All Clear: 2 Years On

Last Thursday I went back for my now-annual checkup with my favourite breast specialist in the world, Dr Hoe Ah Leong.

That was after nearly 4 hours of ultrasounds and X-rays and the mammogram and waiting around for my films and report.

The mammogram technologist that served me was so funny. Whenever I go back for my scans, I need to bring my old films so that the doctors who write up the reports have a comparison, and so would my surgeon. The technologist, a pretty young Filipina, shook my old films out, and stood, stunned for 20 seconds.

“Ma’am, you did your mammogram last year?”
“How come I only have your films for one breast, there should be films for two.”
“I wish there was two. I had a mastectomy in 2010, my dear.”
“OHHHHH!” Pause. “I’m sorry, I’m sorry!”

I must have unnerved her because as she was positioning me for the mammogram on my left breast she kept failing to get my boob in the right position. She knocked my collarbone. She pinched my armpit. She raised the plate. She lowered the plate. Finally, she just squashed it as much as she could and took the darn shot. I could have told her she didn’t press the plates down hard enough. (True enough Dr Hoe later said, “Hmm, this mammogram is a bit fuzzy at the bottom.”)

Next was the ultrasound. My doctor had ordered up scans for my breast, my liver and my gall bladder. There’s something about an ultrasound scan that always makes me edgy. Especially if the technologist is scarily silent. Good thing i got another chatty PInoy girl. Still, the few moments she rolled over one spot from every angle made my heart skip a beat.

After the long wait for my films and reports, I hoofed it to Dr Hoe’s clinic on the third floor of the main medical centre.

Christine, the nurse who christened me Liang Po Po two years ago, took one look at me and said, “How about you go and take a nice long tea break?”

My buttocks were complaining that I was oppressing them with so much sitting down, but I took a look at the two poor teenagers asleep on the waiting area couch as their mother and father waited to see Dr Hoe, and I made an about-turn and went to get a coffee from Delifrance.

Finally at 5.45pm I saw my beloved doctor, looking as cheery as ever, with his ubiquitous blue shirt as neat as it probably had been at 8am.

“You look good, Theresa!”
“You too, Dr Hoe!”
We grinned at one another.
“Okay, so your reports look good. Come come, let’s take a look.”

One thing I love about Dr Hoe is how he operates like a teacher. My mammograms, chest X-ray and ultrasound scans were all clipped up on the lightbox for examination.

There is a single calcification in my left breast, which had been there last year too. Calcifications are not a good sign if they appear in a cluster. My right breast mammogram, two years ago, was peppered with large clusters of calcifications especially just above the nipple area.

“But this single calcification is all right, nothing to worry about,” he assured me.

For breast cancer patients, if cancer recurs, it would usually be in the other breast, the lungs, or the organs nearest to the breast area, like the liver and gall bladder.

All my scans were clear. The only thing of note was that I had a little cyst in my left breast, which also showed up in last year’s scans.

“Probably a fatty piece,” said Dr Hoe with such confidence that any worry I had melted away.

With the help of his nurse, I lay on the examination bed while he palpated my breast, neck and armpit areas. There are also instances where lumps form in the neck or armpit, “but your lymph nodes were clear—remember we did the test on the sentinel nodes. DCIS prognosis is excellent.”

I was deeply happy to hear all he said. Some days, I admit, I take my survival for granted. Some days, I forget, had I not acted on the weird pain my breast, I might be facing a very different today.

True, every time I see Dr Hoe I am reminded that cancer could recur. Some days, that casts a shadow over my heart.

But I thank God that I have Him—and truly, I am living on time that He has so kindly given me. I am determined to make the best use of it as I can, but I am also peaceful, knowing “to live is Christ, to die is gain.”

Mammography, Thermography, Ultrasound: It’s Not An Either-Or

My PET Scan. Kinda trippy heatmap of the body, literally from top to toe.

In recent weeks there’s been a great debate about thermography replacing mammography as the way to identify cancerous growths in the breast. Even Straits Times’ Andy Ho had his 5-cents worth to contribute.

