Anne’s Story: Charting a Successful Course Through Breast Cancer

Anne Rider, with her fiancé Jason

Anne Rider, with her fiancé Jason

You never know where life will take you.

It is a journey filled with winding roads, some smooth and easily traversed and some with boulders and craters big enough to swallow the traveler whole.

Sometimes, a rough path presents itself, as is true when a cancer diagnosis is made, but with the right navigational tools, the journey can pick up again with the same joy and success.

Anne Rider, now 31, understands that as she plans for her wedding day coming up next fall.

“We haven’t set a date yet,” she says, “but we’re enjoying this time together as we start to plan.”

The excitement in her voice can’t be hidden, and she surely deserves the delight that comes with planning one’s wedding day after walking away from the hardest battle she’s ever fought.

“I was blindsided when I was diagnosed with breast cancer at just 30 years old,” she says.

Rider’s journey with breast cancer began in April 2014 when she returned from a run and discovered a lump along the line of her sports bra which she had never felt before. “I quickly consulted Google and the results were reassuring—between 80 and 85 percent of breast lumps are benign.

“However, I feel like I know my body well, and this felt different. I was fairly confident that it was just a cyst but scheduled an appointment to see my family physician,” she says. “He didn’t think it was anything to worry about but set me up to see a breast surgeon at another area health system the following week.

“I remember that appointment like it was yesterday. I sat nervously in the waiting room surrounded by much older women, and I felt very out of place. I was a healthy, young professional, happy in my career and busy with MBA classes. I didn’t feel sick or believe that anything could be wrong.

“My breast surgeon again assured me that cancer was rare in young women as he presented my initial radiology report. He said that what seemed to be a cyst was symmetrical and would likely resolve on its own. I could wait until July to see if there was any change, or he could try to aspirate the cyst. For whatever reason, my gut said I wanted whatever I felt to be out of my body—and I’m so glad that I did.”

Rider says when the doctor put a needle in what was thought to be the cyst, it was solid, and a simple appointment turned into a follow-up for a surgical biopsy.

“On April 15, 2014, I had surgery to remove a tumor that was 2.9 centimeters. A few days later the pathology report confirmed that I had breast cancer. I was in shock,” she says.

“My mother and aunt are breast cancer survivors, and I had watched their battles with the disease first hand. I had opted not to have a genetic panel done to see if I was genetically predisposed towards breast cancer because I’m adopted. How’s that for irony?”

Rider says the days following diagnosis were a whirlwind of doctor’s appointments, research and worry.

“My prognosis was uncertain and telling the people that you love that you have cancer is the most difficult conversation.”

 

Genetic Counseling, Oncofertility and Chemotherapy

Stunned, but relieved that that the surgery was the right decision, she says there was hope that she was in the clear.

“They had removed the tumor, and there was no sign of cancer in my lymph nodes,” she says. “I was diagnosed with Stage II, hormone-positive, Invasive Ductal Carcinoma. With my initial staging, there was a chance that I may not need chemotherapy. My doctor ordered additional tests that included a genetic panel and Oncotype DX, which estimates the likelihood of cancer recurrence in women like me with early-stage hormone receptor positive cancer.

“The research being done on genetics right now is fascinating. I tested negative for both of the BRCA genes that Angelina Jolie has made everyone aware of. This was good news for me and any children that I have down the road. However, I did test positive for variants in two genes that are currently being studied and thought to have a tie to cancer. I will continue to receive updates from my genetic counselor as new information on these genes becomes available.”

Rider, however, received bad news as well.

“My numbers for the Oncotype DX test were high—off the charts high—and chemotherapy was inevitable,” she says. “I was terrified and that is why I decided to seek a second opinion.”

Rider scheduled a visit to the Dana Farber Cancer Institute in Boston, which is affiliated with the Harvard School of Medicine and has a program dedicated to young women with breast cancer—an important visit that would change the course of her treatment.

“The team that I saw in Boston encouraged me to get treatment at the University of Cincinnati,” she says. “They assured me that as a large research facility, the UC Cancer Institute would offer the most current treatment plans available. As an added bonus, my mom was already a patient of Dr. (Elyse) Lower.” Lower is the director of the UC Cancer Institute’s Breast Cancer Center.

