The Warriors

and Their Fight with Breast Cancer

If you’d stumbled onto the scene depicted in this spread, snapped late last December at Porter Road’s Dandelion Salon, you probably would have thought it was just another photo shoot for some new folksy, penchant-for-black-wearing musical troupe. Albeit one with a higher number of ‘X’ chromosomes than most.
    If you’d been near enough when the camera stopped flashing, you’d have overheard a couple of the women’s light-hearted lamentations about missing out on the Music City heyday of the 1950s, a time they heralded as the ultimate rock n’ roll scene. One ‘band member’ surely looked the part of a country legend in her long black dress and matching black coif, bringing to mind a young Loretta Lynn. She casually let slip she was a singer for almost 15 years, no big deal. Another ‘member’ with an impressive, waist-length sheet of the blackest hair is one part of local duo The Smoking Flowers, and has worked as a musician most of her life. Even with these two talented pedigrees in the mix, it quickly became clear this wasn’t what it looked like at first glance. In between sipping wine and romanticizing the supposed glory days they never saw, the real reason these girls were all gathered finally started to reveal itself at first boob grab.
     When the women suddenly and playfully groped at their chests — pretty much in unison, as if reacting to a signal only they knew — things quickly turned into a ping-ponglike exchange of information and silliness. All of it related to those two, weird-looking little mounds roughly half the world’s population have sitting atop their ribcages. Next came the intentional cleavage baring and questions like, ‘So, how do they look?’
     No, these women were clearly no band. And they weren’t talking music. They were talking boobs. Breasts, cans, twins, girls, melons — whatever nickname, crass or otherwise, by which you may refer to this particular part of the female anatomy. More specifically, they were talking implants and expanders. Stages, surgeries and scars. Plastic surgeons and chemotherapy. Yeah. They were talking breast cancer.
     As a conversation, it’s very personal for these women. But it’s a conversation that should also be personal for our community. If you’ve lived in any Eastside nabe for a while, you may recognize most, if not all, of these women. Lisa McCauley, a.k.a young Loretta Lynn, is a fixture in these parts, not to mention the hard-working publisher of this very magazine. Kim Collins, with the hair, is a multi-talented vocalist and instrumentalist who’s played in countless local bands through the years. Brandy Smiley, the jokester of the group, is a scissor-wielding hairstylist by day, fun-loving girl-about-town by night. And then there’s Twiggy look-a-like Tracy Hamilton, co-owner of the heavily trafficked watering hole, the Village Pub & Beer Garden.
     These women are our neighbors. And over the past two years, they’ve collectively experienced four breast cancer diagnoses; the removal of seven natural breasts; four “brutal” expansions; 20 weeks of chemotherapy; 28 days of radiation; hundreds of doctors visits; medications and supplements galore; five reconstructed breasts so far and immeasurable emotional, physical and financial distress. All that’s missing is the partridge in the pear tree. And while most of them have known each other casually through the years (this is Nashville, after all), this is their first planned get-together. Seeing them interact like this — goofing off, posing, chatting — you’d have thought they were the best of friends. With so many similarities in their circumstances, they were able to relate to each other naturally. For starters, all are East Nashville residents, all around the same age, all self-motivating types. However, it is their shared experience as breast cancer survivors that relate them the most.
     Fortunately, each woman’s cancer is currently in a state of remission. However, it’s still a seeming anomaly that all four would suffer from the same disease at a similar point in their lives, one that raises a lot of questions. How did this happen to them? Given their relative ages, are breast cancer rates in younger women increasing? Is breast cancer tied to lifestyle? The environment? What are the survival rates for the disease? What are the treatment and reconstruction options out there? Perhaps most importantly, how can we prevent this from happening to more women? Women like Lisa, Kim, Brandy and Tracy. Women like our neighbors and our loved ones. Women like ourselves.
     Statistics say roughly one in eight women in this country will develop breast cancer at some point in her life. Of course, we tend to think that ‘some point’ will be well into the post-menopausal years, and typically it is, says Dr. Pat Whitworth, a 30-year veteran oncologist who has practiced breast-related surgical oncology at Baptist since the early 2000s. But sometimes, like for our foursome — the oldest only 45, the youngest clocking in at 36 — the bad luck strikes a little earlier, and more often than not, it’s totally out of the blue.

