This month, as the focus is on breast cancer awareness, we bring some stories which were published last year, of breast cancer survivors.
This story was published on October 30, 2022.
Neuro ophthalmologist Dr Jasmine Gopwani counts herself a fortunate woman today, having come through what her girlfriends described as “the best case scenario” of breast cancer.
Two years after first receiving the dreaded diagnosis and following successful surgery and treatment, Jasmine still grapples with the “roller coaster”of emotions she endured during the ordeal. For the professional wife and mother of two young children, the emotions of the experience continue to be ever present.
“There were a lot of emotions and I still deal with them. I have to scan now every six months instead of every year and my risk going forward is increased due to my history of having had it, so getting the scanning, the repeated mammograms, the ultrasounds and MRIs are with a bit more anxiety than it had been before. It is life-changing and I am going to have to live with this experience forever,” Jasmine said.
In her thirties, she made the decision that once she turned 40, she would start doing mammograms, because she explained: “through medical school, through my practice and through what I do right now, I do see and encounter a lot of women that have the unfortunate scenario of developing breast cancer at an early age.
“I would deal with things like brain tumours and sometimes it has spread from the breast. So it is something that I had been very intimately aware of leading up to the age of 40.”
The moment she reached age 40, she started doing a routine yearly mammogram, “not because I am at risk since I do not have a family history of breast cancer; my lifestyle is not one that predisposes to breast cancer in that I am not obese; I don’t drink excessive alcohol; I live a pretty healthy lifestyle; I have two children and they always say that having children and breastfeeding them reduces the risk of breast cancer.
“I was doing everything that I should but I still wanted to do everything to check. Women are always given the option of starting mammograms if they want to from the age of 40, though it is more recommended when you are a bit older.”
After that first mammogram at age 40, she had another at 41 and opted for an ultrasound at 42 because the COVID-19 pandemic was raging at that time.
However, she said: “When I turned 43, I had a mammogram done and it revealed calcifications that were not there on the previous mammogram that I had done. Then I had a follow-up ultrasound and it revealed a tumour.”
The pathology coming back from the biopsy done on the tumour revealed “ductal carcinoma in situ (the presence of abnormal cells inside a milk duct in the breast, considered the earliest form of breast cancer).
Jasmine said: “The ultrasonographer looked at my mammogram, was a bit alarmed at the presence of calcification and did the ultrasound focusing especially over the area that the calcifications were located and that’s where she saw the mass. She said she must do a biopsy.
“That took a few hours rather than the few minutes that I thought it would take. I had to call Chris (her husband, parliamentarian and businessman Christopher Gibbs) and tell him that they found something abnormal on the ultrasound. I was very matter-of-fact because at that time I was just thinking at that time, ‘I have to sort out my son.”
Her immediate thoughts were for her ten-year-old son Naveen whom she had left behind in a section of her office converted to a classroom, doing online school in preparation for 11Plus examination, promising him: “I will go for this quick appointment and come back and get you.”
Jasmine recalled: “I messaged my mother while I was waiting for the biopsy to be done and she told me not to worry because they still have to see what it is. But at that time I already knew.”
The biopsy was sent overseas to determine whether or not the cancer was invasive. It was not, as Jasmine explained, “the tumour margins were clear. That would put me at a very early stage (of cancer)”.
Chris accompanied her to the “jovial lighthearted” appointment with her colleague Dr Margaret O’Shea to discuss the case and the options.
“I told her one way or another, if I have to get them (breasts) off, I would get a nice non-cancerous pair in their place, and that would have depended on whether it was invasive or not. If it was, I would have to have a mastectomy, probably bilateral, but it did not have to be that involved. I managed to just get it locally excised and because I am ample it has not caused a whole lot of disfigurement. I have just got a lovely scar in its place.”
Floodgates really opened
“I left the office with a big bandage on my chest that I did not expect to have and when I got home, the floodgates really opened.
“Chris and I just went for a little walk outside of the house and I told him that I am really scared of my children not having a mother going forward. It was just really all of my fears and his fears coming out. He was very, very sad as well. I think that was probably the worst day. Knowing that I had these two little ones (Naveen, ten and Nalina, four) at an age when they really needed their mother. The emotions were all over.”
Meanwhile, her father, a retired ear nose and throat surgeon, was “very quiet.”
“I am the apple of his eyes and I don’t think he could process it well enough to give me a reaction, but as the good news kept coming out, he was very happy.”
Coming to terms with the reality of her situation, Jasmine next determined she would get radiation treatment and opted for the linear accelerator (a machine commonly used to deliver external beam radiation treatments to cancer patients) which is not available in Barbados.
“I had to go to Miami to get that done. It is a very targeted type of machine that they use in radiotherapy and you want it to be targeted because your breasts are located very close to your heart and your lungs and you can get a lot of complications to those organs while you are doing the radiation. So most oncologists will urge you to seek radiation with a linear accelerator instead of the cobalt radiation that they have here, which is used for other types of tumours.
“Radiation can take six weeks, so it would have normally meant a sixweek stint in Jamaica or Trinidad (the other two countries in the region where the linear accelerator treatment is available), but in Miami they have a special device and technique where they only require it to be done for two weeks. It was a very targeted, partial breast radiation, really just focused exactly on the tumour bed.” Chris was again by her side.
After that would begin hormone suppression treatment to decrease the risk of recurrence of the cancer.
Jasmine revealed: “I am on those tablets for the next five years, which basically has menopause-like symptoms associated with it, which is what made it very difficult for me to start it, because I am 43.
“I have my last few good years left and to be taking a medication that is going to take that away from me, the decision to do that was a bit difficult. But after reading around it and understanding the risk, I decided my life is more important than a couple of hot flashes.”
Because she was so young with “no real risk factors” for developing breast cancer, she also decided to have the genetic check. “Luckily all came back negative, because you think about passing this on now. I have a five-year-old daughter and she is already going to have to screen ten years earlier than I had to, because when you have a first degree relative that has breast cancer, you have to start screening ten years before they were diagnosed. So all of that is going to have implications for my offspring.”
Looking back, Jasmine said the experience “made me very aware of the setback in our community, and what women require here and the fact that the breast cancer mortality is the highest per capita in the entire world, according to statistics put out in 2020.
“Whether it is due to people being hesitant about screening or whether it is due to the lack of a linear accelerator, I am not sure, but there are ongoing studies into that area.
“My appeal to women is go and get the mammogram, don’t wait until you are 45, don’t wait until you feel a lump.” (GC)