By Brenda Cummings
It is February 2024 as I write from southwestern Ontario, but my cancer story begins 25 years ago in London, England.
At 37 I was working a contract position, hoping to explore my UK heritage while progressing my communications career. Things were moving along more or less as planned, until a dull day in January 1999 when I discovered a hard, pea-sized lump near the surface of my right breast, next to the areola. Without a family doctor, I visited the nearest walk-in clinic where I was seen by a nurse practitioner. She shared my concern for the lump and asked the supervising physician for her assessment. I was soon booked for a mammogram and ultrasound. I recall the ultrasound technician commenting with confidence that the lump was “just a cyst” (which they are not permitted to do in Canada), but I was nonetheless referred for lumpectomy and biopsy.
I was unprepared for the results received on a brilliant April afternoon. Looking back, I may have wondered at being the last patient in the waiting room, or the offer of a cup of tea as I was shown a seat. The lump was an invasive ductal carcinoma – I had breast cancer.
In two weeks, I sat with a London oncologist who patted my hand as he expressed strong support for my inclination to return home for treatment. “You’re a Canadian citizen and you have cancer,” he soothed, “They’re going to treat you.” Another two weeks and I’d left my new (permanent) job at a Soho PR firm and was on a plane to Toronto, an awkward manila envelope in my lap containing life-sized chest imaging films.
In Toronto I had to find a GP fast, opting for my sister’s doctor who quickly referred me to a leading teaching hospital. My growing optimism was shattered when staff advised they could not rely on the UK images and pathology; they needed original slides of the tumour for their own analysis. This was not covered by OHIP, and I was tasked with making the import arrangements and paying the overseas courier fees. Eventually, it got done and when I finally sat down with my new lead oncologist, she advised that the tumour was bigger than stated (over a centimetre) and permeating the ductal margins.
The late May surgery comprised two teams, “destruction” and “construction”, as colourfully put by the head of the former team. Opting for a TRAM-flap reconstruction eliminated the need for an implant, but also traded my formerly perfect belly button for a hip-to-hip scar.
Following six weeks of recovery with home care and at least one ER visit for abdominal aspiration, I was offered adjuvant chemotherapy. Sectioning of lymph nodes had revealed no spread of disease, although hormone responsiveness was only 10 percent positive for estrogen, disqualifying me from continued treatment with Tamoxifen. As a relatively young cancer patient, I was presented with the choice of the standard six months of intravenous chemotherapy, which might preserve my hair, or a condensed course of double infusions over three months that was certain to cause total hair loss. I chose the latter to get it over with, a decision later questioned on collapsing in a grocery check-out and emitting my stomach contents in the parking lot. I had been advised there was a 25-30 percent chance of the cancer returning, reduced by a further 25 percent with the chemotherapy I’d received. At a final appointment with my GP in January of 2000 I asked how long I needed to remain vigilant. “Fifteen years,” she said.
Having lived the previous nine months alternately with my sister, parents, and a houseful of other delicately balanced souls, it was time to get my life and career back on track. In purchasing my flight home I’d had the foresight to book an open-ended return to London, and with no local employment prospects holding me back I took the flight before it expired. My first call was naturally to the president of the PR firm where I’d worked for only two months, who informed me with some sympathy that my reinstatement “doesn’t work for us” – they’d hired someone else. In shifting my focus from the West End creative sector to the financial district known locally as “The City”, I eventually found my feet. I was appointed Marketing Executive for a prominent global asset manager.
As an additional priority, I needed to resume monitoring for any possible recurrence. Arriving in Oncology at Guy’s Hospital, London, I was asked to provide a summary letter from my Canadian oncologists. This proved no easy task and multiple calls, emails, and a formal letter to the Toronto hospital’s Oncology department, addressed to the lead oncologist and copying the two surgeons, produced nothing. I was told my lead oncologist had been promoted and the Clinical Fellow had left the province. No word on the third oncologist and in desperation I called the office of the funny surgeon who’d performed the “destruction”, who had always seemed kind. Her assistant said she wasn’t qualified to provide the letter, but if I came to the hospital, she would make photocopies of my file. With a return flight to Toronto not yet an option, financially speaking, I ultimately got my hands on the paper copies the next December when I came home for Christmas. Monitoring at Guy’s proceeded with nothing more than my original consultant’s pathology report.
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It’s December 2014 in Aylmer, Ontario, and my family is raising a holiday toast. I’d returned to Canada at the end of 2003 with enough savings for a 25 percent deposit on a condominium in downtown Toronto, and my financial services communications career had picked up on Bay Street. Things were going well and annual visits to my GP reported nothing of concern, albeit only one scan – an MRI – was ordered over the entire period, in 2004. We all cheered at my passing the 15-year threshold and I finally started to relax a little when it came to health concerns. Hallelujah!
This is part one of a three-part post. Stay tuned for part two of Brenda's story in June.
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