By Adriana Ermter
In our monthly column, senior writer and editor Adriana Ermter shares her personal experiences with breast cancer.
Man, I’d be rich if I was a scientist and discovered a way to prevent a breast cancer recurrence. But I’m not. Instead, I’m a normal woman who is often riddled with worry that I’ll one day have one. I’m not thinking about this 24/7, but I am thinking about a potential recurrence often enough that the thought is a constant in my life, lurking in the back of my brain. It’s normal, I had breast cancer, I could have it again. These nagging thoughts always seem to resurface and escalate right before I’m scheduled to see my doctors for a mammogram or ultra-sound screening. And so, because I’ve been counting down the days until my next breast cancer-screening appointment, I’m having them now.
Waiting for testing
I booked a screening appointment four months ago, and then, when I was told I’d have to wait for nine months for this screening, I fought to have it rescheduled to an earlier date. Having to wait nine months for testing when I’m a breast cancer survivor did not fly with me. I get it that hospitals are still, relentlessly, backlogged with patients from the overflow of Covid, but I have to advocate for myself and my health. Thankfully, my appointment is in 10 days and, yup, I’m nervous. More so than normal. I always have a touch of anxiety around my oncology appointments. But because I’ve been experiencing a dull ache in both boobs, mostly the right one where the pain extends into my right armpit, I’m on high alert, wondering if I have a recurrence.
The pain isn’t debilitating or even a stabbing pain, it’s more like a dull throbbing sensation that comes and goes. It’s regular though and I need to know why. And no, I’m not always rational about this. Sometimes I think it could be a build-up of scar tissue, not that I can feel any or any lumps for that matter. I have dense breasts so I can never really feel anything when I do a breast self-examination except, well, my dense breast tissue. I also wonder if maybe it’s an adhesion, which can form when a band of scar tissue connects to another surface or tissue and sort of fuses together, even though it shouldn’t. The throbbing might also be my monthly hormones kicking in. But, and this is the big but, it could also be a breast cancer again, which is the thought I try not to focus on until I have my testing and know all the facts.
Breast cancer recurrence facts
I’ve read the facts about breast cancer recurrences. Pretty much every reputable breast cancer organization, such as the Canadian Cancer Society, Rethink Breast Cancer, and the Canadian Breast Cancer Network all state that one in eight Canadian women will be diagnosed with breast cancer and one in 34 women will die from it. What’s lesser known or maybe we just don’t talk about it as much, are the stats surrounding a breast cancer recurrence.
According to BreastCancer.Org, 40 per cent of people diagnosed with early-stage triple-negative breast cancer, and up to 50 per cent of people diagnosed with inflammatory breast cancer, are more likely to have a recurrence. Additionally, estrogen receptor-positive cancers have a higher risk of recurring 10 or more years after the initial diagnosis, while hormone receptor-negative cancers have a higher risk of recurring in the first five years after diagnosis. Realistically, if you’ve had breast cancer before you are predisposed to potentially have it again. Stark stats for sure. BreastCancer.Org also states that breast cancer can come back in another part of the body months or years after an original diagnosis and treatment. This is called metastatic recurrence or distant recurrence and nearly 30 per cent of women diagnosed with early-stage breast cancer develop metastatic disease.
These numbers are mind boggling and downright frightening and are basically out of my control, which I hate. There are though, six steps every survivor, including myself, can take to help minimize the risk of a breast cancer recurrence. Knowing this helps me stay sane and refocus on the positive, because honestly, reframing my fear into proactive actions keeps me encouraged, optimistic and feeling good feels instead of falling into the deep end.
