Two women, two very different choices about breast cancer treatment

Doris Marcantel and Elise Hileman are different women: Doris likes science fiction novels, travel, and walks in the woods; Elise likes to crochet while listening to Leonard Cohen albums. But they have one important thing in common: Last year, when they were both 41 years old, they were diagnosed with the same early-stage breast cancer — stage 1 invasive ductal carcinoma, to be exact.

After seeking advice from their doctors, the two women chose different treatment approaches: Marcantel had a lumpectomy, and Hileman had a double mastectomy. They talk about their decisions and the hard choices that followed.

Doris Marcantel

Starks, La.

I was diagnosed with stage 1 invasive ductal carcinoma last January. I never would have guessed that I would have cancer at 41. I’d never even had a mammogram before.

I decided to have a lumpectomy. The whole thing was such a shock. I couldn’t wrap my mind around having my breasts cut off. I wanted to do as little as possible. My doctor didn’t even suggest mastectomy. He said my tumor was small — the best kind of cancer you could have. There was no point in taking the breast off.

I’m a nurse, so I have a lot of medical knowledge. Studies have found that long-term survival is the same for lumpectomy or mastectomy for my type of cancer. But it’s possible to know too much. I’ve known people who had the smallest, best cancer in the world and two years later they’re at stage 4. I’ve also known women who had mastectomies but still developed cancer. It’s a crapshoot.

After my lumpectomy, genetic tests showed that I had a PALB 2 mutation that raises my risk for breast cancer. It’s not as well known as the BRCA1 or BRCA2 mutation, although it may be just as dangerous. My mother had lost touch with her family when she moved here from up north, so we didn’t know how common breast cancer was in her family. When we checked, I was like the eighth woman on her side of the family to have breast cancer.

I’m not considering having a mastectomy. I’m not going to have my breasts taken off just to hedge my bets. I don’t want any more surgeries unless I really need them. Some women cut their breasts off for nothing. As long as they monitor me closely so they can catch something before it gets too bad, I’m OK with that.

I’m trying to stay healthy and keep my mind distracted. I quit smoking a year ago. And I’ve been doing my best to control my weight. I took up adult coloring, and I make cards for people at work. I got involved with a breast cancer support group.

I think about cancer every day. I worry about every little pain — has my cancer spread? I can’t help it. I’m taking antidepressant medicines for the first time in my life. I sleep about four hours every night.

Looking back, I wonder if I did the right thing. Maybe a mastectomy would have been better for me because I wouldn’t have to go back every six months and worry about more tests, biopsies and MRIs. Having the PALB 2 mutation makes makes me anxious, but a lot of women with that gene never get cancer.

It’s all a big unknown.

Elise Hileman

Denver

Last summer, I felt a lump in my breast, and I immediately knew I had breast cancer. But the mammogram didn’t find anything. I made the technician feel the lump, and she persuaded the radiologist to give me an ultrasound. The ultrasound found the tumor.

I started weighing lumpectomy versus mastectomy. But I had very large, dense breasts, the kind that can hide breast cancer. Mammograms missed my first tumor, so I couldn’t trust screening to catch any new ones. And if you’re prone to breast cancer, there’s a chance that more could pop up. My breasts were ticking time bombs.

My doctor recommended mastectomy, and I agreed immediately. If my doctor had said that lumpectomy with radiation would have been better, I would have gone for that. But I’m a mom of three, and I wanted to do whatever it took to not have to deal with this in the future. I’m also a previous cancer patient — I had melanoma eight years ago. I was ready to get this over with and move on. I wasn’t attached to my breasts. They were trying to kill me, so I was glad to have them gone.

I scheduled the surgery as soon as I could. Three weeks later, they were gone.

After a mastectomy, you have to think: What do I do next? Because I was young, everyone assumed that I would have reconstruction surgery. Not getting reconstructive surgery — “going flat” — was never even mentioned as a possibility.

I started going through the process of reconstruction. I had tissue expanders in my chest, like empty turtle shells that they inserted into my muscles. Every time I breathed, they felt like iron spikes. I told my doctor that I wanted them out, but I got a lot of pushback. That wasn’t his vision for me. But I insisted. I went flat.

I feel 100% back to being me again, sans breasts. There are so many benefits of being flat that I didn't know about. I think I look like a ballerina. No bras, no sweat. And I can jog for the first time in my adult life.

I embrace all of my choices now. I know a lot of women struggle with their decisions. I understand why some women choose to have lumpectomies, and why some women want to have reconstructive surgery after a mastectomy. But some women don’t even know that they have a choice.