By Jennifer Eder
When Christy Teal first learned her mother had been diagnosed with breast cancer in 1997, she knew her life would never be the same.
Dr. Teal, chief of breast surgery at George Washington University Hospital, had witnessed the ravages breast cancer can cause when she treated women with advanced cases at Memorial Sloan-Kettering Cancer Center during her surgical residency.
“I remember looking in the mirror that night and thinking, ‘Wow, now I have to worry about breast cancer because I have a family history,’” said the 44-year-old associate professor of surgery in the School of Medicine and Health Sciences.
Luckily her mother’s cancer was relatively “easy.” Dr. Teal’s mother, Nancy Brown, who was 60 at the time, needed a lumpectomy and radiation but was pronounced cancer-free five years later.
Both mother and daughter breathed a sigh of relief.
Thirteen years later, at the June 2010 Race for the Cure, they talked about how Ms. Brown “got off easy” by not going through a mastectomy or chemotherapy – an outcome many women with more advanced cancers require. Since her mother’s 1997 diagnosis, Dr. Teal had watched her best friend, Laurie Turney, undergo numerous surgeries, chemotherapy and radiation for her breast cancer.
But two days after the race, Ms. Brown called Dr. Teal and said she had found a lump under her right arm. Because her first cancer had been on the left, Dr. Teal wasn’t that worried. Recurrences typically occur on the same side as the original cancer, and it was unlikely that her mother had developed a new primary cancer in her right breast.
“I told myself, ‘It’s going to be nothing,’” she said. “Denial is a powerful thing.”
And even after a biopsy confirmed that the lump was malignant, Dr. Teal tried to convince herself that this would be an “easy” cancer too, just like the first. But when an MRI showed that Ms. Brown had stage III breast cancer, an invasive type that spreads to nearby lymph nodes, Dr. Teal could no longer deny what lay ahead for her mother -- and the higher risk Dr. Teal now faced. So she asked her colleague Anita McSwain for a favor.
“Will you do my mom’s mastectomies,” Dr. Teal asked, “and then do mine?”
Hitting Close to Home
During medical school at Weill Cornell Medical College, Dr. Teal was preparing to become a general surgeon. She wanted variety and never considered specializing in breast surgery. During her surgical residency at New York-Presbyterian Hospital, she did a surgical oncology rotation at Sloan-Kettering Cancer Center in New York, where she treated dozens of young patients battling advanced stages of breast cancer. Dr. Teal didn’t think that kind of work was for her.
“It was very difficult and sad,” she said.
In the U.S., one in eight women develop breast cancer – the second-most common cancer in women after skin cancer and the second deadliest cancer after lung cancer.
After residency, she moved to Washington to work as an attending physician at Andrews Air Force Base, where she later met her husband, Dave, a flight navigator. A few months after starting at Andrews as a general surgeon, her mother was diagnosed with stage I breast cancer. (There are five stages, 0 through IV, with the fourth being the most severe because the cancer has spread to other organs and distant lymph nodes.) Ms. Brown needed a lumpectomy, a surgical procedure that removes a tumor from the breast, and radiation. She also needed a five-year course of tamoxifen, a drug that helps prevent recurrences or new cancers by hampering the activity of estrogen in the body.
A month later, Dr. Teal’s best friend was diagnosed at age 34 with stage II breast cancer. Ms. Turney had been a nurse on the cardiothoracic intensive-care unit at New York-Presbyterian Hospital during Dr. Teal’s residency. Ms. Turney had experienced breast cancer before. Her father died from the disease at age 44.
“It was really devastating,” Dr. Teal recounted. “When she was first diagnosed, she would cry and say, ‘I’m going to end up like my father.’”
Ms. Turney needed a lumpectomy, chemotherapy and radiation, followed by tamoxifen for five years. When she finished her treatment, she was tested for the BRCA gene mutation because her father had died from breast cancer at an early age.
