In From Physician to Patient, I introduced Dr. Kelly Shanahan, a mother, wife, and obstetrician-gynecologist living and working in California. Her life changed with a breast cancer diagnosis.
“In 2008, I was diagnosed with early stage breast cancer, stage IIB to be exact. I underwent an aggressive bilateral mastectomy, because
1) as an ob/gyn with a busy solo practice and a mom with a 9-year old daughter, I didn’t have time to have the more common lumpectomy and 35 sessions, with 7 weeks of radiation Monday through Friday
2) I didn’t want to ever have to think about breast cancer again.”
Being a physician with breast cancer
To learn more, I asked Dr. Shanahan if being a physician changed the way her oncologists talked to her about breast cancer.
When you were diagnosed at age 47, did anyone say to you that you needed to be vigilant or watchful about recurrences? or did they assume that as a physician you would be aware and would know about the risks? Was there a problem with them assuming that you knew everything?
“When I was diagnosed with early stage breast cancer at age 47, my surgeons at UCSF were excellent at treating me like any other patient, albeit one who could speak “medical.” Even though I walked in the door knowing I wanted a bilateral mastectomy with implant reconstruction, they reviewed every option with me, including recurrence risks.
But they were mainly talking about local recurrences with lumpectomy. My medical oncologists talked about how chemo would lower the risk of a recurrence, but not one person ever said, ‘you know, 30% of early stage breast cancer patients will metastasize, some many, many years after treatment for early stage.’
I was told that if I made it five years without a recurrence, I was good. When I asked about following tumor markers, or getting periodic lab tests or scans to rule out a recurrence, I was told ‘these things don’t lower the mortality rate, so we don’t recommend them.’
I wasn’t an oncologist, so I trusted their recommendations. Maybe they assumed I knew more than I did, but now I question everything, and I encourage all other patients to question everything as well.”
“Cancer wasn’t done with me.”
“Cancer wasn’t done with me.
In the summer of 2013, as I was walking up the stairs in my office I sneezed, and immediately developed searing back pain. ‘A pulled muscle,’ I thought and I did all the pulled muscle things – ice, then heat, ibuprofen, massage. When it didn’t improve in several week, even after seeing my chiropractor, I thought, ‘ok, it’s probably a herniated disc, probably should get an MRI.’ But I was busy and I kept putting off the imaging tests.
I never once thought it could be cancer rearing its ugly head again. Eventually, I started limping, which was especially pronounced when I chaperoned a high school drama department field trip to Ashland, Oregon in late September.
I didn’t want to reschedule patients to have a silly scan, so it was about 6 weeks later, on my birthday, when I had the MRI and (just because I could) a PET scan too. There were lesions – metastatic spots – in bones from the base of my skull to my thigh. The back pain was a fractured vertebra. My left femur was about to break. My orthopedic surgeon friend wanted to put a rod in my femur the next day, but I was operating on several women and I put it off.
Six days after diagnosis, I had a titanium rod inserted into my left femur. Ten days after that, I started what would turn out to be 14 months of combination IV chemo, an unconventional approach but I liked the idea of thinking out of the box and accepted my oncologist’s recommendation without question. It worked for me, and I achieved the coveted NEAD (No Evidence of Active Disease) status within a few months. I have remained NEAD since April of 2014, and currently am on an aromatase inhibitor, a type of medication designed to block the estrogen that my cancer loves.
For now this approach is working. I am very, very lucky. The median life expectancy for someone diagnosed with metastatic breast cancer is three years – shorter for some subtypes and locations of mets, longer for others, like me with bone only estrogen receptor positive, HER2 negative disease, where the median is five years.
At some point my cancer will progress – that is just the nature of metastatic disease. I will always be in treatment. I will die from metastatic breast cancer before I otherwise should (my paternal grandparents lived well into their 90s, my maternal grandmother to 88, and my mom is 91.5 years old).
When people ask me when I’ll be finished with treatment, my response is ‘shortly before you attend my funeral.’ My hope lies in research, not necessarily for a cure, but for treatments that will extend my life in a meaningful way, and with good quality. I have a daughter to see graduate from college in 2020, and I’d sure like the chance to see her established in a career, happy, fulfilled, and oh, wouldn’t a grandchild be nice!”
Dr. Shanahan has advice for those living with breast cancer that has metastasized.
“For those who are diagnosed metastatic, whether it is from the get-go (de novo) or a later recurrence, as will happen for 20-30% of us, first, take a big, deep breath. While MBC is not curable at this time, there are more and better treatments to not only extend our lives, but that may afford us a better quality of life. Second, GET A SECOND OPINION, preferably with an oncologist that specializes in breast cancer, and ideally has a research interest in or a large practice consisting of metastatic breast cancer patients.
Join a support group for people with MBC, whether in person or online. If you are in a smaller town, like me, online communities can be invaluable. I don’t know what I would do without my online metastatic friends who just get it.”
Dr. Shanahan has become an activist and is involved in reviewing research as well as presenting research. In our next post, we will discuss her most recent work.