Writer, mother and grandmother DIANE TREMBATH lives in Exmoor. After being given the all-clear three years ago, she has recently been diagnosed with breast cancer for the second time.
She has agreed to write a diary about her experiences for Live Better With - sharing her observations and insights, both practical and emotional. Here is part 1...
Love may be lovelier the second time around; breast cancer, not so much...
Three years ago, I was given the all clear after being diagnosed with and successfully treated for breast cancer in 2010: Stage 2, invasive ductal carcinoma, to be precise. So, no more annual mammograms, just one every three years, which I would book myself. That personal awareness of cancer and the sense of vulnerability it carries with it had receded a little, year by year; nine years on, it occupied far less of my conscious thinking than it had done at the beginning.
Half way through 2019, I remembered that I needed to book that three-year mammogram appointment but, before I had a chance to do so, a letter arrived offering me a date and a time for one. This, it turned out, was not in any way connected with my history of breast cancer but was part of a randomised trial known as AgeX, which is currently extending breast screening to women aged 47 to 73 – and I was 71.
On a sunlit July day, I drove to the coastal town where the mobile screening unit was based and joined a group of women of a certain age waiting to check in. Mammograms, as every woman who has had one knows, are not the most pleasant of procedures but the radiographer, thank goodness, could not have been more kind or caring. When it was over, I breathed a sigh of relief, drove home again and didn’t give the mammogram another thought.
A fortnight later, a thick letter in a window envelope arrived. I recognised the hospital’s distinctive typeface - and knew. This was not a technical recall to repeat the mammogram, the first having been unclear, for example; it was, I suspected, a rather more serious recall.
Test, test and more tests
Just two days on, I was back in the familiar surroundings of the breast care centre, where I had been treated nine years previously, and was mentally preparing for an ultrasound and possible biopsy.
This time, I had asked a close friend to come with me – I wasn’t going to repeat my original experience when I had attended the same appointment unaccompanied. On that occasion, I had a mammogram, followed by an ultrasound, and then six - yes, six - breast tissue samples taken by biopsy. Despite practising full yoga breathing and having the kindest of nursing assistants holding my hand, I was, at the end of the procedure, a wreck and practically had to be peeled off the ceiling. I was a wreck facing a 25-mile drive home.
This time round, however, once the ultrasound was done and dusted, only two tissue samples were taken and the procedure, while uncomfortable, was relatively quick and far less painful than previously (thank goodness for local anaesthetic). My friend stayed with me and, along with E, one of the centre’s superb breast care nurses, held my hand and stroked my arm and back throughout. I remembered to do my yoga breathing and used a powerful visualisation technique, but I still cried – and that’s normal. I will be forever grateful to my friend, to E the nurse, and Dr Z, the clinician, who, between them, made the whole experience easier to cope with than it might have been.
Dr Z had already alerted me to the fact that she was very concerned about two small white areas in my left breast; they could be clearly seen on the mammogram from the routine screening. So, it wasn’t really a question of ‘Is it cancer?’ but ‘What type of cancer?’ If it was a return of the original invasive ductal carcinoma, there was a possibility that these rogue cancer cells could have metastasised and taken up residence elsewhere in my body. I would need a full body CT scan to check whether or not this was the case, according to Dr Z, and it needed to be done pronto, before my results appointment in eight days’ time. She would, she said, contact the relevant department and get it set up.
At this point, another nurse arrived to take a blood sample, but I was now feeling pretty overwhelmed and emotionally battered so I hardly felt the needle going in. I reached for my phial of homeopathic arnica, one of several remedies that I always carry, and popped a pill.
‘Do you bruise easily?’ asked the nurse, glancing at the phial label. I told her that I did.
‘Wonderful stuff, arnica, isn’t it?’ she replied – and gave me a hug. I never say no to a nurse’s hug; they make everything just that bit better.
The box of tissues
The last port of call that day was with K, who was to be my designated breast care nurse. We sat in a room that I remembered well – with the obligatory box of tissues on the coffee table - and we reflected on the random nature of breast cancer. Apart from being female, the other main risk factors had never applied to me: I don’t drink or smoke; I’m not overweight; I have a healthy diet; I walk daily and exercise regularly, and have never taken HRT. And yet…
We also discussed my previous diagnosis and treatment, the implications of the day’s tests, and what to expect at the results appointment.
With my original bout of cancer, which had been caught very early, I was able to have a wide angle excision, which left most of my left breast intact, and then 15 rounds of radiotherapy. Would that be a possibility again, I wondered. K said that I should prepare myself that, this time, it might have to be a mastectomy.
Very hard to hear but, on reflection, I’m so glad that she was honest about the possible treatment because it gave me time to do some essential preparatory reading. This would enable me to draw up a list of questions for my surgeon and my medical care team and, therefore, make an informed decision about my treatment.
But you know what they say about the best-laid plans.
Scan? What scan…?
Fast forward a few days and I had heard nothing from the hospital about the CT scan. It was now Tuesday; there would be a team meeting at the breast care centre on the Thursday and my scan results were needed for that, so that my medical care team could agree on a treatment plan and share all the results with me the following day.
I rang the breast care centre to find out what was happening about the scan and had one of those frustrating conversations that have you scratching your head and thinking ‘Is it me or…?’ No-one seemed to know a thing, which was slightly alarming, not least as Dr Z had stressed urgency.
I was eventually put through to the X-ray department and spoke to someone who offered me the earliest available appointment, which was a month away. I mentioned Dr Z’s concern about urgency - a woman with breast cancer really does have to be on her toes and have her wits about her. Hey presto, I was offered an appointment at the end of Thursday afternoon and was told that, with luck and if it wasn’t too late in the day, there might just be someone available to look at the scans.
It was, and please pardon the pun, knife-edge stuff and stressful, which is not what a person who is facing possible major surgery for breast cancer needs. And then I remembered, although the administrative side of things had run rather more smoothly back in 2010 – there had been a run of admin blips this time – nevertheless, once you are in the cancer tunnel, the entire process feels utterly surreal.
I had no idea, however, that things were about to become even more surreal…
To be continued...
Diane with her beloved canine companion Pumpkin
Read all instalments of Diane's Diary here.
For detailed information and advice about breast cancer screening, tests and diagnosis and individual support visit: Breast Cancer Care
Live Better With has a range of online articles and expert guides on breast cancer diagnosis, treatment and beyond.
Visit the Live Better With Cancer Community Forum – for information, advice, and tips on how to cope with a breast cancer diagnosis and to share your own questions and suggestions.
