Subhasmita was diagnosed with breast cancer at 26. She talks of her physical and emotional journey as she made difficult choices. What kept her going through the worst days of breast cancer treatment and how she handles the issues of breast cancer survivorship.
I am Subhasmita, 29 years old, Single. A marketer. I am a breast cancer survivor (ER+, PR+, her2neu-, stage 2A). I grew up in a small village in Odisha and I work and live in Kolkata at the moment for work. I paint, read and write in my free time.
Diagnostic journey
Early symptoms
I felt a hard mass in one of my breasts. It was a hard mass, wasn’t mobile or round at all. It wasn’t painful either. I brushed it off as “something might have swollen. It will get better.” It was a mentally challenging time. I deprioritized getting tested among all the chaos in life. In retrospect, I should’ve taken it seriously. 6 months later, I started having mild pain starting from my breast to hand to back. I panicked and went to see a breast surgeon (surgical oncologist).
Diagnosis
As per the recommendation of the breast surgeon, I did an Ultrasound and Mammogram, both of which showed some spots but were inconclusive. The breast surgeon then prescribed a biopsy. I saw a medical oncologist for a second opinion. He too suggested a biopsy to get clearer idea. It took 2 full weeks for the biopsy report to be finally available. With each passing day, the fear of cancer was getting more real. This time the report was conclusive, it read “Invasive carcinoma of no special type”.
I had gone to collect the biopsy report alone, and when I saw the words ‘carcinoma’, it felt as if the ground beneath my feet collapsed. I didn’t have anyone to share the shock with. I went to the toilet and cried. I didn’t know where to go, who to call, what to do? My whole life flashed before my eyes- I have my job, my ambitions, my study loan, my parents, my cats to take care of and I am just 26. I stay active, and eat healthier than most people. How can I be having cancer? What now?
I immediately called a doctor friend, who confirmed I have tested positive for cancer. I called my mom. She was in disbelief, her voice breaking as she was trying to console me. Both parents were on the bus the next hour, coming to Kolkata.
Next day I went to the medical oncologist to show the biopsy reports. He gently said, “Unfortunately, you tested positive for cancer, but the good thing is age is on your side. You are much stronger to deal with the treatment now. It will be over before you know it and you’ll move on with your life as usual. We don’t know how big it is and whether it has spread to other areas. Once we know the extent of the growth, we will formulate a treatment plan.” He suggested I do a PET CT scan. The PET scan showed the growth was limited to breast (non-metastatic) luckily but was located in multiple places within the breast (Multicentric carcinoma). I could see at least 7 dark spots (growth) in the plates.
Coping with the diagnosis at this young age
At 26, the most pressing issues were boyfriend problems and hangovers. I hadn’t, in my worst nightmares, thought of having a life-altering illness. Don’t they tell you women have high chances of cancer after the age of 50? Then, why now?
The disease ‘cancer’ is synonymous with ‘death’. Society sees with pity the families whose member has any type of cancer.
I was quite uncomfortable identifying myself as a ‘cancer patient’. I asked my doctor multiple times why and when the cancer might have occurred. If only I could know the precise reason, I could explain it. Unfortunately, cancer can be ticked off for thousands of reasons and one of them is “there’s no reason.”
I couldn’t fathom having to deform a breast. For women and myself, breasts are the symbol of sexuality, of beauty, of hotness. How would life be with a flawed body? The body I so proudly flaunt?
After the initial shock, I went into problem solving mode. I was on autopilot. I informed my workplace about the diagnosis, I had my parents with me to support and 2 other cancer survivors who guided me. Two advice that were gold:
- Gamification: treat each stage of your treatment journey as if you are on a game show. Reward yourself for completing each step such as a chemo cycle. The winning prize is the 2nd lease on life. The game will be tough, but the end goal is to survive the game.
- Parenting your parents: Your parents will be at their most vulnerable because no parent wants to see their kid go through cancer. You need to make them comfortable. That means you have to talk to them, show them that you are strong and capable of fighting it, and handle their emotions throughout the journey.
I had a good idea of what to expect next in terms of treatment, effects on my body and short-term future. It prepared me to be mentally resilient. This is why the survivor groups are important. Even though not all aspects will match with others, you can relate to other survivors and take inspiration from them.
Treatment
Treatment plan
The treatment plan suggested by my oncologist was: surgery, followed by chemotherapy followed by hormone therapy. There were questions such as, would I like to freeze my eggs or embryos before going for chemo. If so, that needs to be factored-in. Chemotherapy pauses the ovaries temporarily and though probabilistically the ovaries will get back to normal, some women chose to be on ovary suppression drugs, freeze eggs/ embryos to not risk fertility issues later. I chose not to do either. I went on to having the surgery and then chemo.
