Welcome to Yale Cancer Center Answers with Doctors Francine Foss and Lynn Wilson.  I am Bruce Barber.  Dr. Foss is a Professor of Medical Oncology and Dermatology, specializing in the treatment of lymphomas.  Dr. Wilson is a Professor of Therapeutic Radiology and an expert in the use of radiation to treat lung cancers and cutaneous lymphomas.  If you would like to join the conversation, you can contact the doctors directly.  The address is canceranswers@yale.edu, and the phone number is 1-888-234-4YCC.  This week, Francine is pleased to welcome Eileen Kaplan.  Eileen is the author of ‘Laughter Is the Breast Medicine’, a book about her experience with breast cancer.  Here is Francine Foss.

 

Foss              Let’s start off by talking a little about your experience with breast cancer.

 

Kaplan          Sure.

 

Foss              Can you tell us about your first diagnosis, how you found out you had breast cancer and how you felt?

 

Kaplan          I was doing my regular breast examination, my monthly breast exam in the shower, and as I was rolling up the right side of my right breast, I felt a really significant knot and I knew immediately it was a tumor.  There was no question in my mind.  I got out of the shower and called my primary care physician’s office, actually I called my gynecologist’s office first which is in Boston and she said check with your primary care physician first before you make a run up to Boston.  I said okay, so I called my primary care physician’s office and the receptionist said to me, well you have an appointment next week, why don’t we just wait until you come in next week and we will have the doctor check you, and I said thank you but no thanks and I called Boston back and told them, they said come tomorrow morning.  The reason I was in Boston is really quite an interesting story.  There were four girlfriends and many years ago we decided we really loved shopping in Boston, and so one day we took a ride to Boston and we went into Brigham and Women’s Ambulatory Building and scouted out a group of doctors, four women gynecologists, and we each made an appointment with one of the doctors.  We made the appointments at the same time, we all had a mammogram at the same time, we all got out at the same time and then we went to Bloomingdales.  So that is how I happened to be in Boston at the time that I found this cancer.

 

Foss              Did you go up to see them and get the mammogram right away?

 

Kaplan          Yes, I had the mammogram right away and then of course we did an ultrasound and the ultrasound showed what I had found was definitely a bad girl there.

 

Foss              Had you been having annual mammograms?

 

Kaplan          From the time I was 40 years old, I had a mammogram every single year.

 

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Foss              And this never showed up on any of them?

 

Kaplan          To my knowledge, nothing ever showed.  As a matter of fact, when I was in treatment, my oncologist said to me that that particular tumor had probably been seeded and growing there for about five years.

 

Foss              Did you ever considered yourself a person who was at risk for breast cancer?

 

Kaplan          I never really thought of it and one day I decided I was going to help the American Cancer Society and I was there and we were planning a big fashion show, and I was sitting at a table with about 14 women and every one of them, of all ages, were all cancer survivors and was sitting there saying to myself, why I am here, I seem a little out of place? But it was just one of those unusual happenings and soon thereafter I found my cancer.

 

Foss              It sounds like you had a lot of exposure to cancer and cancer survivors being involved in this group.  How did you feel when you found out that you had cancer?

 

Kaplan          Well, I did not go crazy.  I knew that there was a cancer there, there was a tumor, I wanted to go see the doctor, get it taken care of and go on with my life.  The first couple of days, of course, when you get a diagnosis you’re shaken, you expect it, but at the same time you do not expect it and my husband and I just hugged and cuddled for a couple of days, got over the big bump in the road and he said to me, I wish I could take it from you so you would not have to go through this, but we made it through and after that I was fine.  A little anti-anxiety medication helped me for a few days and I went on to meet my breast cancer surgeon who was absolutely magnificent.

 

Foss              From the time that you had the biopsy till the time that they told you it was cancer, how long was that?

 

Kaplan          Quick, I had the biopsy and within days my breast surgeon called me and told me that it was cancer, and then I was quickly scheduled for a lumpectomy.

 

Foss              Can you talk about what your treatment was, did you get chemotherapy, and did you get radiation therapy?

 

Kaplan          Yes, I had the entire course.  First, I had a lumpectomy, and I was fine and it wasn’t a great deal of difficulty for me going through that, then I had chemotherapy, four infusions and lost my hair, which really did not bother me because hair grows and then I went on to have radiation therapy closer to home, near my hometown, and it was really very interesting. I was lying on my bed resting after my treatment that particular day checking my breast as I always did, checking,

 

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checking all the time and I was rolling around on my good breast, which was my left breast, and as I was rolling around doing my check I found another tumor on the left side, which was in a really odd place.  It was between two ribs and very close to my sternum, and I knew immediately that it was a tumor, it was just one of those crazy things.  So, I called Boston right away and saw my breast cancer surgeon within a day after that and it was so tiny that they had to do an MRI to spot it because it was miniscule.