“My initial visit with Dr. Lower lasted two hours, and I left feeling confident and positive about our game plan for chemotherapy.”

Rider knew that cancer treatment could hinder her chances of pregnancy later in life.

“Protecting my fertility became a priority,” she says. “If I was going to fight for my life, I wanted to protect my dream of having children. I am so grateful that Dr. Lower was willing to discuss fertility preservation and refer me to an oncofertility specialist.”

Julie Sroga, MD, assistant professor in the UC Department of Obstetrics and Gynecology and an expert in oncofertility, is the specialist Rider saw at UC.

“She was encouraging and helped me understand that there were risks involved,” she says. “Fertility treatment required additional hormone therapy that could feed any cancer cells in my body, but I did have options. I decided to have Dr. Sroga guide me through a round of in vitro fertilization and complete a procedure to harvest and protect my eggs. As my fiancé and I start conversations about having a family down the road, I am confident that I made the right decision.”

After in vitro was completed, Rider began 16 rounds of chemotherapy with three different compounds.

“It was a long summer; my energy level was low, and I felt isolated from the most normal aspects of my life,” she says. “After a few weeks, I had come to accept my bald head and found a few foods that my body could tolerate. However, the effects of chemotherapy are cumulative, and the recovery following each treatment became harder. I had to stop working and learn to rely on other people during those 20 weeks. That was extremely hard for me.”

 

Mammography, Mastectomy and Another Tumor Discovery

Eight weeks into treatment, Rider says the “first and only mammogram in her life” was scheduled to see how her tumor was responding to chemotherapy.

“The mammogram showed that there were calcifications in my left breast that were suspicious and needed additional testing,” she says, adding that she was going to have to make another hard decision. “Some experts recommended minimal surgery to ensure we had clear margins around my initial tumor which would allow me to move on from treatment as quickly as possible. Others thought the best plan would be a complete mastectomy. If we went that route, I would have to decide if I wanted to have a double mastectomy and if I would want reconstruction.

“Dr. (Jaime) Lewis recommended that I have a needle biopsy to test suspicious spots that remained, which is a minimally invasive procedure that would remove a few cells to be tested for cancer and provide additional information to guide in decision making. Unfortunately, my biopsy results were positive.”

Rider decided to move forward with the double mastectomy, and on Dec. 29, 2014, during surgery, a second, 2.3 centimeter tumor was found in her left breast.

“I was miserable the day after my surgery, but once I was out of recovery, the quality of care that I received was excellent,” she remembers. “I spent a lot of time in the hospital, and it’s a wonderful community. Lee Ann Liska, the president and CEO of UC Medical Center, even stopped in my room to check on my progress. Her visit was one of many moments that made me feel like I was in really good hands.”

Rider says Lewis, a breast surgeon and assistant professor within the UC College of Medicine, called her late the next day with the pathology report.

“There was a tumor that we were not expecting, and one of my lymph nodes was positive for malignancy, meaning that cancer cells had spread outside of my chest area and that I could expect additional treatment,” she says. “The Tuesday after surgery, my medical chart and pathology slides were reviewed by the Tumor Board. The thought of a team of bright medical minds coming together to talk about my treatment offered hope. My job was to focus on recovering from surgery and slowly rebuilding my strength, and their job was to figure out the best treatment plan for moving forward.”

 

Radiotherapy, Nutritional Assessment and Treatment for Lymphedema

Lower presented the team’s recommendations in Rider’s next appointment.

“First, I was scheduled to have a full axillary lymph node dissection which was another big surgery where additional lymph nodes around my chest wall and under my left armpit would be removed and checked for cancer,” she says.

Lower also introduced Rider to Kris Huang, MD, PhD, assistant professor of in the Department of Radiation Oncology at UC and a physician within the UC Cancer Institute.

“He prescribed radiation therapy to destroy any cancer cells that were missed in surgery, making recurrence less likely,” she says. “Because of my young age and the fact that I had lymph node involvement, my treatment plan warranted a full-court press, including radiation. Dr. Huang explained that radiation therapy would improve my overall prognosis and emphasized the importance of maintaining a healthy lifestyle during and after treatment.

