One breast cancer sufferer’s treatment tale
By Christa Shephard // Photography by Carla Clark
Every year during the month of October, families, friends, survivors and sufferers highlight the struggle of what it is to battle breast cancer. October is a month of spookiness, and tales of breast cancer are often told as horror stories with terrible struggles and grim outcomes. However, with new advancements in technology and treatment and the gift of timing, many people’s experiences with breast cancer — although harrowing no matter the severity of the diagnosis — are much more palatable for those who’ve lived it.
Survivor Ashely Davidson offers her story, with some initial hesitation. “I was concerned because my cancer wasn’t Stage 4 and I didn’t have to do chemo that people [would] read a story like mine and think, ‘Well, that was kind of anticlimactic,’ or ‘Geez, that didn’t seem like such a big deal,’” she says.
But her experience is a common one.
The back story
Davidson was diagnosed after her first mammogram at age 40, on the heels of her mother’s diagnosis the year prior. Without a family history of breast cancer, the diagnoses were bombshells for both women. “My mom was diagnosed with breast cancer when I was 39, and it was a complete shock to our family because it didn’t run in the family,” Davidson says. “We just had never had anyone in our family that had to deal with cancer before.”
Davidson was a faithful pillar for her mother, attending every appointment and educating herself on the disease as much as possible. Still, she didn’t fear for her own health. Although she knew to get her first mammogram at the recommended age of 40, she didn’t worry that she, too, might have developed the disease.
“I didn’t feel concerned like I [needed] to hurry and go get tested,” she says, “but I just knew when I turned 40 that that’s something I needed to do. So I went in for a normal mammogram, my first one, and it came back that they needed to take a deeper look, I guess, and do more of a diagnostic mammogram, so they wanted me to go back.”
Even this, she says, wasn’t too alarming. It wasn’t uncommon, her friends had told her, to need a second screening. “And you know, a lot of my girlfriends said, ‘Oh, that’s totally normal. I’ve had to go back multiple times.’ So … I still wasn’t even thinking this could be a problem.”
Discovering cancer, although terrifying and traumatizing, is a good thing. Unchecked, cancer wreaks havoc upon the body; to catch it is to mitigate the damage and potentially stop or reverse its spread. Dr. Erin Zusan, who works within Community Health Network and who was Davidson’s breast surgical oncologist tells her patients that the team would rather find their cancer now, “so now that we know about it, we can move forward and deal with it. The goal is to get them back to their normal routine and their normal life as soon as possible with the least interruptions possible as well.”
“At our practice here at Community Cancer Care South, we actually say if someone feels a lump in their breast, they can call our office. They don’t need a referral,” Zusan says.
Detection, diagnosis and surgery
Zusan highlights the tremendous leaps in technology that allow for early detection. “Imaging has advanced over the last few years. Now with mammogram, we have tomosynthesis, which is 3D mammography,” she says. “We recommend that women get their mammogram with tomosynthesis because it’s going to pick up cancers when they’re smaller and at an earlier stage.”
Thanks to this technology, patients can receive the diagnosis of breast cancer with a message of hope: It is not a death sentence, and they can take some control in their journey.
“There are so many options now for treatment, and the majority of people who are diagnosed are diagnosed with early-stage breast cancer that can potentially be cured, and they can have many years of life ahead of them,” Zusan says. “I really try to be very hopeful with my patients; I also try to explain their diagnosis very clearly so that they understand in lay-person terms what it is that their cancer is, what we’re dealing with, and then what the treatment options are. And then I try to give them some say in their treatment.”
Ordeals like Davidson’s happen in a flash. The word “biopsy” is unnerving, but the diagnosis of cancer is bone-chilling. She was initially diagnosed with Stage 0, Grade 3 ductal carcinoma in situ, or DCIS. That diagnosis shifted after a second opinion mammogram and an MRI, which determined that she instead was a Stage 1, and instead of in situ — which meant her cancer hadn’t spread — it was invasive.
It is important, Zusan notes, to mitigate the lasting effects breast cancer battles can have on the psyche. “One of the things that’s improved over the last few years with breast cancer treatment is that we have a focus on cosmesis,” she says. “So either around the nipple-areolar line or we’ll hide incisions under the breast, so that when a woman looks at her breast after her treatment for breast cancer, our goal is that it looks about the same as when we started. So hopefully [it] has less of a psychological impact on her.”
“That first surgery, I decided to have a lumpectomy,” Davidson says. “And then I had reconstruction because it was important to me at my age; I just felt like I really wanted to be the same on both sides. I opted to go that route.”
When breast surgical oncologists perform lumpectomies, they look for clear margins, which means that there are no cancer cells in the outer edges of the removed tissue. When the margins are clear, a patient can begin the healing process and work toward further treatment. For Davidson, unfortunately, that was not the case the first time around.
