Yesterday I met with my Medical Oncologist, to go over what I had hoped was a treatment plan for chemo. Turns out I’m a bit of a medical weirdo. One tumor is HER2- and one is HER2+. Both are in my left boob.

My Med. Oncol. is meeting with heads of pathology and radiology to dig into the results and make sure that this is the case. So I have no idea what chemo I will be given or the drug that is to be partnered up.

She did mention that one could be hard on my heart, and that has me concerned, because I am super active and love running and hiking. Running has been my sanity saver for decades, and to think that my heart could not handle any future cardio-craziness, is a hard pill to swallow. I know that chemo will likely knock me on my ass, but I also know that I’m used to pushing through a LOT of physical adversity, and find a way to navigate through. I just had expected yesterday to have more answers than questions with my treatment.

I did some blood labs, and she is scheduling me for a bone scan, echocardiogram, and other tests to get a baseline on the condition of my heart, as well as make sure that no wondering cells have planted a flag in any other parts of my body.

Tumor A:
Left breast, 3:00, 5 cm from nipple, MRI core biopsy:
Number: Multiple
Consistency: Fibrofatty
Dimensions: 0.1-4.5 cm in length x 0.1-0.4 cm in diameter

Extensive ductal carcinoma in situ (DCIS), nuclear grade 3 with luminal necrosis and calcifications, solid and micropapillary type, involving multiple cores, greatest extent 8 mm

Tumor A profile:

• Estrogen Receptor (ER): Positive
• Tumor cells with nuclear positivity: 95%
• Average intensity of staining: 3+
• Progesterone Receptor (PR): Negative
• Tumor cells with nuclear positivity: <1%
• Average intensity of staining: 1+
• Her2 by IHC: Equivocal
• Score: 2+
• Ki67: 15%
• SMM and p63: Both negative
• Additional immunostain results:
• SMM (A4) highlights myoepithelial cells.
• Myoepithelial cells are natural tumor suppressors
• P63 (B2) is negative.
• Pathology Diagnosis: Invasive ductal carcinoma, Nottingham grade 2, greatest extent 1.5 mm

Her2 IHC Result: 2+ (Equivocal)
FISH Results: HER2/CEP17 Ratio: 2.35

• Average copy number for HER2: 6.38
• Average copy number for CEP17: 2.72
• Cells Scored: 50
  Interpretation: POSITIVE
  

Tumor B :

Left breast, 2:00, 2 cm from nipple, MRI core biopsy:
Number: Multiple
Consistency: Predominantly fibrous
Dimensions: 0.9-2.6 cm in length x 0.1-0.3 cm in diameter
Entirely submitted as B1-B4

• Invasive ductal carcinoma, Nottingham grade 1, greatest extent 1.5 mm
• Ductal carcinoma in situ (DCIS), nuclear grade 2 with calcifications and cancerization of lobules
  

Tumor B profile:

• Estrogen Receptor (ER): Positive
• Tumor cells with nuclear positivity: 95%
• Average intensity of staining: 3+
• Progesterone Receptor (PR): PositiveTumor cells with nuclear positivity: 90%
• Average intensity of staining: 3+
• Her2 by IHC: Negative
• Score: 0
• Ki67: 10%
• SMM: Negative

After those initial findings in the pancreas MRI, my boob doc immediately scheduled me for a breast MRI.

Let me just say this. A breast MRI is not what I expected. I have had PLENTY of MRIs in my life, and never have I been faced down for a test. Also you have two holes below your chest, which calls for waggling your tits into. They just hang out there looking at the floor of the machine.

The scans were done and aside of the noisy machine and misaligned headphones, it went well.

The results though told a different story.

IMPRESSION:
Multiple enhancing masses are present in a ductal distribution in the left breast and are suspicious of malignancy. While MRI directed ultrasound could be performed, given the patient’s extremely dense breast tissue two area MRI guided biopsy of the most suspicious enhancement anteriorly and posteriorly in the left breast should be performed in the absence of clinical contraindication.
BI-RADS Category 4C:
Suspicious for Malignancy

Well fuck.

Boob doc was on it. She got me in for this biopsy within a few days. I had to tell my wife the results and the game plan. I then had to call friends and tell them what was going on, before I made this kind of news public. I would have made more phone calls, but I was in the midst of a huge project at work, which demanded a lot of time and detailed work. My days and evening were getting chewed up, to the point that I only was able to tell a handful of friends.

So if you’re just hearing about this now, I’m sorry it happened in this manner.

Back in late 2022, my company offered free genetic screening through Color Labs. Being one who always wants to be aware of my health, I jumped at the opportunity. I’m a nerd when it comes to data, and who wouldn’t want to have as much info as possible about their health and wellness?

Once the results were made available one of their counselors contacted me to go over the results. This was an interesting offering, and different from the 23 and Me process, which was more a DIY read on my results.

The counselor informed me that I had an ATM Gene mutation. She went into an in-depth, but easy to understand explanation, of what this meant in my case.

High risk for breast and pancreatic cancer.

I just listened and took it all in. I think she was surprised at my matter-of-fact attitude. I’m sure she has heard many others panic or freak-out at the news. She released my full results, to send to my doctor, which I immediately did, and my doctor took action.

“I’m sending you to UTSW, and getting you into their genetics program for cancer prevention.”, my doctor said. I trust her care, and have been a patient of hers since 2010.

UTSW set me up with a genetics counselor, and he met with me to come up with a plan. He refered me to a breast specialist, and pancreatic specialist. I had appointments with both within a two week span.

The boob doc, as I call her, met with me, and ordered all the testing. The plan was to alternate a mammogram with a brest MRI every six months in between. We also spoke of other risk-cutting options. I made her aware of my thought of a pre-emptive strike, with doing a double-mastectomy. She agreed with this option, but also suggested that we start with testing, to see how everything looked. Mammogram first, with ultrasound if needed. This was done within a few days of my initial visit.

The mammogram showed some shadowed areas, which called for the ultrasound. After the radiologist looked at those results, he said that everything looked fine, and that it was likely fibrous breast tissue.

The radiologist final report stated:
IMPRESSION:
No mammographic or sonographic evidence of malignancy is seen.
Supplemental Breast MRI screening is recommended in keeping with the patient’s known ATM mutation status.
Screening mammogram in 1 year is recommended.

BI-RADS Category 2:
Benign Findings

Two months later was my pancreatic MRI. This was a scan of pretty much my entire torso. I was told that if there were any abnormal findings of other organs, that I would be refered to doctors to address any concerns.
Results:
IMPRESSION:

1. 2-5 subcentimeter cystic pancreatic lesions without worrisome features.
2. Asymmetric enhancing nodules in the left outer lower breast are not further assessed on this study. Patient had prior breast mammogram and ultrasound 05/11/2023 where supplemental breast MRI screening was recommended for patient’s known ATM mutation status.

Pancreas good.

Left breast? Ehhh WTF?