Spring/Summer 2004

Target and Control Strategies to Battle Cancer Target & Control Strategies Mining Breast Cancer Imaging Data Molecular Complexity Treating a Chemotherapy Side Effect Catching Cancer Before It Spreads Sentinel Against Ovarian Cancer Peering into the Body - MRI Changing Cell Signaling Pathways Molecular Profiles of Cancer 3-D Modeling - Prostate Cancer Neutron-Based Therapies Calculating Radiation Dosage Fighting Disease with Disease Optimizing Radiation Therapy A Breast Cancer Survivor’s Story A Stomach Cancer Survivor’s Story More Geogia Tech Cancer Research

AFTER YEARS of breast self-exams, Missy knew the hard lump she found in her right breast was not one of the typical benign fibrocystic nodules she had felt before.

photo by Gary Meek Missy was 38 when she was diagnosed with breast cancer. Now disease-free, she is an active “Relay for Life” American Cancer Society fundraiser at the metro Atlanta high school where she teaches science. Fundraising activities include bake sales and sponsored walks.

A mammogram showed denser tissue around this hard lump, but Missy’s doctor did not recommend a biopsy, only periodic checkups and continued breast self-exams to watch for changes.

“We’re in trouble,” Missy remembers saying through tears to her husband David. But she did not press the doctor to do a biopsy, which she now wishes she had done. It might have prevented the harrowing experience that lay ahead.

Ten months later, Missy, then 38, noticed an indentation shaped like a kidney bean around the outside margin of the hard lump in her right breast. Within days, the small-town mother of two young children and teacher of science drove 40 miles to her surgeon’s office for a biopsy.

“I was hysterical driving home,” Missy recalls. “I kept thinking I was not going to be able to raise my children.”

About a week later, the surgeon delivered the news – it was cancer. Missy heard those words via a cell phone as she sat in her car in a grocery store parking lot. Her family was shopping inside.

“I was a walking zombie,” she recalls. “I went back in the store and looked at David, and he knew. When we got home, the kids went out to play in the backyard. Then David and I burst into tears. We just held each other and cried.”

It was an aggressive tumor, and the doctor wasn’t certain whether it had spread. For 10 excruciating days, Missy had to wait for surgery. The surgeon offered several options – a lumpectomy, or a single or double mastectomy – and recommended removal of some lymph nodes. Missy chose the single mastectomy and no reconstructive surgery to avoid the differences that age might bring to the intact breast compared to the new one.

“I should have chosen the double mastectomy, and then I wouldn’t have the worries now about getting cancer in my other breast,” she laments. “But I wasn’t thinking straight when I was diagnosed.”

Two weeks after the surgery, Missy felt physically strong except for her right arm, which she had to exercise to restore her range of motion. The pathologist’s report indicated Missy’s tumor contained estrogen, which promoted breast cancer cell growth. The surgeon put her on Tamoxifen, an anti-estrogen drug, which brought on menopause-like symptoms – hot flashes, night sweats, mood swings and dry skin.

Missy’s surgeon did not favor chemotherapy because her tumor was only 1.2 centimeters in diameter, and chemo is not recommended for tumors of less than 1 centimeter. But because cancer cells had spread to the tumor’s margin, the doctor could not be certain about whether the cancer had spread. It was not present in Missy’s lymph nodes. But with three oncologists’ opinions, she decided to undergo modified chemotherapy, a course of eight outpatient treatments during a six-month period.

The first two treatments caused mild nausea and thinning hair. Treatments three and four prompted her to take a couple of days of sick leave from her teaching job. By the fifth and sixth treatments, the chemo began to cause yeast and kidney infections as it attacked healthy cells. Treatments seven and eight put Missy in bed for three or four days each.

“I got ear and sinus infections,” Missy recalls. “It was tearing my body up. My hair thinned. I didn’t look pretty. I lost my menstrual cycle halfway through the chemo, and it didn’t come back until I stopped taking Tamoxifen five years later.”

During chemo, Missy’s family endured additional stress when her husband was promoted at work and asked to relocate from rural north central Alabama to metro Atlanta. For four months during the chemo treatments, Missy’s husband commuted 180 miles a day. Meanwhile, Missy was struggling emotionally with the disease.

“I was mad as a hornet,” she recalls. “I resented the fact that at 38, I had lost my breast and went into early menopause. I think I could’ve gotten by with fewer chemo treatments. Eight was just too many, I think, because of how my body reacted. But I was afraid not to take the seventh and eighth treatments.”

After she completed the chemo, Missy visited her surgeon every three months for the first year, and then once every six months for the next two years. Though her insurance will no longer pay for these twice-a-year follow-ups, she still gets checked by her gynecologist and surgeon and gets an annual mammogram.

“I know I have a higher risk for breast cancer now because I’ve had it,” Missy explains. “The doctor says now that I wouldn’t get that type of tumor again. And I’ve had no close calls since then.”

Missy stopped taking Tamoxifen in February 2003, and her menstrual cycle returned a few months later, but it was abnormal. By the end of the year, she had to undergo a complete hysterectomy – a surgery that revealed she had a tiny cancerous tumor in her uterus. It had not spread. The surgeon believes the tumor was Tamoxifen-induced because the drug increases the risk of uterine cancer.

Missy is much better now, but still experiences anxiety over her checkups. She wishes she had done some things differently in regard to her cancer treatment – perhaps that she’d looked into alternative or experimental methods, or chosen a double mastectomy and reconstructive surgery. But she is focusing most of her energy on caring for her family, growing her faith, teaching science and raising money for breast cancer research through Relay for Life. As leader of the campaign at the small high school where she teaches, Missy has more than quadrupled the school’s contribution in the past five years – raising $3,200 in 2003. The county’s efforts now make it the 10th highest Relay for Life contributor in the nation among communities of comparable size, and it’s 24th overall.