I had read this article on Huffington Post: “The Best Breast Test: The Promise Of Thermography”. I love Huffington Post but I have to say this was the first time I violently opposed any Huffington article; I absolutely oppose writer Christiane Northrup’s suggestion that thermography can effectively prevent breast cancer. Until the day we can actually dissect and accurately pinpoint how cancers begin and how they get aggravated, any such claim is hogwash.

Thermography could never replace mammography, not in the foreseeable future anyway. To say it can is an outright lie. I don’t think Dr Northrup has had breast cancer, and shouldn’t be allowed to make such a sweeping statement that could put women off mammograms. Already, as it is, it’s hard enough to make women go for mammograms — the pain and fear factors are big enough deterrents.

I personally had a mammogram done, plus an ultrasound, and just to play safe, I also had a PET scan done (Thermography works like the PET scan – it identifies “hot” areas in the body that could possibly reveal cancerous activity).

The mammogram showed the approximate area and size of the cancer. It also revealed microcalcifications (these show up like white dots on the film) which cannot be seen in PET Scans nor ultrasounds.

My ultrasound. The dark area in the middle is where the cancer was.

The ultrasound could more or less pinpoint the location, size and shape of the mass. My surgeon used ultrasound to do a core biopsy as the ultrasound could locate the various areas of the cancer.

The PET Scan – I don’t know enough about it yet but as my surgeon explained, this very expensive scan has been effective in showing potential areas of cancer spread. I say potential because the human body is such that heat and inflammation can be caused by a variety of factors. So it’s really all a maybe.

Currently, the surest way to know you have cancer is to locate the mass and do a biopsy. The doctor draws out samples of tissue and tests them for cancer. Anything else (for now) is guesswork.

I think perhaps the heart of the matter is this: What is going to be your reaction to having breast cancer if you do discover it early?

I have had strangers comment that my choosing a mastectomy (instead of chemotherapy or some form of partial mastectomy followed by chemo/radiation) was too extreme. I think that really depends on how you look at cancer.

For me, seeing my mother go through the same ordeal three times has been a life experience I cannot cancel. It has also ingrained into my brain that 1) early detection is good and 2) don’t fool around with cancer. If you need to remove it all, and surgery’s going to do it, then, REMOVE IT ALL.

It’s like that old story about a little lie. A pastor caught his children telling a white lie. To make his point, he baked a batch of brownies, and when they reached out for one each, he told them, he mixed in just a bit of shit in the brownie mix. A very very little bit, they would hardly be able to smell it. None of the kids wanted to touch the brownies, of course. A lie is a lie whether it’s small or big – just as crap in your brownie is crap whether it’s the whole pile or just a smudge.

To me, that’s cancer. It was that little bit of shit mixed into my breast, and I didn’t want it there. So I got rid of the whole brownie.

For some women, knowing “maybe” they have cancer (and maybe they don’t) is fine. For me, it’s not. I do still have a life to live. I have seen too many women hem and haw over whether to go organic after discovering they have cancer, or ignore that lump hoping it will go away. I have seen more of these women die from cancer than should have. I have nothing against going organic – but do it after you are rid of the cancer. And of course, do it way before any cancer begins. Being healthy is a lifelong quest.

So, all that said, I’d rather not get into futile fights over which scan works the best. My prayer (and money) is on finding a vaccine for breast cancer. Now, that’s what preventive really means.

Oprah magazine ran two of the most interesting and encouraging breast cancer stories I read all Breast Cancer Month:

1. The Potential For A Breast Cancer Vaccine: A vaccine that scientists have found to work in mice (reducing and obliterating cancer tumors) exists, but it has to be tested on human subjects.

2. And linked to the first story is this one: How Scientists Are Rethinking A Cure For Breast Cancer. This one talks about the efficacy and accuracy of scientific studies on breast cancer. Are who and what scientists have been testing on/for, the correct subjects? Are the conditions set for finding an accurate answer to combat breast cancer?

Of course, all this means that we are far from a real answer and a working vaccine. But just as scientists have to soldier on and make their research more and more efficient, we — breast cancer patients, former patients, daughters/nieces of breast cancer sufferers — have to keep hoping, keep praying, keep giving to make sure the search for a cure never stops.

Until breast cancer is stopped.