.  The thing about breast cancer is that you often feel perfectly healthy when you are diagnosed – I used to correct people all the time when they would refer to me as being ‘sick’, “I’m not sick, I have cancer.”  Not sure why this was empowering but it made me feel stronger – my body hadn’t failed me, it was under attack.  Regardless of age and circumstances, the words ‘You have cancer’ are shocking to hear so to say that we felt blindsided is an understatement.  In near perfect health and being so young, I could not have imagined that this diagnosis was headed my way at that time.  Following that experience, it is pretty common to have some degree of ‘what’s next’ concern or ‘scanxiety’.  I certainly did, particularly following my pregnancies, but I also knew that I was strong, that my body was resilient and that should I have to fight cancer again, I could do it.  I made a conscious decision not to live in fear of a repeat diagnosis, which was more likely given my genetics than it is for some others, and instead to focus on the things I could control.

Diet, Exercise and General Care and Keeping
Life is busy and stressful.  My husband and I run FiT, volunteer with the kids’ activities, have aging parents, etc.  It’s easy to get sidetracked from the most important aspect of being able to keep up which is taking care of yourself which I am guilty of in spades.  Having said that, there are changes that I made years ago that I have carried forward throughout these 15 years that I believe have helped keep me strong and healthy.  I still enjoy running but will not participate in anything longer than a 10K because I no longer have the time to focus on the recovery long distance aerobic activities demand.  Exercise is a form of stress, a good form but still, physiologically, something that requires recovery.  When left unchecked, stress depletes the body and compromises the immune system which is key to cancer prevention among other things.

Regarding diet, I was already eating fairly healthy but the notable changes I made were to increase vegetable consumption and decrease the sugar.  I didn’t and don’t do this in a regimented way but more as a health optimizing strategy – how can I add vegetables to my breakfast?  Nah, I don’t have time for that this morning so I’ll make sure I get extra at lunch and dinner kind of thing.  If I treat myself to something sweet, that determines other choices for a period of time. Simply, anywhere I could cut sugar out (coffee for instance) I did and anywhere I can add vegetables, I do.  I choose the highest quality proteins and fats that I have access to and am very mindful of my choices when access is limited (i.e. if conventionally raised meats are the only option, I will choose the lowest fat cut as toxins are stored in the fat or no meat at all).  A friend recently described this path as aiming for progress, not perfection, which I think sums it up well and is applicable to all who endeavor to optimize their health.

General care and keeping involves continued monitoring and not being fearful of what might be found.  I have found lumps and bumps over the years and have had each and every one worked up, followed and assessed until there was certainty that all was good.  Once we were done having kids, we decided bilateral mastectomies and having a hysterectomy were our best protection so had those procedures along the ways well.

What it is like Today
Fifteen years out and I am beyond grateful to continue to put distance between now and then but being a survivor is a part of my life and always will be.  At my best, I am grateful that I know what’s ‘out to get me’ so I can be on the lookout. Other times, I’m annoyed that this remains a part of my life even this many years out.  Most of the time, I appreciate that we all have to deal with tough stuff, that it is the human experience, and so long as we learn more about who we are and how we want to be in the world that it’s not all bad.