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Living with Risk: Ashley Martin

Written By Mary Alice Hartsock

Ashley Martin, 27, remembers her mom’s breast cancer diagnosis clearly. Ashley was around 11 years old at the time, and she watched her mom go through surgery, chemotherapy and hormonal therapy.

"I feared that I would lose my mom," she says. "This turned into major separation anxiety. I couldn’t leave her, and I didn’t go to school for a time. I was afraid that I would go to school and come home and she wouldn’t be there."

Ashley’s anxiety gradually lessened as her mom’s health improved. Her mom read about breast cancer and took an active role in managing her health, and Ashley followed her example. At that time, Ashley never imagined she would later have her own breast problems.

Making Decisions After An Unsettling Discovery

All of that changed in 2007 when Ashley’s gynecologist found a lump in her breast. Because of Ashley’s family history, the doctor sent her for a mammogram.

"That day was unnerving and awkward," Ashley says. "You’re not supposed to be getting a mammogram in your 20s, and I’m a modest person to begin with."

After the mammogram, Ashley’s doctors wanted her to have an ultrasound, leaving her with more questions about her health. After the results came back inconclusive, her doctor referred her to a surgeon for a consultation.

"The surgeon said there was a lump, but because of my age and health, she thought it would be best for me to perform breast self-exams periodically and to follow-up with her if I felt any significant changes. She didn’t entertain anything other than watching it on my own."

Ashley wasn’t happy with the surgeon’s recommendation, and she felt their personalities didn’t click. So she decided to see a breast specialist.

"[The specialist] was great," Ashley says. "She did an exam, looked at my films, and ordered a digital mammogram and ultrasound. The lump looked the same. So she suggested that I get a mammogram and ultrasound twice a year. That’s what I’m doing now.

"I trust and like this specialist, and I am comfortable with her. When I leave her office, I don’t feel like I need to keep worrying about it. She performs the mammograms and ultrasounds herself and walks you through each process, helping you understand what she sees and feels and what that all means in terms of management or treatment. She also is empathetic to what my mother is feeling and takes the time to talk to both of us about future decisions."

The doctor also helped Ashley understand the option to undergo genetic testing to find out if she carries one of the known breast cancer genetic mutations, but Ashley decided not to have the testing and does not plan to in the future.

"I feel that I have a specialist that is providing me with continuity of care and going above and beyond to monitor and manage my situation," she says. "I am afraid that if … the outcome does reflect that I carry a mutated BRCA 1 or BRCA 2 gene, that I will become consumed with thinking about my breast cancer risk. Moreover, if I do carry the mutated genes, I do not think my care would change. I am already practicing risk management options such as frequent clinical exams, mammograms, ultrasounds and positive lifestyle changes, and continuing these practices is what will keep me a step ahead of any cancer issues that may arise."

Her doctor supports her decision not to undergo the testing because Ashley is focusing on regular screening and overall health.

Coping with Screening

For a graduate student like Ashley, twice-yearly screening has caused financial strain. Because of her young age, her screenings are only partially covered by her health insurance.

"I know your health is of utmost importance, but when you’re trying to survive financially, money is one of the first things you think about," Ashley says.

Luckily, Ashley’s good relationship with her doctor allows her to feel confident that she is moving forward in the best way possible.

"When all of this started, I was crazed about feeling the lump. Ten times a day, I would feel it. But my doctor said, ‘You’ve got to stop doing that. Let me take care of what needs to be done.’ I think I owe much of my sanity in terms of my health to her."

Planning Ahead

Ashley wonders what she will do if she needs surgery in the future. She also worries about how her health could affect her relationship with her fiancé and plans for the future.

"I just got engaged a few months ago, and my fiancé is very supportive. He knows the history and has gone with me to a couple of mammograms. I always think in the back of my mind, though, is my sexual relationship going to change if I have to have surgery?"

Ashley is not ready to have children now, but she thinks about whether her history of breast problems and her mother’s history of breast cancer could resurface in her children. But her mother has advocated for Ashley to get the best tests possible, and Ashley knows she will support her children in the same way if they develop breast problems.

In her work as a public health student, Ashley uses her experience with breast problems to better relate to people with health issues. Last spring, she worked with Sisters’ Health Initiative, a breast cancer support group for African-American women in North Philadelphia.

"I’ve gotten through having all the mammograms and ultrasounds, and I’ve completely gotten over my modesty issue," Ashley says. "I’m more comfortable talking about it and why I’ve made the decisions I did. You need to talk to people. That’s what will help us get through it."

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