Krista Colvin’s children barge in as she emerges from a soak in the bathtub. As she covers herself with a towel, she feels something in her right breast.
After she shoos her kids out, she probes the spot with her fingers. A lump. Part of it feels hard, like the tip of a baby carrot. Pushing on it makes her stomach queasy because she knows something’s wrong.
Eight days later, Krista learns that what she felt was invasive ductal carcinoma, a mass roughly 3 centimeters around.
She’s among 190,000 women nationwide — nearly 700 in Clark County — likely to be told they have breast cancer this year, based on past rates. More women are diagnosed with skin cancer; more die of lung cancer. But there’s something especially devastating about a disease that attacks a woman’s outward manifestation of nurturing, femininity and sexuality.
Krista goes to appointment after appointment to refine the diagnosis, but the idea of cancer seems unreal.
“I don’t feel sick,” Krista says. “I don’t look sick.”
The 43-year-old is 5-foot-8, with a dark bob and hip glasses. She’s often found in Cafe Piccolo Paradiso in Camas, working on her netbook and taking calls on her iPhone as she runs her organizing and social media consulting business. On a recent day, she’s wearing a denim jacket over black slacks and high-heeled animal print shoes. Illness seems a distant threat.
Her friends are quicker to realize the seriousness of Krista’s diagnosis, and it hits them hard.
“It’s kind of a shocker,” says Krista’s friend Dana Bell, 37. “You think of your parents having breast cancer.”
They realize if Krista could get cancer, they could.
“I’m the first person they can identify with,” Krista says.
Perhaps every woman half expects to be in Krista’s shoes someday. Roughly 1 in 8 females born now will develop breast cancer at some point in their lives, according to the National Cancer Institute.
Maybe that’s why the question that keeps popping into Krista’s head isn’t “Why me?” but, “Why not me?”
Statistics don’t prepare you for finding a lump. Krista isn’t sure what to do. She keeps touching the lump, hoping it’s gone away. Should she call her ob-gyn? Her primary care doctor?
She calls both, and a friend, a breast cancer survivor about 10 years older. The friend counsels her to call the Kearney Breast Center at Southwest Washington Medical Center. Krista’s ob-gyn makes a referral, and Kearney gets her an appointment for later that day, a Friday.
Krista reports for an ultrasound. As she waits for her appointment, she spots an article in a news magazine about new guidelines for mammograms.
While the American Cancer Society and the American College of Radiology still advise mammograms yearly beginning at age 40, the U.S. Preventative Services Task Force late last year changed its recommendations. The task force now doesn’t recommend mammograms until age 50, and then only every other year. Even though screening reduces breast cancer deaths by 15 percent, fewer women in their 40s develop breast cancer to begin with, according to the task force.
For every 1,000 women in their 40s who undergo one round of mammogram screening, 97.8 will get a false-positive result, 84.3 will have further imaging tests done, 9.3 will undergo biopsy, and 2.6 will actually have cancer, according to research cited by the task force.
As for self-examination, the task force determined, “there is moderate certainty that the harms outweigh the benefits.”
The dispassionate analysis by the task force, which is sponsored by the Agency for Healthcare Research and Quality, flies in the face of Krista’s experience.
“This is enough evidence for me,” she says, gesturing to her chest.
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Before finding her lump by accident, Krista had had a mammogram 10 months earlier that did not detect anything abnormal. She performs breast self-exams, sometimes in the shower, sometimes laying down — maybe not on a set schedule, but fairly regularly. She knew her body well enough to know something was amiss.
Dr. Kathryn Kolibaba of Northwest Cancer Specialists in Vancouver, who would later become Krista’s oncologist, says “multiple patients every year come in after finding breast cancer by self-exam.”
“It’s free, and women are best served by knowing their own bodies,” Kolibaba says.
The rest of the women with breast cancer who end up at her practice had lumps found by mammograms, Kolibaba says.
Some women who have heard about the change in recommendations are deferring mammograms without first discussing it with their doctors — a big mistake, Kolibaba says.
“They need to have a doctor look them in the eye and say that we save lives by getting (mammograms) at 40,” Kolibaba said. “We have lots of women who have cancer under the age of 50.”
Over the five years between 2003 and 2007, 367 women between the ages of 40 and 44 — women roughly Krista’s age — were diagnosed with breast cancer each year in Washington, according to the state cancer registry.
On that day of the ultrasound, Krista still doesn’t know for sure she has cancer. After the weekend, she and her husband, Mike, have an appointment with an ob-gyn, who tells them the lump “feels cancerous.”
“Have you mentioned it to your children yet?” the doctor asks.
Mike, 43, is so well-acquainted with loss that his body reacts before his mind can absorb the news about Krista. His father was in coma for a week after terrible car accident in 1979. Although Mike’s father survived, he was never quite the same. Ten years ago, just after Mike and Krista’s son, Wes, was born, a brain aneurism killed Mike’s mother.
Mike breaks into a cold sweat, and feels like he is going to faint or vomit, or both. Nurses bring him a trash can and some crackers.
“I don’t think anybody ever wants to hear the word ‘cancer.’ It’s a difficult one to hear,” Mike says.
But it will take more tests to confirm the diagnosis.
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Two days later, another doctor plunges needles into Krista’s numbed breast and armpit for biopsies.
