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When a Breast Cancer Surgeon Undergoes a Double Mastectomy
Comments () | Published July 5, 2011
Teal didn't want cancer to get in the way of watching her children grow up. Photograph by Chris Gavin Jones
When Teal was 11, her older sister, Marci, accidentally got her hand stuck under a lawn tractor while their parents were out. Marci came running into the house screaming—she’d cut three fingers down to the bone—and Teal tried to calm her down and used Kleenex to try to stop the bleeding. A few years later, when their mother accidentally ran over the family dog in the driveway, it was Teal who got on the phone with the vet because everyone else was too upset.

Teal knew in high school she wanted to be a surgeon. She was good at math and science and enjoyed doing things with her hands, such as drawing and cross-stitching. Her parents asked a family friend, the head of surgery at a hospital in her hometown of Wilkes-Barre, to take her on rounds with him. Teal watched the doctor care for a burn patient and perform leg bypass surgery. She thought it was amazing the way he could go inside people’s bodies and fix things.

In medical school at Cornell, she planned to become a general surgeon, doing everything from repairing hernias to removing gall bladders. Breast cancer wasn’t on her radar. As a resident, she did a surgical-oncology rotation at Sloan-Kettering Cancer Center in New York and took care of many young women with advanced stages of the disease. She was in her late twenties, and so were they.

I could never, ever do this, she thought.

Soon after Teal moved to Washington in 1997 for a job as an attending physician at Andrews Air Force Base, her mother received her first diagnosis. A month later, Teal’s best friend, Laurie Turney, found out she had breast cancer at age 34.

When Teal and Turney had met, Teal was just out of medical school and a first-year resident at New York-Presbyterian Hospital, where Turney was a nurse on the cardiothoracic intensive-care unit. Teal was talking with a patient, and Turney saw her hold the woman’s hand, something she’d never seen a doctor do. Turney started sharing her meals with Teal—who was so skinny that the weight of her pager pulled her scrub pants down—and soon they were meeting to roller-blade in Central Park.

After four years at Andrews, Teal called the breast-care center at George Washington University and said she was looking for a job. She wanted to help women such as her mother and Turney. With general surgery, she’d realized, she might operate on someone and never see that person again. If she worked with cancer patients, she’d get to follow them for life.

Teal’s decision to have prophylactic surgery to remove both breasts—with reconstruction—didn’t involve any statistics. It wasn’t based on research or something she’d read in a medical journal. With patients, Teal practiced evidence-based medicine, relying on data and percentages. This time she wasn’t acting as a doctor: She was a daughter and a mother, and she was scared.

She usually wasn’t a worrier. She ate well and jogged every day near her home in Alexandria, but she didn’t obsess about her health. She’d missed a mammogram one year because it slipped her mind, and sometimes she forgot to go in for a Pap smear. But this was a fear she couldn’t ignore.

She knew there were options other than a double mastectomy. She sees 20 patients a day in the breast-care center, and many have a stronger family history of cancer than she does. Her high-risk patients are watched extra closely: They get MRIs or breast-specific gamma imaging (BSGI) six months after their annual mammograms, along with clinical exams twice a year. BSGI is a newer technology that detects the metabolic activity of breast tumors and has fewer false positives than MRIs; GW is the only breast center in the Washington area offering them. Unless a woman tests positive for a genetic abnormality, which Teal did not, they usually don’t have their breasts removed.

See Also:

Debunking the Mammogram Myth

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But this wasn’t about her patients, Teal says. This was about a feeling in her gut, one that told her the cancer she was going to get would be as ugly as her mother’s, the kind that could fail to show up on a mammogram and still involve 13 lymph nodes. Some people could live with that risk; she couldn’t. She didn’t like it when she wasn’t in control, such as when her twins arrived six weeks early and had to spend a month in neonatal intensive care. If she ever did get breast cancer—even ductal carcinoma in situ (DCIS), a noninvasive cancer in the lining of the milk ducts—she was confident she’d have a double mastectomy. This way, she got to decide when it happened. Breast cancer wouldn’t dictate her life.

I can do this intense screening and hope to find cancer early, she thought, or I can have surgery and avoid it altogether. She scheduled her surgery for January, giving herself six months to change her mind.

A double mastectomy wouldn’t eliminate her chances of getting breast cancer: The procedure reduces one’s risk by 90 to 95 percent, but patients can still develop cancer after surgery because a small amount of tissue remains. She was electing to have a nipple-sparing procedure, which meant her risk would be slightly higher because there would be more skin and tissue left in place. But she was okay with those odds; they wouldn’t keep her up at night. She wouldn’t need any more mammograms, just an MRI every three years to make sure her silicone implant wasn’t leaking.

It wasn’t just the cancer Teal feared but the scares. She watched patients go through them all the time: A mammogram or MRI shows something suspicious that requires a biopsy. It might be cancer; it might not. For days, they imagine the worst. She knew the wait was torture, which is why she checked for lab results on weekends, hoping to be able to call a patient with good news. She didn’t want to be the person waiting by the phone.

Next: Living in denial

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Posted at 10:35 AM/ET, 07/05/2011 RSS | Print | Permalink | Washingtonian.com Articles