Surgery
Time was of essence because the growth was happening quite fast. The medical oncologist said, “Why wait longer? We should aim to do the surgery in 10 days.” “10 days?” I thought. “In 10 days I have to do a body-altering surgery because I have cancer.” None of it felt real. So, we went to see a onco-surgeon. He presented me with two options. Mastectomy without reconstruction and mastectomy with reconstruction. I blinked, “Wait, why are you jumping straight to mastectomy? Can’t you go for lumpectomy or partially remove the parts with growth? Would I have to lose my breast altogether?” Because the growth had been spread in all 3 quarters of the breast (multicentric), I had no option other than mastectomy.
Mastectomy- Losing a breast
"I had the toughest inner dialogue of two hours after being presented with mastectomy as the only option." I had to think about how my life would be from perspective of marriage, society, kids, my own sexuality. After a deep conversation with myself, I concluded that none of it mattered. What matters is that I need to LIVE right now. I have to get rid of the cancer because it’s killing me each minute. I went for a mastectomy without reconstruction. I didn’t get a reconstruction because I didn’t feel the need to. The surgery itself wasn’t too extraordinary. I was asked to rest for 3 weeks after the surgery, do my arm exercises regularly and take the prescribed medications.
Chemotherapy
I was prescribed 8 doses of chemo- 4 of AC and 4 of Paclitaxel, dose dense (2 weeks apart). I had already shaved my head after the 1st dose. I didn’t want to give cancer the power to take away my hair. Around the 2nd dose, all the remaining scalp hair fell out as well. By the 4th dose I was lethargic, slow, pale, and in general zombie-like. The next 4 doses were the worst.
Before every chemo, I had to get blood tests done. Since my arm veins were used to inject chemo, finding suitable veins to extract blood was a major pain. The veins in the arm where chemo was given had turned black. The arm was difficult to lift, and would hurt. Just when I would start to feel a bit better, the next cycle was due. It felt like it was never ending.
I felt weaker after each chemo cycle. By the 7th, I was completely exhausted. I couldn’t walk more than 2 minutes. I would get dizzy. I lost taste on my tongue. I couldn’t taste salt. I could only taste spicy and sweet near the oesophagus. I would imagine how the food must be tasting in real. My mom and cook helped immensely by cooking food I liked. I loved soups.
Hormone therapy
Somehow all 8 cycles of chemo were done. It was the happiest day of my life.
Now, I am on the hormone tablets called Tamoxifen. It is supposed to be taken once a day before breakfast. It has to be taken for the next 10 years as of now.
How did your family deal with it?
My family was supportive of the journey once it started but, at the beginning it was hard for all of us.. Some relatives made rude comments to my parents like “Poor girl, how will she marry now?” or “It must be her bad luck, well, what can you do?”
My father was in denial, and is still to this day. Maybe it is to do with being an Indian father, he never expressed his sadness nor said anything sweet. My mother was the one who stayed with me mostly because she could with her job. She was putting on a brave face in front of me but she would cry on calls with her siblings. She never showed but I knew it bothered her a lot. In serious illnesses such as cancer, the support for the caregivers is as important as the support for the patient. I was happy my mom had her siblings helping her through it. My mom’s worst fear is nobody will marry me because of my history and lack of a complete set of breasts. I have tried to make her understand that to live and be happy is more important than being married and miserable.
How did you navigate body image issues?
Being bald is no fun for a girl in her prime. I used a wig when going out and attending weddings. Once my hair grew a little long, I stopped wearing wigs altogether.
Uneven chest area: I don’t wear tight clothes anymore. I prefer wearing oversized t-shirts. In case I have to wear something fancy or traditional, I use a bra insert that gets the job done.
The fear of judgement: It was scary at first, but once I started opening up about my body image issues with my friends/ date prospects, they were all quite supportive. To my surprise, most men I met didn’t care about the fact at all.
Intelligence vs. beauty: I reasoned with myself that I am a smart person with a lot to offer. A flaw in my body shouldn’t be the highlight of my profile.
How did you handle your mental health during the journey?
Certain days were purely cruel especially the last few chemo cycles. They were painful and depressing, I would burst into tears and sleep a lot. I wouldn’t say I was graceful all the time even though I was trying hard to keep it together.
Therapy: I spoke to my therapist (she was my therapist from before cancer, so, I didn’t have to start over). She helped me feel validated about my feelings and helped me express anger as well as sadness.
Journalling: I would journal all the significant moments- good and bad, and try to revisit them when things became tough. Journalling showed me that I was resilient enough to go through the worst bits and made me hopeful about the best bits.
Painting: I painted a lot during this time. Surprisingly, all of them are florals, landscapes etc. so positive paintings. It was a great outlet to fall into a flow state during the treatment.
Support system: I had a great support system- all of who still are close to me, my parents, sibling, my best friend and others took great care of me. Made sure to always check on me and be available when I needed them.