 

Foss              Did they go ahead and take that one out as well?

 

Kaplan          I had them both taken out at the same time because I had my breasts removed.

 

Foss              So you went for a bilateral mastectomy at that point?

 

Kaplan          I did.  After we found that tumor and I went through all of the pros and cons of having a mastectomy, having conservation, I was saying to myself, well Eileen, you know, this is one tumor here in June and you found another tumor on the other side in November, what is this telling you?  So I had a boob survey with all my girlfriends and everybody agreed that if the same thing had happen to them, or even one side, that they would immediately have both breasts removed, they would not want to deal with the emotions of conservation and worry.  So, after I put all my facts together between conservation and mastectomy I decided that I was going to have both breasts removed.

 

Foss              Can you talk about making that decision?  Did you get all of the information that you needed from your healthcare providers, from your doctors, or did you also go online, did you read books on the topic? How did you come to that decision to get the mastectomy?

 

Kaplan          I did not do a lot of research.  I was formally an x-ray technician, so I knew all about the body and I have heard from so many people already who had had breast cancer and they found a lump and they did lumpectomy and then went through everything and they were fine, and then they had a recurrence, and I usually make rather quick decisions.  My husband and I had a very long meeting with my breast surgeon and laid out the facts and I said, I know 95% recovery rate and survival if you have conservation, and 95% survival rate if you have your breast removed and that really bothered me a little bit because you think that, well I am going to have my breast removed, it is gone.  So I was fortunate enough that I found the tumors very early and they had not reached my lymphatic system, which to me was God given, and putting all of these things together and that my tumors were HER2/negative, I would not have been able to have taken any of the medications after my mastectomy, and so I decided that they were too many cons and the pros were on my side to have the breast removed, I just decided that day, breasts removed, go on with my life.

 

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Foss              What advice would you give to a woman facing that decision today?  Do you feel that the decision is pretty much based on what the surgeon recommends or do you feel like there is still some negotiation? How should a woman think about that?

 

Kaplan          Actually my breast cancer surgeon said, Eileen, we probably should do conservation, he said because the tumors are really small and of course one was gone already by lumpectomy, but I have always been an advocate for doing what your gut feeling is and my gut feeling was, for myself, that I did not want cancer on my body, or have to worry everyday when is the next lump coming, and after I had two in five months I did not want to worry more and more and have to check my breasts every day, and you just don’t know what’s going to go on once you conserve as well, there would be biopsies, and there would be more needles in your breasts, and I just did not want to deal with that, I just felt that I had a great deal of support.  My husband told me, I do not care what you have, I only want you.

 

Foss              For you this really was a sense of assurance in a way that you had gotten rid of the problem?

 

Kaplan          Absolutely, I did not want to take any chances of having another lumpectomy, and then coming back in another six months and having a recurrence in one of the breasts.  I just did not want to deal with that and I felt that I had really been fortunate to have found them while they still had not escaped into my lymphatic system; I just wanted to get the breasts off.

 

Foss              I think the important message with what you are saying is also the self-examination aspect because these lumps did not show up on mammogram.

 

Kaplan          To my knowledge, they did not and I feel that breast examination is really a very important part of advocating for your body wellness.  I think that there is a reason for it.  Even though people may not find their cancers, their lumps, bumps or whatever when they are doing their breasts self examination, I feel it is an integral part of advocating for yourself and your wellness and awareness of what is going on with your body, in addition to all the other things that we have such as mammograms, ultrasound and so on and so forth.

 

Foss              Eileen, did you have any treatment after the mastectomy or were you done at that point?

 

Kaplan          I was finished.

 

Foss              No hormones?

 

Kaplan          No hormones.  I couldn’t take them anyway because of the negativity of my original tumors and so I walked out of Brigham with no breasts and no cancer.

 

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Foss              We are going to talk a little bit more about your story, and particularly about your book when we come back after a short break for a medical minute.  Please stay tuned to learn more about Eileen Kaplan’s experience with breast cancer.

