I’m a physician and a breast cancer survivor


by Nicole Conselman, MD

Oct 12, 2016

Three years ago I was given a diagnosis by my doctor that would change my life. I had breast cancer — invasive ductal carcinoma-estrogen and progesterone positive, HER negative.

How could this happen?

I was 41.

According to the National Cancer Institute (NCI) algorithm for predicting at-risk patients and helping physicians decide who should have a mammogram in their 40s, my risk was estimated to be 0.5 percent for getting breast cancer in the next five years — one-third less than other women of my age.

I had four children that I nursed, I exercised regularly and ate a generally healthy diet. None of my family members had ever had breast cancer. I had never smoked, my menstrual cycles started at a normal age, and I had my children starting at 22 years of age. I was told I could wait until 50 to have a mammogram by the new U.S. Preventive Task Force guidelines.

I chose to have a mammogram that year because my first mammogram at the age of 40 showed dense breast tissue. Dense breast tissue can increase the risk of developing breast cancer by six times and can make it harder for the mammogram to detect. Unfortunately, the NCI guidelines do not take this into consideration.

My screening mammogram showed an asymmetric area requiring additional imaging. On return for the diagnostic mammogram, a cluster was found in the area of asymmetry and biopsy proved it to be a very early but aggressive 9mm cancer in my right breast. My radiologist and oncologist said that it was very fortunate that we found it when we did, before it had a chance to spread. Being a premenopausal woman with regular monthly cycles, my estrogen peaks were feeding the cancer.

I wanted to do everything I could the first time, to never have to deal with this again.

After discussion with my breast surgeon and oncologist, I chose to have a double mastectomy. I reasoned that at 41, I didn’t want to have to contend with repetitive mammograms and anxiety over a prospect of a second diagnosis or a recurrence of the original cancer. I wanted to do everything I could the first time, to never have to deal with this again. After four rounds of chemotherapy — and now, ongoing daily use of tamoxifen; my estimated cure rate is 98 percent.

I am one of the very fortunate breast cancer survivors for which modern science has found a great answer for my cancer.

How can I help my children avoid this diagnosis? How can I best help my patients decide which guidelines to follow and how best to protect themselves?

While this is a very complex topic and one that doesn’t have one right answer for everyone, I think it is important for us all to be aware of up-to-date information and guidelines in this field and advocate for ourselves. I think we all need to continue to discuss preventive measures and early diagnosis tools with our physicians. Women should be empowered to determine their own personal risk/benefit ratio of getting a mammogram and have access to them throughout their 40s+.

About 1 in 8 women will develop invasive breast cancer over the course of her lifetime. Science has not identified one particular cause for breast cancer, but many contributing factors are theorized: BPA in plastics, the overuse of sugar in processed foods, the increasing use of pesticides and herbicides in our food and water supply, and a possible link to a virus. Of course, lifestyle risk factors such as smoking, alcohol, lack of exercise, and obesity continue to be risk factors for breast cancer. Different genetic mutations have also been linked to breast cancer, like BRCA1 and BRCA2, however, most cases of breast cancer are spontaneous — occurring in women who do not have a family history. Less than 15 percent of women who get breast cancer have a family member diagnosed with it.

Mammograms have been shown to reduce the number of deaths from breast cancer among women 40-74. So during the month of October, with pink ribbons everywhere, please know that great advances are being made to cure this disease…but early detection and prevention help make this more possible.

I encourage everyone to lead a healthy lifestyle. Exercise at least three days a week, reduce your added sugar intake, eat a diet with plenty of fruits, vegetables and omega-3 fats. Get a good night of sleep (at least 7 hours daily), don’t smoke and avoid excess stress. Daily supplementation of vitamin D, fish oil, and multivitamins may help in the prevention of cancer as well.

I was very fortunate to have had a mammogram detect my cancer when it did. I encourage every woman to get a mammogram at the age of 40, and from that discuss with your physician.

About the Author

Dr. Nicole Conselman, MD is a family practice physician in Rockwall, Texas, and is affiliated with Baylor Family Medical Center at Rockwall.

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