Stoicism: This was around the same time I was exploring the stoic philosophies. I came across Ryan Holiday’s work, Reddit’s r/stoicism, many stoicism sites that talk about dealing with tough times and life in general. It resonated with what I was going through. On the days I could, I practiced stoicism.
Hope: of a normal life. I looked forward to be being able to do basic things like taste food, walk for half an hour, lift things, not be pitied, and conquer life.
How did your workplace support you during treatment?
My workplace is an MNC with great culture. My team and clients were supportive of my journey. I requested to stay on the role during the chemotherapy (I asked my oncologist and he said it was fine). I worked through my chemo and my team, my manager and everyone was every supportive of me. They would regularly ask if they could help me with any task. My manager would regularly check-in on how I was feeling.
I was lucky in that I happened to be working at a great organization which prioritises health.
What are the long-term effects of the treatment?
Since the ovaries undergo a literal ‘pause’ during the chemotherapy, my periods stopped and I got hot flashes for 6 months. The hormonal imbalance seems to continue even now. The PMS is at life-time worst, I can feel the mood swings and foggy brain more prominently now (after the chemotherapy) than I did prior to cancer.
Constipation is still a regular problem. When combined with low hydration, low fibre intake and high stress, it gets worse. It is somewhat manageable with proper care and medication.
I have been working out ever since I felt a bit stronger. A lot of upper body strength exercises like chest press is limited to a certain weight(5 kgs each). When I tried to increase to 7.5 kgs, I started having pain in the back muscles. Exercises where you have to support your weight with your arms such as side-plank and push-ups are also difficult for me.
Effect on personal and intimate relationships
Cancer ghosting: I had a circle of people I called friends before the diagnosis. Slowly they all disappeared from my life. Texts and calls faded. It felt as if they saw me as a burden.
Closeness with family: Before cancer, I prided in my independence. I lived alone with my cats, never asked my family for help financially, emotionally or otherwise. After cancer, I had to accept that fact that, the only people who unconditionally could be there for me 24x7 was my family. It was a big adjustment initially having them in my space. My father for example, was in denial and was struggling in his ways with the news. There were ugly back and forths but eventually we found our rhythm. I am the closest with my family right now, and I am grateful for their care and support.
Dating: I was speaking with a guy who seemed nice and cared about the journey at first. Soon he wouldn’t check in on me as frequently and eventually we stopped talking. While reasons might be many, I couldn’t help but think it was because of cancer.
Seeking friendship: Since cancer, I cherish all forms of friendships, short and long. I try to be more present with them and reach out to them more often. This has led to a solid set of friends with various level of closeness.
What helped you
Accepting the reality, being in a problem-solving mode, being at the driver-seat of the treatment, asking for help, being open to receiving help, having a support system of reliable people, going to therapy, staying as much active as possible, asking for help from or checking with other cancer patients and survivors about the experience, being stoic, letting the emotions out once in a while, art and journalling, hope of a normal life post-cancer, and last but not the least cancer memes helped.
What did not help you
Searching for why: Trying to investigate why cancer occurred, and why it happened to me only made me fall into victim mode. I should have rather focused all my energy into getting better.
Unsolicited death news: On hearing about my diagnosis, most people would recall all the people in their lives who have died of cancer or are miserable because of it. While I understand that it is human nature to share things that come to our minds, a cancer patient who is anyways fearful of death does not want to hear such stories.
Forcing friendships: I thought if my friends saw how elegant a patient I am, and not a burden on anyone, they would want to speak to me and be friends with me again. It was a reality check moment for me when they still replied “Why don’t you go home, your parents will take care of you?” I wasn’t even asking for any help when this reply came. It broke my heart. Cancer is a great filter of fake friends.
How does staying active help you?
Since I gained back my strength after the treatment, I have been working out fairly regularly. It helps me become more confident about my appearance as well as makes me mentally strong. It also helps with the hormonal imbalance, digestion, stress and sleep.
Each morning when I finish my work out routine, I feel a sense of accomplishment that sets me up for the challenges of the day. Recently I have added “cold exposure” to my morning routine where I take a cold shower just before hitting the gym. Lifting heavy things, staying positive, being more present are all side-effects of which I am very proud.
2 years after treatment – where are you physically, mentally?
Physically, I am at my best. This might be the only silver lining to the journey. I am now careful about what I eat, when I eat, my work outs, my online content consumption, my thought patterns etc.
Mentally, it’s mixed. While I am more resilient, try to stay positive, and be mindful; the issues I had deprioritized like anxiety & depression are coming back. I am trying to deal with them one by one.
I can’t help but feel if I hadn’t got cancer, I would’ve achieved much more in life. A lot of things in life have a compounding effect. I am rebuilding my life and career brick by brick.