BRCA 1 and BRCA 2 genes suppress tumor growth. When these genes mutate, the risk of cancer increases significantly – 60 to 80 percent for breast cancer and 10 to 45 percent for ovarian cancer. About five to 10 percent of breast cancers are hereditary. Most women who test positive for BRCA mutations develop cancer before they go through menopause. If a patient tests positive, they can consider preventative surgeries – bilateral mastectomies (removal of both breasts), a hysterectomy (removal of the uterus) or an oophorectomy (removal of the ovaries). They can also take tamoxifen, which reduces their risk of developing cancer by half.
When Ms. Turney tested negative, she and Dr. Teal both thought she was off the hook.
“Laurie felt this enormous sense of relief that she was going to be fine,” Dr. Teal said. “She was never going to face cancer again.”
After watching her mother and best friend both battle breast cancer, she decided to specialize in breast surgery to help women facing this disease. She left Andrews and came to the Breast Care Center at the George Washington University Medical Faculty Associates.
“I love what I do. I think it’s the most rewarding job – you can’t even really call it a job,” said Dr. Teal.
Her favorite part of the job is the relationships she forms with her patients. She spends half of her week in the clinic meeting with newly diagnosed patients, women she has recently operated on and patients she has been seeing for years.
“The patients are truly amazing,” she said. “I learn from them every day.”
A ‘No Brainer’
After her mother’s first cancer, life eventually returned to normal. Dr. Teal knew she faced a higher risk for developing breast cancer, but the fear had faded. She even missed a mammogram one year because she simply forgot. She became the director of GW’s Breast Care Center and had three children – a daughter, Ashley, and twins, Nick and Ellie.
That’s why her mother’s second diagnosis in June 2010 came as such a shock.
Ms. Brown had taken tamoxifen for five years after her first cancer, and that was supposed to protect her from future cancers. She hadn’t missed a mammogram since her first diagnosis, and her most recent mammogram showed no signs of cancer. Mammograms fail to detect cancers in about 10 percent of patients.
“She was doing everything right,” said Dr. Teal.
But still, Dr. Teal’s mother had metastatic breast cancer. While the tumor was only about one centimeter in size, the cancer had spread to 13 out of 18 lymph nodes under her right arm. This time, Ms. Brown needed a mastectomy on her right side, along with chemotherapy and radiation. She chose to have both breasts removed.
Just four years before Ms. Brown’s second diagnosis, Ms. Turney was diagnosed with metastatic adenocarcinoma, a cancer of the glandular tissue. Cancer was also found in her left breast – the opposite side from her first cancer in 1997. Ms. Turney needed another lumpectomy and another round of chemotherapy and radiation. Just like Ms. Brown, Ms. Turney took tamoxifen for five years after her initial bout with cancer, but in both cases, tamoxifen failed to protect them from a second cancer.
After finishing treatment, Ms. Turney elected to have both of her breasts removed as well as her ovaries and uterus. Although Ms. Turney had tested negative for BRCA, her doctors and her best friend believed she had some type of genetic breast cancer that had yet to be identified.
And as Dr. Teal watched her mother’s second cancer progress, she began to believe it was also behaving like a genetic cancer. It didn’t show up on a mammogram or ultrasound. It spread rapidly. And it withstood the power of tamoxifen. It was around this time that Ms. Brown also learned that her aunt had died in her 50s from breast cancer. Ms. Brown was tested for BRCA, but like Ms. Turney, she tested negative.
But still, Dr. Teal believed her mother’s cancer was genetic.
As she planned her mother’s surgery and treatment, she began thinking about how she could protect herself. A woman’s risk of breast cancer doubles if she has a first-degree relative (mother, sister, daughter) who has been diagnosed with breast cancer.
She could have chosen to take tamoxifen, which cuts the risk of breast cancer in half, but because tamoxifen failed to protect her mother, Dr. Teal worried that it wouldn’t be enough for her. And because her mother’s cancer was estrogen receptive, meaning her cancer is fueled by estrogen, Dr. Teal was especially nervous. She had undergone in vitro fertilization – a process that raises a woman’s estrogen level through drugs used to stimulate egg production – when she and her husband were trying to get pregnant after their first child.