Brandy’s diagnosis two years ago, at 43, was definitely one that came out of left field for the spirited stylist, whose cancer was completely asymptomatic. After seeing a segment on Talk of The Town about a free mammogram service for uninsured women at Meharry Medical College, she decided to go. “I didn’t have any problems, it was just time, so I went,” she said. “And they told me they found something.” What they found was a slow-growing, invasive form of Stage I, estrogen-fueled breast cancer.
    While she says she was shocked at the news initially — after all, she had just gone in for a routine screening — it didn’t take her long to rally and start moving ahead with a plan of action. Brandy found assistance through a United Way-sponsored breast-health program at Vanderbilt. They immediately got to work chipping away at her ever-mounting medical bills and placing her in the care of some of the country’s best doctors. With that help, Brandy was able to put her diagnosis in perspective pretty quickly, being the ‘live and let live’ type she is, and easily decided on pursuing a double mastectomy. “To me, it was a no brainer, really. Why have to go through this again?” she asked. “Plus, they’re just part of you. I mean, there’s children losing their legs.” About four months after the bad news dropped, Brandy said goodbye to her inherited set for good. “Good times,” she laughed with sharp, discernible sarcasm about the recovery period following her April 2011 surgery.
     Now, Brandy said she feels confident she’s through the woods. Finished with the reconstruction process, the vivacious 40-something is happy and enjoying her new rack. “They don’t look the same, of course. They’re scarred. But they’re boobs. They still serve the same purpose,” she joked. Her oncologist did prescribe chemotherapy as backup, but Brandy declined. “I said, ‘I’m a hairdresser, and I could make a lot of suggestions for your hair. But that doesn’t mean you’ll take them,’” she recalled, restating the past sentiment with just a touch of sass.

Luckily we live in a time where early detection makes cures almost a certainty for most, and there are a number of different treatment options available. These strides have helped make every woman’s unwanted journey with the disease as personalized and comfortable as possible. Women diagnosed a few decades ago received a one-size-fitsall treatment plan, complete with mutilating mastectomies, shoddy reconstructions, across-the-board chemo and virtually no resources for support. Today they can choose more individualized surgical plans ranging from lumpectomies, partial, single or double mastectomies to even nipple- and skinsparing mastectomies, depending on their breast and tumor size. As for supplementary treatments, where doctors used to give some form of chemotherapy to every patient with a tumor bigger than a centimeter, Whitworth said they know now because of molecular testing, it isn’t necessary for every patient.
     According to Whitworth, it’s not these measures that have made the most indelible impact on how we treat breast cancer today. In his eyes, the best thing that has changed is the way women dealing with it are treated by his very profession. “We’ve gotten a lot friendlier in how we navigate women through this process and how we respect their preferences. Different women want different things.”