 

Medical

Minute         It’s estimated that nearly 200,000 men in the US will be diagnosed with prostate cancer this year and over 2000 new cases will be diagnosed in Connecticut alone.  One in six American men will develop prostate cancer in the course of his lifetime.  Major advances in the detection and treatment of prostate cancer have dramatically decreased the number of the men who die from this disease.  Screening for prostate cancer can be performed quickly and easily in a physician’s office using two simple tests, a physical exam and a blood test.  Clinical trials are currently underway at federally designated comprehensive cancer center like the one at Yale to test innovative new treatments for prostate cancer.  The da Vinci Robotic Surgical System is an option available for patients at Yale that uses three dimensional imaging to enable a surgeon to perform a prostatectomy without the need for a large incision.  This has been a medical minute and more information is available at yalecancercenter.org.  You are listening to the WNPR Health Forum on the Connecticut Public Radio Network.

 

Foss              Welcome back to Yale Cancer Center Answers.  This is Dr. Francine Foss and I am joined by my guest Eileen who is a breast cancer survivor and author of the book ‘Laughter is the Breast Medicine’.  We talked a little bit, Eileen, about your experience with breast cancer and how you opted at the end of the day to undergo a bilateral mastectomy.  Can you segue way for us from that to what happened next and how you ended up writing a book?

 

Kaplan          I have always had a really wild and crazy sense of humor.  It has been with me since I was a kid and actually before I found the tumor, I was reading through my high school year book and underneath my picture it said, she shall have laughter wherever she goes.  So it really has followed me.  Laughter, a sense of humor, has followed me through everything I have done in my life and I really wanted to make the doctors smile.  I mean they go through horrible days seeing so much unpleasantness, that my goal was always to crack them up and make them smile and make them become friends with me as well as being my physician and that is what we did, my husband was with me when I had my first examination with my breast cancer surgeon in Boston, can I name him?

 

Foss              You certainly can.

 

Kaplan          Dr. Mehra Golshan who is now Director of Breast Surgical Services at Dana-Farber and Brigham and Women’s Hospital and my husband was with me when we were having the first exam and he said something really funny and Dr. Golshan laughed and blushed actually and that was the

 

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beginning of wonderful friendship with my doctor.

 

Foss              Tell us about the book.

 

Kaplan          The book came really from encouragement from my team there, they said I drove them crazy with all my questions and my humor and when I approached something I always turned it into something positive and humorous and something to laugh at, and that’s what I tried to do the entire time I was going through finding out my diagnosis and going through all the rigors of treatment.  I did not have a problem making them laugh and Dr. Golshan was sitting there one day and he said, you know Eileen, you really should write a book, you have just driven us crazy for the past year, you have got to put it down paper. I did not initially jump out of the hospital and start writing. It was maybe a year later, and I didn’t have the inclination to write a book and I have never written anything before, but I was in shower one day and the first line of the book sort of just fell out of my head and I thought, this is a good start.  So I used that as the foundation for the book and followed it with vignettes of my going through treatment from diagnosis, to walking out healthy with no breasts.

 

Foss              Can you take us through the book?  The book is basically your experience with breast cancer?

 

Kaplan          Yes, the book is my experience with breast cancer from the outset.  Actually, it starts with when my breasts grew, when I was a little girl, that’s how I started the book and went through to the time at the end of the book that I am now a big girl and I have no breasts, but each story is a little vignette about each of the things that happened while I was going through the diagnosis and the treatment, chemo and radiation therapy, and I basically just put humor in with everything that I did.

 

Foss              Did anybody help you with the book?  Did anybody proofread the book with you?  What was the process of actually writing the book and getting it done?

 

Kaplan         It was really very interesting.  I wrote it and wrote it, and wrote it, and then I read it with my husband who is a retired school teacher, so he had a really sharp eye for all of the things that I had written and I had an editor that worked with me that edited the book twice before it was published, and she was really wonderful, she knew what she was doing and she said, well what you can to do is give it to a big house to publish, or you can self-publish.  I knew that to go to a big publishing house, I would have to have probably about 250 proposals written to find an agent to take it to a publishing house, so I decided to do it myself, I had it edited, I found a designer in California who designed and formatted the book for me and I found the printer and out came ‘Laughter is the Breast Medicine’.

 

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Foss              How long has the book been out?

 

Kaplan          The book has been out for a little over a year, about a year and four months, and of course it has baby legs and I am a very aggressive marketer myself from having been in business prior to writing the book, so I have marketed the book very aggressively myself and now it is starting to be that I am getting phone calls to speak here, to keynote there, to be part of all these exciting things that are going on, and if I can help one person through a bump in the road, it is my pleasure.  My doctor in Boston selects particular patients of his whom he thinks might get some really good help from me, and so I get a message from Boston by E-mail and they say, Eileen, we have someone who would like to talk to you.  They approved for my phone call and visa-versa and so I have ended up mentoring about 12 women, under the auspices of my breast cancer surgeon of course, and I have friends all over the country.