“They called me and told me that they did not get clear margins, and that I was going to have to come back in and have another surgery to try again,” Davidson says. “And if they weren’t able to get clear margins that time, then there was a pretty good chance that I might lose my whole breast. So that was kind of a major blow.”
As terrifying as the diagnosis and initial surgery were, Davidson powered through. She scheduled her second surgery for the end of April — about two weeks from her first — and hoped for the best. “Luckily, I did get news after that second surgery that it had gone well and that they did get clear margins, and I was not going to have to have any further surgeries. So that was exciting. And then I started radiation in [the end of] May.”
Radiation therapy has advanced greatly in recent years. Radiation oncologist Dr. Chandrika Patel has witnessed those advancements firsthand. “From a radiation perspective, you know, routinely, we used to treat breast cancer patients every day, Monday through Friday, for six weeks of treatment. And now we have shortened those courses dramatically, so it’s a lot more convenient for the patient with just-as-effective treatment,” Patel says.
One advancement in radiation, although only available to specific populations of women whose cancers meet certain parameters, shows major promise for the future of breast cancer treatment. “At Community South, we’ve been doing something called intra-operative radiation therapy for selective patients to treat them,” Patel says. “When they get their lumpectomy for surgery, they get their radiation at the same time.”
Carrying on and taking care
As wonderful as advancements in technology are, doctors, nurses and patients all cite the same tools for surviving cancer: attitude and support. “I felt like I had a ton of support,” Davidson says. “I happened to have an acquaintance that was diagnosed literally within probably a month-and-a-half of when I was. So just between her and my mom and a couple of other women that … had been through it or were going through it, those were really the people that I would lean on the hardest. And that’s kind of what got me through.”
Support comes in many forms; perhaps fundamental to the success of each patient is a team of nurse navigators, who are there for them as much as possible. Danielle Peters, a nurse navigator for Community South, loves her job and the individuals she supports every day.
“As a nurse navigator, once a patient has a cancer diagnosis, we follow them throughout whatever treatment they might need, try to guide them,” Peters explains. “A lot of times they’re not able to recall what was being said, so we reiterate that over and over again. They just need that guidance.”
Peters finds her job to be the most rewarding she’s ever had. Watching patients come in as newly diagnosed and seeing them through to survivorship with personalized care is a challenge but always worth it.
“It’s the most rewarding field I’ve ever worked in,” Peters says. “It’s challenging to watch people fight and fight and fight, and sometimes have to fight multiple battles. But to be there for them and help guide them and support them is what it’s all about.”
Nurse navigators offer more than answers to questions and shoulders to lean on. They often point patients toward other services that lighten the load from their shoulders.
“We have social work resources that are available, so we try to get counseling if that’s needed in the beginning,” Peters says. “There’s financial situations that come about, and we have a financial counselor for that. So, [we’re] just trying to meet whatever needs they might have.”
It seems like an understatement to say that breast cancer is a huge, often traumatizing disruption to a patient’s life. Although so much of a breast cancer patient’s life is at a standstill, the world keeps turning around them. Suddenly, the halted treadmill beneath their feet comes back to life, but survivors may find themselves stumbling to keep pace, especially once they realize their perspectives have shifted so drastically from those around them.
“Many people like to keep their mind occupied or continue to do their routine,” Zusan says. “At the same time, we encourage patients to take time for themselves. Because many of our cancer patients are used to being the primary caregiver for their family and now they need help with care.”
Self-care is something Davidson wishes she had prioritized once she reflected upon her experience. “In my circumstance, I was still able to do a lot of my day-to-day life activities, and so I did all of those things,” she says. “I think that after it was over, after I kind of got through everything, I thought to myself, ‘Maybe I should’ve taken a little more time during the process to just stop and let myself feel things.’ I think I stayed so busy, and I pushed myself so hard that it kind of hit me when it was all over.”
In the long run
Physical and medical care doesn’t end with a good report or a successful lumpectomy. Patients must still receive continued care long after their acute battles have ended. In some ways, this is a blessing in disguise, as it leads to long-lasting, personal relationships between patients and their doctors and nurses.
“What I specifically like, too, is getting to know patients long term,” says Zusan. “And so we’ll see patients, especially our cancer patients … when they have their abnormal imaging. I biopsy them, I talk to them about their new cancer diagnosis, and then I see them in office for about five years after their cancer diagnosis until we release them from care. So you get to know people, and it’s nice to have that relationship with them.”
Similarly, Peters says she enjoys this aspect of her role, having built lasting friendships with her patients. “I have several patients that are my friends and will be my lifelong friends forever,” she says.
Perhaps the most crucial takeaway to know is that each struggle matters, and more difficult battles can be avoided.
Davidson returns to a conversation with her physician. “‘I cannot believe this is happening. I’m only 40 years old; I’ve never had a mammogram before, and now you’re telling me I have cancer,’” she says. “And her response was kind of like, ‘You are the poster child of why we tell everybody to get a mammogram when you’re 40. This is why it’s so important.’