On Friday, just a week after her first appointment, Krista is shopping in the lingerie department at the Lloyd Center Nordstrom with her friend Dana when her phone rings. Krista sees it’s her ob-gyn’s office, and before she even answers, she knows. She sits on a bench to take the call.
Dana watches her friend’s face, and she knows, too.
“I’m calling with the news you don’t want to hear,” the doctor says.
Krista gets out a pen and paper and starts scribbling notes. As soon as she hangs up her phone, Krista turns to Dana.
“I need to get some big girl panties and kick cancer in the ass,” Krista declares.
They laugh and cry and peruse the lingerie selection. Krista picks out nice pajamas — one set in navy, and another in leopard print. She normally buys pajamas at Target. The upgrade makes her feel better.
“One day at a time,” Dana tells her. “For now, you have cute pajamas.”
Colvin tries to imagine what it will feel like later, when she’ll be sick and need to rest. For now, her body feels fine.
Krista puts off calling Mike. He tries her several times. She usually gets back to him quickly, but not this day. He worries.
Krista knows Mike, a financial advisor for Chase, has appointments with clients. She figures there’s nothing he can do anyway. He finally reaches her.
She tries to stay calm. “Let’s talk later,” she says.
That’s when Mike knows his wife has cancer. They talk later together about the chance that Krista would have a breast, or both, removed.
“I don’t care what you look like,” he tells her. “I just want you here.”
After the day of shopping with friends, Krista greets her children when they arrive home from school. She and the kids play for a while in the yard. Her 7-year-old daughter, Annie, asks whether she’s heard from the doctor.
“You know, Annie, it wasn’t good,” Krista says.
Later, Mike talks to the children.
“Mom did find out that she has cancer. The good news is that we found out Mom can be treated,” he tells Annie and Wes. “She is going to need help more than ever. We’re going to have to chores we’re not used to doing.”
He explains that Krista might have to have her breasts removed to get rid of the cancer.
Annie asks, “Will Mom’s hugs feel the same?”
At her first appointment with Dr. Kolibaba, Krista learns that her cancer tests positive for HER2/neu, or human epidermal growth factor receptor 2. That means it’s aggressive. Doctors need to find out if the cancer has moved to her lymph nodes or the rest of Krista’s body.
Krista’s mind teases things from her past that might have increased her risk. Her family doesn’t have a history of breast cancer, so was it putting the plastic lids for glass containers in the microwave? Was it wearing deodorant or underwire bras? The fact that her elementary school in Southern California backed up to a farm heavily sprayed with pesticides year-round?
Research, however, has found that the strongest risk factors for breast cancer are things that a woman can’t change, Dr. Kolibaba says. They include BRCA1 and BRCA2 (breast cancer gene 1 and 2) gene mutations; being older than 65; having a close relative with breast cancer; or having dense breast tissue.
The factors women can control — these include being overweight, not breastfeeding and using hormone replacement therapy — are not as significant, Kolibaba says.
Krista tries not ruminate on how she got cancer, and instead focuses on planning. Most of all, she wants to protect Annie and Wes. She contacts her children’s teachers to let them know what’s going on at home. She meets with friends who will help keep her household running.
She sees reminders of cancer everywhere. When she sorts blueberries to pluck out the moldy ones, she imagines them as tumors. When she notices that the gardeners have cut a branch of a tree, she thinks of the likelihood that she will have a piece of her body cut off.
Her mind dwells on odd things — Should she go for her routine eyebrow waxing if she’s bound to lose all her hair in chemo? If she does have a mastectomy, could she make one breast look like it’s two?
Washington Breast and Cervical Health Program offers free women’s health exams, pap smears and mammograms to qualified individuals.
For more information, call 360-514-1663 or visit http://www.doh.wa.gov/cfh/bcchp/.
Visit Krista Colvin’s blog at: http://www.puttingonmybiggirlpanties.com/
When she bumps into friends who don’t know yet, the hi-how-are-you exchange takes on weight.
“Well, actually, I have breast cancer,” she replies.
Krista, a former Hudson’s Bay High School teacher, switches into educator mode and urges nearly every woman she encounters to do a self-exam or get a mammogram.
The woman whom she has recently hired back to clean her house tells her she doesn’t go to the doctor because she needs to make money, and she doesn’t know how to perform a self-exam.
“The teacher in me wants to let people know what resources are available, and to tell them to check, and not rely on an annual exam or a husband or boyfriend to find this,” Krista says.
Three weeks after she found the lump, Krista is scheduled for surgery to take a biospsy of her lymph nodes at Southwest Washington Medical Center. The day before, she gets a call from Dr. Kolibaba, who asks her to come in to go over the results of the positron emission tomography (PET) scan that Krista underwent to detect whether cancer has spread beyond her breast.
Krista didn’t expect results so quickly. This can’t be good, she worries.
But Dr. Kolibaba tells her that the PET scan shows the cancer is confined to the breast. The scan identified four cancerous lymph nodes, eliminating the need for a node biopsy. There’s still another spot on the same breast that will need a biopsy.
For now, Kolibaba orders two 12-week rounds of chemo to begin the following week. After chemo, Kolibaba will have a better idea of what surgery Krista will need — removal of just the lump, one breast, or both. Kolibaba can finally assign a grade to Krista’s cancer. The worst would be Stage 4. Krista’s cancer is Stage 3A.
Krista is surprised at how ecstatic she is to hear this.
This is her new reality, one so topsy-turvy that what constitutes good news has a new definition.
“Stage 3,” she says. “I can do that.”