A New Year, A New Approach to Survivorship After Cancer

Cancer survivorship takes courage. We are often called to step outside our comfort zone. A big step for me as a survivor of invasive HER-2 breast cancer is to shift screening care from oncology back to gynecology. I may be a little late in making this decision, but my oncologist’s impending retirement inspired me to try gynecology again as a home base for breast health.

Five years after the original cancer diagnosis, my oncologist did say I could transfer care for post-treatment follow-ups and general screenings to a primary care doctor. I was not ready to cut ties. While I might be past the HER-2 breast cancer experience, knock on wood, I am still high risk for cancer. With family history of breast cancer, my personal history and dense breast tissue, I felt comfortable with an oncologist.

To be honest, I feel like I slipped through the cracks of my routine gynecology screenings the first time around. After moving to stage 2B cancer from “no cancer detected,” in one year, I felt safer in the cancer center. Annual visits addressed bloodwork, mammograms, the occasional MRI and general questions. I got advice about breast cancer and related matters such as blood sugar, bone density and heart health. To keep a body in balance, to hope to avoid further cancer or catch it early, diligent care is required.

For survivors feeling “once bitten, twice shy,” routine care can affect our relationship with the breast screening system. I finally feel ready to shift from the safety net of oncology, especially because I advocated to move from a nurse practitioner to a gynecologist. After having previously visited a nurse practitioner because I had aged out of pap smears and had no discernible “female” issues, I decided the transition from oncology would be easier if I returned to seeing an experienced specialist in gynecology.

While change, such as a new doctor, can take a little getting used to, change is not bad. For example, it might be good to have a new perspective. There are also a few research developments that will make this shift easier psychologically. The 3D mammogram, which my oncologist assured me works better with dense breast tissue, has become more widely available. Practices regarding follow-up, which can include ultrasounds or other testing, have become more commonplace.

I plan to be more involved with my gynecological care this time around. I will ask more questions about mammogram reports. Because I still wonder why I could go from a report of no cancer to invasive cancer in one year, and never feeling a lump with two tumors hiding out for a time in my dense breast tissue. I will be assertive about seeking further testing as warranted as we follow mammogram trends.

I hope never to have cancer again, but if I do I hope it is found earlier. I say this not out of regret, but out of a mature sense of self-advocacy. Making a decision related to survivorship is intensely personal, yet it is best informed by advice from medical professionals we trust and breast cancer research. In my case, I feel comfortable with the new normal that heralds a new year.

If you are wondering about when or if to leave a trusted oncology office, if the office suggestes that it is time, talk to your oncologist and do research about options for breast health care with, for example, a gynecologist or internist. Read up on specialists that are taking new patients. Read mammogram reports and ask questions. Compare trends and ask more questions. Never feel shy about your own health if your gut says follow-up is needed to look more closely at something.

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