Six Ways You Can Help to Prevent a Recurrence
Step 1: Make good choices
Getting seven to eight hours of zzzs at night, drinking lots of water, moving your body with regular exercise, eating a balanced diet loaded with fruits and vegetables, and maintaining a healthy weight are all good choices. I strive to do these things. Although I don’t eat of ton of fruit, I balance this out by eating more veggies. I eat less cheese, which I love so this is hard and I’m fairly consistent at walking past the chips aisle at No Frills. Managing my weight, a.k.a: losing the Tamoxifen 40, still kills me. I do my part, mostly, by walking briskly and frequently, and I’m in bed by 9:00pm like clockwork and then up again at 5:30am. Could I be better at all of these things, of course, but I’m not a robot and what I’m doing works for me and makes me feel more in control of my good choices, which I like.
Step 2: Advocate for your post-cancer appointments
Post-treatment follow-up care is the safety net. Period. Regular medical check-ups, mammograms and other recommended screenings are essential. These appointments not only monitor your health but also provide an opportunity to discuss any concerns with your healthcare team. Remember, knowledge and vigilance are key components of your arsenal against recurrence. You may have to advocate for these appointments, which can be time consuming and frustrating, but it’s always worth it.
Step 3: Know your hormone receptor status
Breast cancers are categorized based on hormone receptor status to determine their responsiveness to hormonal therapies. If your cancer was hormone receptor-positive, adhering to prescribed hormonal therapies, such as Tamoxifen or aromatase inhibitors, can significantly reduce the risk of recurrence. Now, I’ll be honest, I was not good at this and stopped taking Tamoxifen at the two-year mark, three years short of the finish line, as my quality of life was in the negative. I didn’t just randomly dump the pills into the toilet and flush though, despite really wanting to. I consulted my oncology team and weighed the odds. I don’t regret my choice, because it was my choice and I had been on a two-year merry-go-round of let’s-try-this-and-see-if-it helps-with-Tamoxifen’s-horrendous-side-effects solutions, but to no avail. I’m happier and higher functioning off the drug for sure. There are moments, however, when I wonder if I made the right decision to quit or if I’ve put myself at an even higher risk for a recurrence.
Step 4: Go to therapy
Thinking about my choice to quit Tamoxifen early, sometimes come up in my weekly therapy sessions. As a whole, cancer survivors face heightened stress levels and anxiety about life in general, which can impact our overall health so therapy, in my opinion, is a great support. The National Institutes of Health agrees, stating that approximately 25 per cent of cancer survivors experience psychological distress, which can manifest as anxiety, panic attacks, PTSD, cancer worry and more. Having a resilient mind is a powerful ally in the fight against recurrence. So are activities that bring you joy, like meditation, walking outside with friends, reading a good book, rewatching a favourite show on Netflix and joining support groups or talking about your feelings with family or friends.
Step 5: Be aware of the genetic factors
Some breast cancers are linked to genetic mutations, such as BRCA1 and BRCA2. If you have a family history of breast cancer or carry these genetic mutations, discussing risk-reducing strategies with a genetic counselor can be life-changing. Your oncology team can point you in the right direction to connect with a counselor too, so all you have to do it ask. Prophylactic surgeries or increased surveillance may be options to also consider, empowering you to make informed decisions about your future health.
Step 6: Remember, your diagnosis does not define you
Breast cancer is definitely a part of my life story. But it’s not the whole narrative and it does not define me. I may have to remind myself that I am strong, independent and a damn good cat mom, and every time I do it’s worth it. When I remember who I am, it gives me comfort and a reality check that I am more than a woman with an ice cream scoop of flesh missing from my right armpit and breast. I am resilient, I am armed with knowledge, and I possess the strength to navigate any uncertainties and challenges that come my way. By embracing a healthful lifestyle, staying committed to my follow-up care, understanding my needs and managing stress, and doing the things that bring me joy, I am actively doing my part.
Adriana Ermter is a multi award-winning writer and editor. Her work can be read in Sotheby’s Insight, Living Luxe and IN Magazine, as well as online at 29Secrets.com, RethinkBreastCancer.ca, Popsugar.com and AmongMen.com. The former Beauty Director for FASHION and Editor-in-Chief for Salon and Childview magazines lives in Toronto with her two very spoiled rescue cats, Murphy and Olive. You can follow Adriana on Instagram @AdrianaErmter.