 

Foss              That is very impressive.  Can you talk a little bit about people that have read your book, who has talked to you?

 

Kaplan          I have had so many wonderful inspiring people tell me that they have enjoyed the book, some people have said their whole family has been through cancer, so they knew everything I was going to say, but after they read the book, it was so different, and they knew that one of the people in the book was one of their sisters and it was a really funny story, so I had to use it.  At the end of the book I used bits and pieces of quips and things of stories that I had received over the time between I started writing and the book was published and at the end of the book I had a very fabulous story about a longtime friend, though we had never met each other, and I called him and I told him that I had breast cancer and he was just beside himself.  The last story in the book is about my friend Henry.

 

Foss              Do you think that the book has some inspiring moments that people who do not have breast cancer can benefit from, people who say have other kinds of cancer?

 

Kaplan          I do, I think it is not necessarily about breast cancer but about cancer and how you approach it. When I have spoken to survivor’s groups, keynote speeches, I just don’t speak about breast cancer, I use all the cancers that are more common to people’s knowledge like lung cancer, and colon cancer, melanoma, and ovarian cancer, and I bring that into my presentation when I speak to a big mixed group.  I do not let the men get away with anything, even with prostate cancer.  I give them a good jab as well.

 

Foss              This may be a tough question, but when did you first know that you are a cancer survivor and how have you evolved as a cancer survivor?

 

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Kaplan          I knew I was a cancer survivor when my doctor said to me, you are free of cancer.  I knew that Ihad made it. Initially going back to when I received the phone call that I had negative nodes, I was in the grocery store with my husband and the doctor called me, it was a Saturday afternoon, 4:30 in the afternoon, and he told me, Eileen, the nodes are negative, there is no cancer in the nodes and I was shouting in the aisles of the grocery store, I have negative nodes! I have negative nodes! And I just knew that I could beat it.  There was just something in me that told me that this was part of beating it, that it had not reached my lymphatic system, and when Dr. Golshan said to me you are free of cancer, I just went on with my life.  I went on with my life.

 

Foss              It sounds like your life has certainly evolved and a large part of what you are doing now is breast cancer advocacy?

 

Kaplan          Absolutely, breast cancer advocacy, body awareness, do not forget to check those breasts, it is so important, even if you do not feel anything, it’s important to know your breast history, so if you are checking yourself on a monthly basis and all of a sudden one month you feel something you did not feel the month before you can have it checked. I know that there are types that you can’t feel, like lobular cancers is a very tough one, and inflammatory breast cancer we know is also a really tough one, but I think that advocating for yourself, knowing your body, knowing the cancers, knowing what is out there, really leads you to being well and going forward with your life with the knowledge that you know all of these things to look for and that is really the way I have done it.  I love mentoring, I love speaking, and this has really been something that had just evolved from my breast cancer.

 

Foss              If a woman out there has breast cancer and wants to try to hook up in a network or talk to somebody else with breast cancer, or get information about breast cancer, can you talk a little bit about what the steps would be for them?

 

Kaplan          There is a really wonderful group of women out in California that I have touched base with called the Pink-Link and they can go right on the website and look for Pink-Link.com and what Vicki Tashman does, is she links people together who are suffering from the same thing, need the same help, and need the same encouragement, and I did not know Vicki when I was going through this,  I met her afterwards by computer, but she is just darling and I think her Pink-Link is really extraordinary.

 

Foss              Do you think that there is enough support out there for breast cancer research now-a-days, do you think that we need more money, more support and more advocacy for women?

 

Kaplan          We always need more money because we have not found the key yet to eradicating it, but what we have found, I believe, from all the money that has been invested in breast cancer, is cure for many

 

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breast cancers.  One of my friends is 18 years out from when she had her mastectomy and she is alive and well and walking and just an absolutely perfect individual, so we know that you can survive, and it is not an easy task, but put yourself in your positive bubble and that really helps you to go forward with your treatment and all the people that are around you, the angels that keep you floating. I think that there is much more out there now than there used to be to help people through this really difficult time in their lives.

 

Eileen Kaplan is a breast cancer survivor and the author of ‘Laughter Is The Breast Medicine’.  If you have questions or would like to share your comments, visit yalecancercenter.org, where you can also subscribe to our podcast and find written transcripts of past programs.  I am Bruce Barber and you are listening to the WNPR Health Forum on the Connecticut Public Broadcasting Network.