Kim Collins fits that bill to a T. As close to a health nut as you can get without being over the top, Kim said she’s lived more than half her 42 years in a consciously preventative way: becoming a vegetarian at age 20, staying fit with exercise, de-stressing with yoga and meditation, even using “green” products before they were mainstream. Kim made these efforts mainly because with her career choice as a musician, she knew money might be tight and affording insurance could be tricky. Along with these practices, Kim chose to avoid most traditional western medicine, opting to learn all she could about holistic and alternative remedies. Naturally she also avoided things like mammograms because of the radiation exposure, but after noticing a cyst-like bump during a self-exam in late 2011, Kim thought maybe a mammogram might be just what the doctor ordered, literally.
     But her screening came back negative, as did her ultrasound. That could have been the end of it. That it really was just a cyst on top of another cyst like she was told. Not being the type to take chances where her health is concerned, she pushed forward with a biopsy anyway.
     When she found herself sitting in the doctor’s office receiving a diagnosis of early stage, invasive breast cancer, she said it was “mindblowing,” especially considering how healthy her overall lifestyle had always been. She was further dumbfounded, though, by the fear that first doctor instilled, saying she needed to ‘get it out’ as soon as possible. “He frightened the living daylights out of me,” Kim said. It was that fear-based mentality that propelled Kim to look elsewhere for medical advice and find the strength to chart her own path to recovery. She chronicled her experience in a blog, The Warrior and The Wishbone: “I decided that I could choose to take one of two routes: I could pity myself and think it’s the end of the world and only listen to mainstream doctors … or I could step up, find strength and use the mass of information … out there on alternative cancer treatments and use it to heal and better myself… .”
     And step up she did, with the help of Dr. Stephen Reisman, who practices non-conventional medicine with a mind-bodynature orientation. It was he who encouraged Kim to take time and really delve into the abundance of literature available in order to find a treatment plan that most fit her life. “The first thing he told me was that time was on my side.” She quickly realized if that truly was the case, then she had the choice to battle her cancer with fear or without. She chose without. Kim immediately adopted a raw food diet to put her body in its most optimal state of health (which sounds ironic given the cancer) and prevent it from metastasizing. She also began a rigorous regimen of natural supplements and treatments. “I chose to do the therapies I thought would suit my type of breast cancer the best,” she said.
     She did elect for a single mastectomy in conjunction with these treatments as she said she’s fine with western surgery in most cases. And fortunately for Kim, reconstruction has made major advances even in the last five years, according to Dr. Kristina O’Shaughnessy, a plastic and reconstructive surgeon specializing in mammoplasty at Nashville’s Maxwell Aesthetics.
     “Patients today get a choice,” she said. “But you have to weigh out your risks and decide which option is right for you.” Choosing to pursue a single mastectomy instead of a double was just another decision that Kim felt best aligned with her overall attitude toward modern medicine. With her small frame, she was a good candidate for a single mastectomy with reconstruction, a procedure that used to be plagued with problems like asymmetry and lop-sided nipple placement. But now, doctors are able to produce just as beautiful results with single mastectomies and even lumpectomies, said O’Shaughnessy.
     “Expander and implant-based surgery has come a lot further,” she explained, mainly due to the use of acellular dermal material, or cadaveric cells that function like a “musclein- a-box.” Where surgeons used to have to raise as many as three large muscles in the chest cavity to protect the expander and eventual implant, they now suture the expanders and implants to the chest wall, using this faux muscle to cover them. By not having to raise actual chest muscles, expansion before augmentation is not nearly as painful an experience. O’Shaughnessy reiterated that reconstruction is “a very difficult process, but it used to be a lot worse.”
     Working solely with the latest in breasthealth science and technology, O’Shaughnessy and her colleague, Dr. Patrick Maxwell, are taking reconstruction to another level. In fact, their office is the beta site for the nation’s only 40-imaging machine specifically designed for breast reconstruction. “It’s very difficult for women, after mastectomies, to think they will ever look normal again,” said O’Shaughnessy. “With this system, I can take a picture and virtually show them what they’re going to look like with implants,” giving them a better understanding of the process, helping turn devastation into hope for many women.
     As the youngest of the group, Tracy knows that devastation all too well; it was the hope that was a little harder to come by. Diagnosed exactly one year ago at 35, she and her husband, Jesse, were running a thriving business and had just become parents to their first child, Charlie. They were on top of the world. Or so they thought.

As a new mom, Tracy was always breastfeeding, so when she noticed some swelling under her right arm, she thought it was probably just a clogged milk duct and applied a hot compress. After a week with no change, she went in to see her OB/GYN, not wanting to take chances since breast milk was her son’s sole diet at the time. Not convinced of Tracy’s theory, her doctor ordered an ultrasound, and with that, Tracy knew it couldn’t be good. Next came the biopsy and eventually her growing fears were confirmed when she was told she had a malignant tumor, 5 cm in diameter. Breast cancer. Stage III. “I had kind of prepared for it,” she said, “but I wasn’t prepared for how advanced it was. That part was unnerving.”
     A little less than two weeks later, Tracy had her first chemo treatment. She recalled that time as a real “nightmare,” one that kicked off with her diagnosis, then CAT scans, PET scans, MRIs — the full-on alphabet soup. In this situation, it seems only natural to wallow and indulge in a little self-pity, especially someone with an infant child. And wallow she did, but only for a brief moment, deciding rather quickly that she would be all right. She had to be all right, for Charlie. “It’s scary,” she said. “But after those first couple weeks, it became a lot easier. You flip a switch in your brain. You just have to deal with it.”
     “Dealing with it” for Tracy involved 20 weeks of intense chemo that eradicated every hair on her body, a double mastectomy in which they not only removed both her breasts but 18 of her axillary lymph nodes, and roughly six weeks of radiation. Her life became a never-ending parade of treatments and doctors’ appointments but Tracy refused to lose sight of what was important through it all: her family. That was her hope. That is her hope.
     Youth is her hope, too. Youth is hope for all these women and it has served them well, enabling them to bounce back from the incredible physical stress and trauma. It is their blessing. But it is also their curse, because the earlier breast cancer rears its ugly head, the more likely it is to come back later in life, Whitworth explained, partly because these women will most likely live longer in general.
     Still, the question begs to be asked: Is there really a growing prevalence of breast cancer in younger women? Whitworth doesn’t think so. “I don’t know of any data that shows women under 40 are having a spike in cases, or really under 50,” he said. In fact, according to The Maurer Foundation, a breast-health education resource, 95 percent of all breast cancer diagnoses occur in women over 40. Whitworth said what may seem like an epidemic is really due to so many advancements in diagnostic techniques, like better mammography and ultrasound imaging, which allows for earlier detection.
     Even if there isn’t evidence to support the idea that incidence rates are rising in younger women, there’s still something going on here. Whitworth cited the usual risks for women of all ages like being overweight or a heavy drinker. Of course, none of those risks apply to this group. But he also proposed the idea that high stress levels could potentially be a precursor for the disease. In today’s dogeat- dog world, it can be challenging for any woman to keep a handle on her stress, especially the independent types like this bunch.