She also could have supplemented regular mammograms with additional screenings, such as ultrasounds, Breast Specific Gamma Imaging and MRIs, in order to detect cancer early. But Dr. Teal didn’t want to have to worry.
One morning, while Dr. Teal was helping her mother recover from the bilateral mastectomies, her mother said, “I know I’m going to die from breast cancer. All I want is 10 more years.”
At that moment, Dr. Teal knew she wanted to avoid the risk altogether by having a prophylactic bilateral mastectomy – a procedure that reduces a woman’s risk of breast cancer by 90 to 95 percent.
“The choice for me seemed clear. My husband called it a ‘no brainer,’” Dr. Teal said. “He would much rather me do this than have me go through what my mom went through.”
Becoming the Patient
After watching her mother and her best friend undergo a double mastectomy and after performing many of them on her patients in GW’s Breast Care Center, Dr. Teal thought she knew what the surgery was like.
But she was surprised at how little she actually understood until she became the patient.
“It was such a different experience than what I expected. I would get out of bed, go downstairs and eat breakfast, take a shower, and I was completely exhausted and would have to lie back down for several hours,” Dr. Teal said of her January 2011 surgery.
Because Dr. Teal decided to undergo breast reconstruction, tissue expanders were inserted under the muscle during the surgery. The expanders slowly stretched the skin and muscle before the implants were surgically inserted several months later. She was surprised at how many muscle spasms she experienced from the expanders. But what surprised her the most was the numbness she experienced.
“All of a sudden you’re taking a shower, and you can’t feel part of your body. It’s like another body,” said Dr. Teal. “I thought I knew what my patients went through, but I had no idea. I learned a lot.”
Although the recovery took several months and she may never regain full feeling in her breast area, Dr. Teal has no regrets.
“I just feel total relief,” she said.
Several people have told Dr. Teal that she’s brave for electing to have the surgery. Dr. Teal doesn’t see it that way. She believes she was lucky to be able to choose when to have the surgery and to avoid breast cancer. It’s her mother, her best friend and her patients battling cancer who are the brave ones.
Even before her surgery, Dr. Teal decided to share her story. She documented her surgery in a video diary, and after her final reconstructive surgery, Dr. Teal was interviewed by Robin Roberts on Good Morning America and was featured in the Washingtonian.
“Women who find themselves in my shoes need to feel empowered to seek information and to make their own very personal choices, and they need to know that a prophylactic bilateral mastectomy is an acceptable option,” she said. “If sharing my story will help even just one woman, it’s worth it.”
Now, she can speak from personal experience.
“You’re going to find that the very basics are exhausting. Just getting dressed in the morning is really tiring. You’ll want to read a lot of junk magazines and watch a lot of movies,” Dr. Teal recently explained to 50-year-old Annie Beatty, who was diagnosed with breast cancer earlier this month. “Those four months that the expanders are in, they’re like having bricks inside you, but once the implants are in, they’re nice and soft.”
While cancer was only found to be in Ms. Beatty’s left breast, Ms. Beatty is choosing to have both breasts removed because she doesn’t want to risk facing cancer again.
“It’s not fun. I’m going to be honest. But at least you’ll have perky boobs,” Dr. Teal said with a smile.
It’s the little things that can help patients relax.
A preventative double mastectomy, however, is not the right option for everyone, Dr. Teal said. For some patients, their breasts are a big part of their identity, self-esteem and sexuality. Other patients don’t want to go through such a significant surgery if there’s a chance they won’t even get cancer.
But for Dr. Teal, the decision was ultimately about taking control.
“I wanted to take control before cancer had a chance to take control of me,” Dr. Teal said. “And I know that something else might happen, who knows. But at least I know that I can make sure breast cancer isn’t what gets in the way of me watching my kids grow up.”