Sometimes it seems that life is unfair and the odds are stacked incredibly against us. More than 1 in 3 persons will get cancer. The chance of survival if you get lung, pancreatic or brain tumors is pathetically small. The most common cancer in 20 to 30-year-olds is the deadly beast melanoma. We have no easy or effective early detection for most cancers.
However, there are remarkable stories of hope. Here is one that defies the odds.
In the spring of 1995, when she is 37-years-old, Rachael becomes my patient. Her gynecologist finds a mass in her left breast on a routine exam. When the biopsy shows cancer, she undergoes a lumpectomy, chemotherapy and radiation. A lot of stress for a mother of five. Still, she gets through and the cancer never comes back.
Four years later, she complains of sudden pain in her lower abdomen, right above the pelvis. Ultrasound reveals a mass; it appears her appendix has ruptured. They rush Rachael to surgery. As soon as he makes the incision, the general surgeon knows he needs help. A gifted gynecologic oncologist finishes a four-hour operation for cancer of her right fallopian tube. An appendectomy turns into a total hysterectomy with removal of both tubes and ovaries. The cancer never comes back.
A “routine” mammogram shows suspicious calcifications in Rachael’s right breast in 2005. By then genetic testing is available. Rachael carries the high-risk BRCA2 gene, which accounts for her three cancers. Both breasts are removed with plastic surgical reconstruction. The pathologist finds a small previously undetected cancer in her treated left breast. She starts oral hormone suppression. Neither of these cancers ever comes back.
2007. Melanoma of her right forearm. It is excised with wide margins and graft. It is only half a millimeter thick. No further treatment is needed. It never comes back.
Finally, in 2011, she develops bleeding, despite a negative colonoscopy four years before. She has a stage 2 colon carcinoma. This is treated with combined chemotherapy and radiation, and then surgery. Despite requiring a colostomy, she recovers very well. This cancer has not come back.
2012. Rachael has five children, four of them are girls. For each child there is a 50% (one half) chance they have inherited the BRCA2 gene from Rachael. If she gave it to one child, it does not affect the risk for another child. In reverse, even if some of the children did not inherit the gene, it still means a 50% chance for each of the remaining children. Any child receiving the BRCA2 gene from Rachael is very likely to have a life similar to her’s. It is time to test each child.
- July 2012: Daughter #1, blood drawn. Test result, 3 weeks later: normal.
- November 2012: Son, blood drawn. Test result, Christmas time: normal.
- January 2013: Daughter #2, blood drawn. Specimen lost. Blood redrawn. Insurance company delay. March result: normal.
- May 2013: Daughter #3, blood drawn. Result back in 8 days: normal.
- September 2013: Final test. Fifth and oldest child. Daughter #4. She hates doctors and has delayed genetic testing for years. Normal.
Miraculously, five flips of the coin showed healthy and normal every time and in a 1 in 32 chance Rachael gave the gene to none of her children. They will all live without the shadow, the challenge, and the fear, which has marked her life.
Rachael is the ultimate survivor. Slammed down, she gets up. Again and again. In her own life and in the life of her children she has truly beaten the odds. Hers is a story of triumph, faith and powerful inner strength. We can overcome the monster and tomorrow brings hope.
James C. Salwitz is an oncologist who blogs at Sunrise Rounds.
