The Voice of Many Women | A Breast Cancer Prevention Story

With Breast Cancer Awareness Month coming to an end, the pink will fade from storefront windows, and with it, perhaps the urgency to schedule that mammogram. That was always the indicator for scheduling mine. As women, we already have too many pressing responsibilities with impending deadlines that should come first. Scheduling a mammogram becomes a task that’s easy to push into the following weeks, months, or even to your next physical exam. By the following February, pink-filled storefront windows again reminded me I still hadn’t scheduled a screening. This time that nagging voice in my head was accompanied by my doctor’s insistence about me being 4 months overdue for my mammogram. Her persistence was founded on utmost urgency since my breast cancer risk was nearly 25%.

She was not the first woman to plead with me about the importance of timely screenings. Even at the age of 12, my grandmother’s voice pleaded, between bouts of breast cancer treatments, that “someday you’ll have breasts too, and it’s important to get them checked”. Then at the age of 19, I watched my mother begin her battle with breast cancer, which took her life before I turned 30. At the age of 32 an earlier doctor, informed me that my screening should start earlier than most women and urged me to pursue a breast cancer risk assessment. That’s when I learned that breast cancer prevention could begin long before your first mammogram. I completed the breast cancer risk assessment, which evaluates familial history, genetic mutations, and other risk factors, such as breast density, hormone influence, weight, height, etc. That assessment concluded that I had no known genes for breast cancer, but since we didn’t know if those genes did exist in the family, they could not determine that my risk was less than that of my family history. With all factors calculated, my risk was determined. The genetic counselor guided me through my options for breast cancer prevention, such as pharmaceutical treatment that would force early menopause, or to have a preventative mastectomy. I wasn’t ready to make that choice, but I had gathered everything I needed to confront that decision when I was ready. Preparation and prevention go hand in hand, and over time I settled that the right path for me was to take drastic measures with a preventative mastectomy if anything suspicious was ever found.

I told my current doctor about that plan early on, and she knew how important preventing and detecting breast cancer was to me. So, when she learned that I was 4 months past my annual screening, her voice felt as if it boomed when it joined my own inner voice and every voice that urged before. Embarrassed, I replied, “I know! I’ve been meaning to schedule that for a while”. Intentions have no value without follow-through, and it was time to turn my well-meaning intention into a real appointment.

Two business days after my screening, the screening clinic office called to request more detailed imaging. This seemed to be a standard process for extremely dense breast tissue since it makes breast changes difficult to detect. During an ultrasound, 2 dense masses were discovered, and a breast MRI was ordered for further detail. Weeks later, I was laid on the MRI table face down with my hands stretched out in front of me. Earphones were placed over my ears and in them, The Eagles sang “Take another shot of courage”. The timing of that line hit me with the reality that this could be a season when another shot of actual courage may be needed. The very next day, the MRI Report noted both masses as “highly suspicious for malignancy”. By the time the biopsy was done, I had already met with a breast surgeon and a plastic surgeon, and a surgery date was set. The day after the biopsy procedure the report identified one mass as Pseudo-angiomatous Stromal Hyperplasia (PASH), a benign but problematic type of mass that should be removed. The second one was so strange that it was sent to the Mayo Clinic for diagnosis. During those weeks of waiting, I was caught up in this strange limbo of waiting; moments of hoping for a solution and other moments grieving the loss of my breasts, without knowing for sure if I would be losing them. After all, sometimes our medical care is not our choice but rather that of our health insurance provider, and I was still fighting with insurance for pre-authorization for prophylactic surgery. 6 days before surgery, the results from Mayo Clinic came back as a complex benign, but precancerous tumor, and insurance finally sent the pre-authorization letter. Now just less than a week before surgery, I was moving forward with a mastectomy to ensure nothing would have the chance to become cancer.

On July 1, 2024, I had a bilateral prophylactic mastectomy with direct-to-implant reconstruction. For some, it felt like surgery was jumping the gun. All that matters is that preventative surgery was the right choice for me. Today my cancer risk is around 3%, and for me, that’s breast cancer I can live without.

By Anna Homen