Life After Breast Cancer

Sandra Gurvis
Dr. Deepa Halaharvi

When 46-year-old Dr. Deepa Halaharvi joined OhioHealth as a breast cancer surgeon in 2014, she never expected to become a patient herself.

“I had just finished my surgical training,” she recalls. A later-in-life medical student, she was married with two young children and an aging father to care for, so she worked as a physician’s assistant prior to getting her doctor of osteopathic medicine degree from Kansas City University of Medicine and Biosciences in 2008.

That was the same year she arrived in Columbus to do a general surgery residency at the former Doctor’s Hospital, which is now part of OhioHealth. Reaching her professional goals, including certification from the American College of Osteopathic Surgeons, took many years and sacrifices and finally, it seemed, she had achieved her long-held goal.

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With no family history of breast cancer, she was shocked in 2015, after her first mammogram, to be diagnosed with invasive ductal carcinoma.

“My initial reaction was what you would expect from anyone getting the same news: denial, followed by anger. … I was starting my career, and I wanted to do a lot of things with my life,” she later wrote in her OhioHealth physician blog.

A Life-Changing-Decision

Halaharvi’s focus on kindness, compassion and a nonjudgmental outlook on life informed her decision to become a breast cancer surgeon. “When I was a resident, I worked with a young woman, a breast cancer patient, who later passed away,” she says.

Their connection was instrumental in her decision to specialize in breast surgery. “Not only is the research constantly changing, but I wanted to work with patients from diagnosis to treatment to survivorship,” says the doctor. “I wanted to follow up and make sure they were making the best decisions possible.”

One of the ways she accomplished this was to give newly diagnosed patients the Oncotype DX Breast Recurrence Score test, which, by profiling the tumor, helps women avoid unnecessary chemotherapy, “as well as identifying the important minority for whom chemotherapy can be life-saving," she explains.

Thus, some women with breast cancer are spared a potentially invasive treatment with serious side effects. “I’m not saying chemotherapy is bad,” she continues. “The test is also predictive and can tell you your risk of the cancer coming back.”

Unlike genetic tests that measure abnormal changes in blood, saliva and other tissues, Oncotype DX is a genomic test that went into clinical trials in 2007 and began general use in 2011. (This followed the finalization of the Human Genome Project, which completed the identification and mapping of all genes in the human body, in 2003.)

The Oncotype DX test analyzes the activity of 21 genes taken from the cancerous tumor. By seeing the test results, doctors can predict the activity of the genes and the effect they have on the cancer, including how likely the cancer is to grow and spread, according to the nonprofit organization

According to the website, the test score is used by doctors in two ways:

  • To find out the potential for recurrence of early-stage, estrogen-receptor-positive breast cancer, as well as how the patient will benefit from chemotherapy after breast cancer surgery.
  • To determine a patient’s potential recurrence of ductal carcinoma in situ and the risk of a new, invasive cancer developing in the same breast, as well as how likely a patient will benefit from radiation therapy after surgery.

Recent results from the largest breast cancer study ever conducted provided clinical evidence demonstrating Oncotype DX to be the strongest and most effective predictive measure available today.

Halaharvi’s experience is also a good argument for even low-risk women to get mammograms starting at age 40, as recommended by the American Cancer Society. Halaharvi had hers the week before her 42nd birthday.

“Had I waited until I was 50, I would likely have died,” she adds.

A Long Battle Won

There’s a saying that doctors often make the most difficult patients, but Halaharvi proved to be the exception. “Showing and receiving kindness was extremely medicinal for me,” she wrote in her blog.

“The phone calls, the text messages, people dropping in to see me. I remember even the little things, like the older gentleman at the hospital wheeling me down the hall after my surgery as I was getting ready to go home, the conversation we had was very nice; he made me laugh—it is the human connection—that was meaningful.”

Combined with Halaharvi’s age, her low score of 18 confirmed that she would not need chemotherapy and has a low risk of the cancer returning. Although hers was the most common type of breast cancer with an extremely high survival rate, she opted for radiation and underwent a bilateral (double) mastectomy, performed by the surgeon who had trained her.

The following year was exceedingly difficult for her, she confesses.

“I took six weeks off after surgery to recover and then returned to work,” she says. Along with having to deal with the effects of radiation, she had a total of five surgeries, fighting off an infection after getting breast implants and dealing with other complications from reconstruction.

“It took a year to recover from everything. I managed it one day at a time and prayed a lot. It was not easy emotionally or physically.”

Even today, almost five years later, she thinks about recurrence. “I worry, but not as much as when I was first diagnosed,” she says.

Halaharvi’s experience provided the impetus for her to start a “Put Chemo to the Test campaign, which helps women make informed decisions about early-stage cancer treatments. “It’s about raising awareness of the [Oncotype DX] test and encouraging recently diagnosed women to have open conversations with their doctors about their options, so they can feel confident in their treatment plans,” she explains.

She also emphasizes that the test should be given to all ages, pointing to a study from the National Cancer Institute that found that patients under 40 and over 70 are far less likely to get a genomic test compared to those between 40 and 70.

Age can be an important factor regarding risk and recurrence. Treatment options are different for women under 50 whose Oncotype DX scores are between 25 and 50. Additionally, “older women may not tolerate chemo as well,” says Halaharvi, making it even more vital that they be aware they may not need it in the first place.

The “Put Chemo to the Test” campaign has caught on nationally, resulting in Halaharvi’s appearance on the Today show and hundreds of radio, television and print interviews, taking even more time out of an already busy schedule filled with family and patient obligations.

Along with being honored in 2017 with a “Hero of Hope” award by the local division of American Cancer Society, she has lectured at commencements, talked with dozens of different groups ranging from students to survivors to employees at Fortune 500 companies, and co-authored papers and book chapters, along with participating in breast cancer-related research projects. “It helps that my husband and children—now ages 20 and 14—are understanding,” she says with a laugh.

Her patients are still a priority and, as odd as it may sound, she is now almost grateful to cancer, she says. “It taught me so many things—to live in the present, to appreciate my family, to let go of the need for ‘control’ and accept help from family and friends,” she adds.

It also changed the way she perceives and treats patients. “Before, I had a hard time understanding why women kept asking the same questions over and over again,” she says. “Now I realize they are in shock and denial and only retain a small portion of the information [that I initially give them]. So I answer all of their questions and repeat myself a lot.”

As a result, once they are diagnosed they become close, like family, which gives her a deeper understanding of her patients’ emotional and financial security. All of this gives her the willingness to answer even the most challenging questions, including those about sexuality.

“The cancer has taught me to say ‘yes’ to a lot of things I might not have considered before and to emphasize the fact that we women—especially those who care for others and tend to put things off or aside—have to take care of ourselves first,” she says.

Reprinted from Columbus Monthly Health 2020.