Thread by @SfPRocur

I was getting acclimated in my lab, following along on #BCSM, and attending tumor boards. And then cancer hit home - my best friend was diagnosed with HER2+ breast cancer at the age of 28.

We later found out that she was BRCA "positive".

BRCA is a gene (a specific part of the DNA) that produces a protein involved in DNA repair during damage. When BRCA is mutated, it is unable to repair the DNA leading to cancer development.

Approximately 5-10% of all breast cancers have a BRCA mutation (either BRCA1 or BRCA2). Being a BRCA carrier (this mutation is found in ALL cells in the body aka germline mutation) means there is a 5X increased risk of developing breast cancer.

Being a BRCA carrier means there is also an increased risk for developing ovarian cancer. Some BRCA carriers decide to have surgery prophylactic surgery to remove their breast and/or ovaries to prevent cancer from developing.

BRCA mutations are the most common. However "in addition to BRCA1 and BRCA2 gene mutations, some of these include mutations in ATM, PALB2, PTEN, CDH1, CHEK2, TP53, STK11, PMS2, and more."

verywellhealth.com/gene-mutations…

My BFF was only 28 so she wasn't receiving mammograms. Mammograms help to detect breast cancer but are better for postmenopausal women because the breast tissue regresses during menopause making it easier to detect cancer.

Instead, she found her cancer through a self-exam.

Everyone should complete self exams. This amazing group, @knowyourlemons, shares information about how to perform a self exam and what to look for.
knowyourlemons.com

On the Monday before Thanksgiving 2016, BFF went to her doctor and had a core needle biopsy (CNB). A CNB is a way the clinician can take part of the tumor out for a quick analysis. While she was on her way to my house to go shopping Wednesday, she got a call from her doctor.

We went to the hospital to meet with the doctor and the doctor said the words no one ever wants to hear "you have cancer". The next few weeks were largely a blur. She got a PET scan that confirmed the cancer hadn't spread and met with her oncologist at @sloan_kettering in NYC.

The cancer was found in her lymph nodes and she was young so she would need chemotherapy WITH her targeted therapy as well as surgery and radiation. She started her first chemotherapy (Adriamycin aka the red devil and Cytoxan) a week before Christmas.

Having the amazing mentor I do (hey @prof_riggins!) I was able to stay with BFF for a week while her boyfriend went on a business trip for the first week of January. We went to chemo together and I took care of her while she rested.

We also shaved her head. The AC didn't cause her to lose her hair immediately, but it would and she wanted to get ahead of it. We shopped for wigs.

The most surprising part to me was that she didn't really puke. In addition to chemotherapy, many patients are given antiemetics to prevent vomiting. She was mostly tired, a little achy, and anxious.

After 4 rounds of AC every 2 weeks (8 weeks total), she started her taxane (T) and with the targeted therapy Herceptin (trastuzumab) and Perjeta (pertuzumab; HP). T was weekly infusions for 12 weeks and HP was given every 3rd week. She got HP infusions every 3 weeks for a year.

We took a trip to Florida with our girlfriends for her "Cancelorette" after chemo was done.

She then had a double mastectomy with lymph node dissections. At this point, she was declared NED - or no evidence of disease. (NED is used instead of cured.)

After she recovered from surgery she had radiation 5 days a week for a few weeks.

Throughout the majority of these 7-9 months, she worked. Another common misconception is that it's impossible to work. For some, it's impossible but for others, working is manageable.

My experiences with BFF's diagnosis and treatment showed me a lack of communication. While her oncologist and nurses are WONDERFUL, I felt there were times where she was unsure about what was happening or why.

It made me determined to communicate more effectively.