Pulling Back the Curtain

Coming to grips with my Triple Negative Diagnosis

So after receiving my breast cancer diagnosis in January of 2015,  I was about to be hit with another bomb.  A couple of weeks later in February 2015, it was confirmed that I had Triple Negative Breast Cancer.

Now, I had no idea there are subsets in breast cancer. As far as I was concerned breast cancer was and is ugly, plain old breast cancer.  So when I got the call from the nurse who works with my breast surgeon, I actually thought it was good news at first.  I mean -  that's how little I understood, about breast cancer and the different variables.    I had been tested for the BRCA 1 and BRCA 2 gene mutations and found to be negative, so when the nurse told me that my HER2 test also came back negative I was initially happy (a protein called human epidermal growth factor receptor 2 (HER2), which promotes the growth of cancer cells).  I had no idea that there was no positive in testing negative for all three gene mutations  

The names BRCA1 and BRCA2 stand for BReast CAncer susceptibility gene 1 and BReast CAncer susceptibility gene 2. BRCA1 and BRCA2 belong to a class of genes known as tumor suppressors. When functioning normally, these genes help keep breast, ovarian, and other types of cells from growing and dividing too rapidly or in an uncontrolled way.

When certain changes or "mutations" in the BRCA genes occur, cells are more likely to divide and change rapidly which can lead to developing cancer.

It was only after looking at my pathology report and then calling my sister to give her the latest results did the news sink in and the bomb go off. 

My sister and I met at a little cafe across the street from City College located in Harlem, N.Y.  I remember it being a cold February evening, but we were comfortable in the neighborhood cafe (the owner is a super sweet, petite Asian woman who works really hard to provide a quality product and knows my family very well).  My little sister in all her furious kenetic energy, enters the cafe and greets everyone cheerfully and settles in across from me in the low comfortable lounge chairs.  I order the usual black bean burger (my favorite at this establishment) and settle in beside my sister. Huge windows expose a swirly wind swept street and I pull myself upright out of the chair and lean in closer to my sister's face.  Her expression is concentrated, focused but at ease, quietly hiding any emotions.   Pulling out my pathology report, I tell her that I'm not understanding what my HER2 test indicates in relation to the pathology report.  My sister calmly scans the papers in front of her and explains that the pathology report indicates that I am ER Negative/PR Negative and the HER2 test was being run again.  With the confirmation from the nurse, regarding the HER2,  my sister explained that my tumor was:

Triple Negative Breast Cancer: 

A diagnosis of triple negative breast cancer means that the three most common types of receptors known to fuel most breast cancer growth–estrogen, progesterone, and the HER-2/neu gene– are not present in the cancer tumor. This means that the breast cancer cells have tested negative for hormone epidermal growth factor receptor 2 (HER-2), estrogen receptors (ER), and progesterone receptors (PR). Since the tumor cells lack the necessary receptors, common treatments like hormone therapy and drugs that target estrogen, progesterone, and HER-2 are ineffective
— National Breast Cancer Foundation

At this point, it sinks in.  Very slowly, sort of a "out of body" experience slow.  I now realize why my breast surgeon showed such concern.  For people diagnosed with Triple Negative Breast Cancer there are currently no targeted hormone therapies.  We don't get a "magic" hormone suppressing pill.  Suddenly the realization sets in that chemotherapy may be part of my treatment program.  I observe as my sister sits back to gather herself and make sure that I understand all the news I've just been given.  The curtain has been pulled back and the reality of my diagnosis has taken up the room, front and center.  I feel my biological clock starting to tick.  Surprisingly I was still in an upbeat mood, as my mortality was being challenged.  The cafe owner cheerily checks in.  Her voice high and animated - "Are you girls alright?"  "Nice to see you spending some time together!" A strained grin crosses my face as I acknowledge the cafe owner with a nod,  and turn back to my sister.    "Options", I thought, " I need to find all my options".  My sister and I began to come to the realization that I was going to have to form a game plan, with the best players possible and very quickly.  Despite my lack of knowledge I was going to have to put together a team, and make a decision on how I wanted to proceed.  Will I go thru with chemo, will I pick the right oncologist or will I just party and smoke my way into a inebriated calm?    The process is about to get real zany!  Hennessy anyone? 

Next up:  Last call for alcohol and vetting the oncologist.