It was around the same time Tracy’s fate was becoming clear that self-professed workaholic Lisa was embarking on a similar misadventure. At 43, she was plugging away, turning her one-year-old baby, The East Nashvillian, into a relatable and successful read. An admitted type-A personality, Lisa had always been a go, go, go kind of girl, so when some soreness and pain in her right breast slowed her down, she went in for a check-up. Her doctor didn’t notice anything unusual, only advising the Diet Coke fiend to lay off the soda since high caffeine intake can cause pain in women with dense breast tissue, like Lisa. But since it was time for her yearly mammogram, he went ahead and set one up just to be safe. A couple weeks later, he called her back in to further investigate some abnormalities found on that first screen. After an enhanced mammography and ultrasound, her OB/GYN turned her over to Whitworth, who recommended a biopsy, saying she had a lesion that “looked highly suspicious for cancer.” “My heart sank,” Lisa said.
     Sure enough, the “highly suspicious lesion” was, indeed, cancer. Stage I. Even though Whitworth told her the tumor was slow growing, having been there for years maybe, they quickly got the ball rolling. “He was fast and furious with me,” she said, “but not because he had to get it out or I’d die, but for my sanity and peace of mind.” For Lisa, who is used to being in control, that was exactly how she wanted to play it. She underwent a double mastectomy about two months after she first heard the news, but being a naturally positive person, it didn’t take her out for long. This whole experience has changed her perspective on what really matters. Yes, work is important, she admitted, but it’s not the end all, be all and sometimes, she realized, all that self-imposed stress just isn’t worth it. Learning to let go of the control that she so fiercely held onto as an independent businesswoman and focusing less on the little things are perhaps the most positive things to come from her diagnosis, she said. Not that Lisa’s no longer prone to stress, but she is learning how to take it all in stride. “It’s been such a tough year, emotionally and financially, but I feel like I’m coming to the light at the end of the tunnel,” Lisa said. “And luckily the magazine has done so extremely well, but really, it’s been in spite of me.” Whitworth said that while stress is not a direct cause of cancer, “it’s better for your quality of life and health in general to be less stressed.”
     But the question remains, how did these women wind up with breast cancer? “When something like this happens, it’s like a lightning bolt. You want an explanation for what the heck happened,” Whitworth said. And these women are no different. Of course, they all have theories on what triggered their bad luck. Brandy blames the doctor-prescribed hormone replacement therapies she started when menopause set in in her mid-30s. Tracy chalks it up to hormone therapies she took in order to conceive. Kim hypothesizes potential poisoning from mercury fillings in her teeth, which she says were improperly removed years ago. And Lisa, who grew up in the factory town of Old Hickory Village, believes it to be the result of some possible environmental pollution.
     While there is an indisputable link between hormone therapies and breast cancer, for Kim and Lisa, who claim a potential environmental factor, Whitworth and O’Shaughnessy agree there just isn’t enough concrete evidence out there to prove that link, even with all the increased hormones in our food and higher levels of toxins in our world. “We just don’t have good evidence yet,” Whitworth said, “but we also don’t have proof against it.”
     His explanation? It’s just plain old biology. If a woman has a family history of breast cancer or a genetic predisposition with a BRCA mutation, it goes without saying that her likelihood of an onset is infinitely higher than if she did not have those ties. This group of women, though, unanimously lacks both a family history and presence of the gene, making the onset of their illnesses all the more curious. At the end of the day, there is no known direct cause of breast cancer, but doctors agree that every single woman on this planet is at risk. Put simply, if you’ve got breasts, you’ve got risk. Still, getting a positive diagnosis can throw a wrench in any woman’s life. That’s why it’s so important to assess and monitor that potential risk as early as possible. Whitworth hopes to accomplish this by adopting a more individualized approach to how women are screened, profiling all possible risks like their family history, first menstrual period, first pregnancy, etc., at a younger age. Because it is early detection that allows for the majority of women diagnosed to be cured.
     Of course for Brandy, Kim, Tracy and Lisa, and for all women who have had breast cancer, the latent possibility of another reoccurrence down the road never goes away. Unfortunately, it’s a cross they must bear, but they all bear it proudly. Even though they’ve been dragged through the mud that is breast cancer, each of them would surely admit to having come out the other