Surgery Consult

On Thursday, September 5, 2024, we met with breast surgeon Jane Hui to learn of her plans for me. I’m receiving care at Masonic Cancer Clinic at M Health Fairview University-MN.

What’s going on: breast cancer. For you healthcare types wanting more detail, I have invasive ductal carcinoma, stage 2a, ER/PR negative, HER2 positive. My first TCHP chemo was August 28. I’ll be getting TCHP every 21 days for a total of six cycles. This arm of treatment includes two chemo agents, Taxotere and Carboplatin, plus two monoclonal antibodies, Herceptin and Perjeta, that specifically target the HER2 protein.

Now back to the surgery consult, with a side stop at an insurance denial. At my first oncology consultation, blood was drawn for genetic testing. My whole genome will be sequenced, though my meeting with a genetic counselor will focus on the results of testing for 11 genetic mutations specific to breast cancer. A few days after the oncology consultation, I received a call from the genetic counseling office to schedule an appointment and was told the first opening would be February 13, 2025. No, there is no cancellation list, but I’m welcome to call as often as I like and ask if there have been any cancellations so my appointment could be bumped up.

Then early last week I received a letter from the Medical Director of Saying No at BCBS, who determined genetic testing to be utterly unnecessary for me. In addition to delivering this pronouncement, the letter was insulting and condescending in tone. Dr. Hui sighed and rolled her eyes when I handed her the denial letter. She said, “I’m sorry. You do not need to do anything. We will take care of writing the appeal and expedite your genetic counseling appointment. I need this information to plan your surgery.”

The surgical options she presented include lumpectomy, single mastectomy, or double mastectomy. If there are no genetic considerations, Dr. Hui said lumpectomy would be a good option for me. Imaging has not revealed any lymph node involvement, but during surgery she will check 1-5 sentinel nodes on the affected side for cancer or scarring that might indicate cancer was there. If genetic mutations exist that would predispose me to more breast cancer, I will opt for a double mastectomy. I’m not interested in reconstruction and would have what’s called aesthetic flat closure.

If we are able to proceed with lumpectomy, I will be allowed to recover 4-6 weeks after the sixth round of chemo, then have surgery. After healing another 4-6 weeks, I will have radiation 5 days a week for a month. Then we go back to the monoclonal antibodies—just Herceptin and Perjeta—for several more months.

That’s a lot to take in, and at the same time I find it mentally and emotionally helpful to have a plan in place. On Friday I received a medical message informing me that Dr. Hui’s office has already submitted evidence to the insurance company for medical necessity of genetic testing. And just this morning I received a call rescheduling my genetic counseling appointment to October 3, 2024. Dr. Hui doesn’t mess around.