“Because both tumors were in my left breast, not too far from my heart, there would be some risks to my heart that could not be prevented. Radiation would also slow down my recovery from surgery and prolong the timeline for breast reconstruction.”

“My course of radiation was 28 sessions, which meant coming to the Barrett Center Monday through Friday for six weeks,” Rider continues. “The thing about radiation is that it takes time to start working; the first few weeks I felt great, but then, my skin became sore and started to peel, and the familiar cancer fatigue returned. While radiation is intended to destroy any stray cancer cells that weren’t removed surgically or by chemo, it also affects healthy cells, and they take a lot of energy to heal which makes you tired.”

Rider says she started to meet with Tammy Ward, registered dietitian and specialist in oncology nutrition from the UC Cancer Institute, who helped her find a food plan that worked best for her.

“Good nutrition, including high protein foods and lots of veggies, helped offset the exhaustion that comes with radiation fatigue,” she says. “We also talked about long-term lifestyle changes that I would have to make to keep my heart healthy and curb my chance of cancer reoccurrence.”

Sometimes after lymph node surgery, patients develop lymphedema, or swelling which results from the disruption to their lymphatic system.

“Halfway through radiation, I noticed that my arm was heavy and starting to swell,” she says. “I had the beginning signs.”

Lymphedema is just one of many ongoing side effects with which many breast cancer patients must deal. Rider continues to have weekly physical therapy to help manually circulate fluid through her lymphatic system.

“The effects of cancer treatment certainly linger,” Rider says, adding that she went back to work shortly after finishing radiation but admits that she still deals with fatigue. “The transition after chemo, surgeries and radiation was harder than I expected. There are days that I am exhausted, and I am working to rebuild my strength. Yoga and long walks are really helpful for my body and mind, and I hope to get back to running again someday soon.”

 

Rider Prepares for Reconstruction Surgery and Helps Others through Clinical Trial Participation

Rider’s new normal includes plenty of follow-up appointments, and treatment remains top of mind for her.

“I receive a monthly shot that keeps my ovaries from making estrogen and lowers the hormone levels in my body,” she explains. Similar to natural menopause, she complains of having hot flashes.

Rider is also taking Tamoxifen, an oral drug that is a form of hormone therapy and works by blocking estrogen receptors in breast tissue, helping to prevent cancer from returning.

“There is an inherent anxiety in post-treatment checkups, but it’s comforting to know that I am being watched very closely,” she says.

Rider will continue to have regular follow-up appointments with her oncologist, surgeon and radiologist. She is also enrolled in a clinical trial at UC called the e3 study, evaluating the drug Everolimus to prevent recurrence and/or the spread of cancer in early stage breast cancer.

All patients in the phase-3 trial are treated with long-term hormone therapy following chemotherapy, and are randomly assigned either a daily dose of Everolimus or a placebo for one year.

“I don’t know if I’m getting the placebo or the drug, but things seem to be working fine,” she says. “I’m happy to participate in the study and hope that something can be learned that will help treat others with this disease more effectively.”

Rider knew that reconstruction was something that she wanted at the time of her mastectomy and discussed her options with John Kitzmiller, MD, professor in the Department of Surgery and chief of the Division of Plastic Surgery.

“He put expanders in underneath my pectoral muscle at the time of the mastectomy, slowly filling the expanders with two ounces of saline at a time to stretch the area and make room for the implant,” she says. “The process is far from comfortable.”

Kitzmiller recommends that patients, like Rider, give their skin at least six months to recover following radiation.

“I am eagerly waiting for what I hope will be my last surgery on Oct. 27; it will be another victory in my journey.”

Rider now works as corporate recruiter for the E.W. Scripps Company, and will join the board for the Komen Race for the Cure this November.

She’s grateful to have this time to spend with her loved ones, and excited to start planning for her wedding.

“For a while, it was hard to think I would make it through treatment,” she said, “Now, I am thrilled to be able to focus on my future.”

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