This post was first published on The ASCO Post, April 25, 2023. It has been edited for content. The ASCO Post, in partnership with the American Society of Clinical Oncology (ASCO), communicates news of evidence-based multidisciplinary cancer care to a broad audience of oncology professionals and ASCO members.
Becky Dicker, RN, MSN, is a cancer survivor living in River Vale, New Jersey.
Cancer has stalked my family for generations. My mother, brother, and uncle were all diagnosed with melanoma. Fortunately, they all survived. When my sister was diagnosed with early-stage invasive ductal carcinoma, a type of breast cancer, in 2010, she underwent genetic testing, which showed she was positive for the BRCA2 gene mutation. With this information, my mother, my other siblings, and I also decided to have genetic testing to determine whether we, too, were carriers of this mutation. One brother and I tested positive for the BRCA2 mutation, but my mother did not, so we suspect we inherited our genetic risk from my father, who died suddenly at the age of 60 before genetic screening was available.
Although my sister was successfully treated for breast cancer a decade earlier, in 2020—during the height of the COVID-19 pandemic—she died from stage IV adenocarcinoma of unknown primary, just months after her husband also died of cancer. Soon after, I would receive my own cancer diagnosis.
Being proactive
After learning I was a BRCA2 mutation carrier at age 45, I underwent risk-reducing surgery and had my ovaries removed. My plan all along was to also have a prophylactic double mastectomy to have both of my breasts removed and reduce my risk of breast cancer. However, life kept getting in the way, and pulling the trigger on the breast surgery was harder than I thought.
While I decided on the right time to have the surgery, I was enrolled in a BRCA2 breast cancer screening surveillance program and was carefully monitored for the early signs of breast cancer. I had alternating mammograms and breast magnetic resonance imaging (MRI) scans every 6 months. For 12 years, everything was fine, and I got into a routine of surveillance screenings.
I had a mammogram in early winter of 2020, and it was clear of any suspicious masses. But in March 2021, while undergoing my regularly scheduled MRI, a mass was detected in my right breast. It was later diagnosed as ductal carcinoma in situ. Although it wasn’t a shock—I had expected that shoe to drop—I was disappointed that I hadn’t gone through with the surgery before the cancer could develop.
Saving my life
I had decided long before I went through with the breast surgery that I would have deep inferior epigastric artery perforator (DIEP) reconstruction surgery, a type of tissue flap procedure, after the removal of my breasts. That decision likely saved my life from another life-threatening disease: pancreatic cancer.
While undergoing a computed tomography (CT) scan of my abdomen before my breast surgery to determine which arteries to use for my flap reconstruction surgery, the test found that the head of my pancreas was bright, which indicated normal blood flow. However, the body and tail of my pancreas were smooth and dark. Although my surgeons were not initially alarmed, they suggested I meet with another doctor specializing in pancreatic cancer in New York as a precaution. An endoscopic ultrasound found a cancerous mass on the body and tail of my pancreas, halting my plans for the breast surgery.
Although I was a candidate for pancreatic surgery, my doctors recommended 12 rounds of a “sandwich approach” of chemotherapy, then surgery, then additional chemotherapy. In August 2021, after 7 rounds of chemotherapy, I had surgery to remove part of my pancreas and my spleen. During the surgery, one lymph node was determined to have cancer, which was staged as IIB.
I completed chemotherapy in 2021. Interestingly, the chemotherapy not only helped to shrink the tumor in my pancreas, but also destroyed the cancer in my breast. This gave me time to recover from the pancreas surgery and treatment before moving forward with my decision to undergo the mastectomy and breast reconstruction surgeries. In early 2022, I had a successful double mastectomy and breast reconstruction surgery, and I breathed a sigh of relief that I had gotten that ticking bomb out of my body.
Going forward
Today, there is no evidence of cancer in my body, and I remain in remission. I am so grateful to my health care team for getting me through this ordeal, but I know I will always be looking over my shoulder for the next cancer to appear. My goal now is to raise awareness on cancer prevention and the benefit of early detection, which saved my life twice. I’m paying my good fortune forward through patient advocacy and spreading the word that a diagnosis of breast or pancreatic cancer is not a death sentence when diagnosed in the early stages.
These past few years have meant devastating personal loss for me and my family and have been emotionally and physically trying, but I finally feel that the broken pieces are being put back together. In the book Nobody Will Tell You This But Me by Bess Kalb, the author quotes what her grandmother Barbara “Bobby” Otis Bell used to say whenever she confronted an obstacle: “When the Earth is cracking behind your feet, and it feels like the whole world is going to swallow you up, you put one foot in front of the other and you keep going. You go forward.”
I’m better prepared now to face the future with all its uncertainties and just appreciate every day. I’m going forward.
