Postpartum Breast Cancer

By Michelle S. Lin | September 20th, 2011 at 10:00 am

Growing up, I believed in fairy tales where heroes conquered evil monsters and lived happily ever after. With time, I accepted these stories as fiction. Little did I know that at age 38 and the mother of two young children, I would slay my own monster, breast cancer – definitely evil, and definitely real.

In August 2010, eight months after giving birth to my second child, a girl, I was still enjoying the tender, life-affirming nighttime ritual of nursing her to sleep. One evening I felt a lump in my left breast. It was the size of a walnut, fixed and deep-set.

I panicked. My husband tried to calm me down. “You’re probably going too long between feedings.” I gave him a look. He started Googling. Our adrenaline-charged internet searches pointed us in two directions. One, breast cancer. The other, a galactocele, a milk-filled cyst that can occur near the end of breastfeeding. The latter described me perfectly as I planned on weaning my daughter soon. Furthermore, I had assumed that pregnancy and nursing prevented breast cancer.

“What nursing mother doesn’t have lumpy breasts?” I reassured myself.

But somehow I could not shake the feeling that there was more to this lump. The next day I went to see my general physician. Because I was breastfeeding, he refrained from overreacting and asked me to empty my breast every time I nursed my daughter and put a hot compress on the lump three times a day to unblock the plugged milk duct. “Come back in a week.”

At my recheck, my GP seemed to think the lump had diminished in size but still sent me for an ultrasound and a mammogram and asked me to make an appointment with a breast specialist.

Because of my age and the nursing, my breast tissue was so dense that it made the diagnostic images difficult to interpret. The radiologist sent me home with a clean bill of health. “No worries. Schedule a follow-up in three months.”

Thankfully, I worried and kept my appointment with my breast specialist. I was diagnosed with breast cancer in early October, 2010.

It was then that I learned:

• Breast cancer occurs in about one out of every 3,000 pregnant women. It is the most common cancer in pregnant women.
• A woman’s risk of developing breast cancer is related to her exposure to hormones produced by her ovaries. Reproductive factors that increase the duration and/or levels of exposure to ovarian hormones, which stimulate cell growth, have been associated with an increase in breast cancer risk.
• Factors related to pregnancy that may increase the risk of breast cancer are older age (after 30) at birth of first child, recent childbirth, and taking diethylstilbestrol during pregnancy.
• Women who recently gave birth have a short-term increase in risk that declines after 10 years.
• Pregnancy-related factors associated with a reduced risk of developing hormone receptor-positive breast cancer later in life are early age at first full-term pregnancy and increasing number of births.
• It can be hard for pregnant women to detect a lump because the breasts become larger and more tender during pregnancy.
• In the U.S., about 5% of breast cancer cases occur in women under 40.
• Diagnosing breast cancer in women under 40 is more difficult because of their dense breast tissue. By the time a lump in a younger woman’s breast can be felt, the cancer often is advanced enough to lower chances of survival.

My initial reaction to the above information was anger. Why didn’t I know about this? If I did, I would’ve included routine breast exams in my prenatal and postnatal care. The truth was that the information had always been available but is not widely known because it’s rare for pregnant and postpartum women to develop this disease.

The weeks leading to my surgery were the stuff of nightmares. I had to wean my daughter as more imaging was required. Because of the denser breast tissue, the doctor wasn’t able to determine the exact size of the lump which made it difficult to decide the type of surgery I needed. Lumpectomy or mastectomy. I transferred to a major cancer center under the care of more experienced specialists.

Medical stress aside, the fear of not being able to watch my children grow up haunted me everyday. I looked into memory development in children, wondering how much would a 10-month-old and a four-year-old remember. The answer was not much. I thought about starting a journal or making a video of myself for my kids. I ended up just holding them close every chance I got and prayed like there was no tomorrow. “I love my children. I will survive this.” This was my desperate – but earnest – mantra.

I spoke with oncology social workers about how to best tell my 4-year-old son about my condition. Use simple terms, share your feelings but don’t scare him, maintain normal routines but let him know that you may not be able to do some of the things that you both used to do together and suggest substitutes. So I put away our Twister mat and bought Junior Monopoly and more Lego blocks.

I’m in awe of children’s ability to grasp difficult, grown-up concepts. After I explained that a lump in my chest was making me sick and the doctors were going to help me get rid it, my son, an avid Star Wars fan, pressed his palm to my chest, “I’m going to push Jedi – ten, no, fifty-five of them, and that’s a lot! – in you to destroy that lump.” I hugged him, “Thank you, my little Luke Skywalker.”

The morning of my surgery, I quietly peeked into my daughter’s room. She was still asleep. I blew her a kiss and closed the door. Awoken by my husband’s and my footsteps and hushed voices, my son was watching me from outside his room. I told him I was going to the hospital to get better. “If you miss me, just call. I promise to answer my phone.” He frowned, “But I don’t have your number.” I wanted to cry.

Tears brimming, I wrote down my cell phone number and handed it to him, “Okay?” He nodded and, again, pressed his palm to my chest.

So armed with an army of Jedi, a team of healthcare experts, and the support of family and friends, I slew my monster. I had a partial mastectomy with TUG flap reconstruction. The biopsy results showed Ductal Carcinoma In Situ, stage 0. The tumor measured at 5.5 cm. I needed 28 treatments of radiation.

After four long days at the hospital, I came home but not before stopping by a bakery to buy treats. I wanted a joyful homecoming, to see my children’s laughing faces covered with frosting, to make up for not being able to pick them up for six weeks because of my surgery. My daughter had quickly learned to go to my husband to be held, but to me for kisses and snuggles. My son, instead of playing kickball with me, kicked my butt in Junior Monopoly. In between my radiation treatments and visits from homecare health professionals, we found our new normal.

The day before Christmas and three days shy of my six-week mark, I called my surgeon’s office. “Can I PLEASE get clearance to pick up my kids? It’s Christmas, after all!” So on Christmas morning, I lifted my son and daughter up and into my arms. It was the best present:for me and for them.

The other day, I was chasing my children around the Disney Store and came across a women’s T-shirt with a glass slipper and the line, “And she lived happily ever after:” I bought that shirt. I know life is not that simple and the fear of my disease returning is ever present. But for the moment, I have my happy ending. If I had any words of wisdom for my children, I’d tell them, “Cherish the present because it’s all you really have. As for the rest, hope for the best. That’s what your mommy did!”

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