Young Doctor, Unexpected Diagnosis: Breck McCarty

April 23, 2015

2015McCarty-Breck_mediumAfter finishing her family medicine residency at age 29, Breck McCarty felt “as if I had been going to school forever.”

That was about to change, as she and her husband-to-be prepared for the next step in their careers: moving from South Dakota to join a medical practice in a small Wyoming town.

When she felt a breast lump, Breck let it go for a few weeks. “It persisted, so I saw a surgeon who was one of our preceptors [teachers] in our training and requested that I get a biopsy.” He told her she was young and he didn’t think it was cancer, but would biopsy it anyway.

“He came to my house to deliver the news,” Breck says.

The new doctor was diagnosed with stage IIA breast cancer. She had a mastectomy just days before moving to Wyoming.

Pregnancy planning

At first, she didn’t think about how treatment might affect her fertility. Then a friend, also a family doctor, asked her about it. “I would not have even thought of it if she hadn’t mentioned it,” Breck says. “I was so overwhelmed.”

She had no children and wanted them in the future. She learned it was important to have fertility preservation, storing embryos or eggs before chemotherapy, to avoid damage. Fertile Hope, now LIVESTRONG Fertility Services, helped Breck get discounted rates for fertility preservation services. She had eggs taken, then embryos created from them and the resulting embryos frozen.

After initial breast cancer treatment, Breck received tamoxifen because her disease was hormone receptor-positive. Tamoxifen cannot be taken while pregnant. She worried whether taking it for 5 years ( 10 years is now recommended) might be too long to wait for pregnancy. She looked for research, joined online groups and talked with other women about her concerns.

“My oncologist was very science- and data-oriented and he did not have scientific information or adequate data to help me,” she says.

After almost 3 years of tamoxifen, she decided to stop and try to get pregnant. She had to wait 3 months for the medicine to leave her body before starting the embryo implantation process. She became pregnant with twins, lost one, but the other did well. Jacob was born in April 2011.

“I chose not to breastfeed and went back on tamoxifen the night I had him,” says Breck.

Second diagnosis

The family moved again, to a larger town and new practice. In 2013, Breck felt a painful nodule on her mastectomy side. “I really wasn’t that concerned, other than it was new.”

She promptly went to a radiologist, who advised a CT scan. Later that day, he showed her and her husband worrisome areas on her liver. A biopsy confirmed she had a metastasis: that the breast cancer had spread to her liver.

“Being a doctor and knowing the statistics, I thought this was about the worst news I could receive. I didn’t anticipate ever getting my life back after that,” she says.

She was referred to an oncologist in another city who specializes in young women. They met a week later, which helped.

“I left her office thinking I would get some semblance of my life back. Having her tell me she has many women living many years with metastatic breast cancer, knowing she was actively seeing women who had lived several years, gave me some hope,” recalls Breck.

She went back on chemotherapy, which shrunk some of the liver tumors, and trastuzumab (Herceptin) for HER2-positive disease. Later, she was switched to a new anti-HER2 medicine, ado-trastuzumab emtansine (Kadcyla), when it received FDA approval. Her uterus and ovaries were surgically removed and she began taking an aromatase inhibitor.

Breck says she found more support after her metastatic diagnosis than the first time. After recurrence, she met another young woman affected by breast cancer and they became close friends. There are no local support groups, but she reaches out to area young women who are diagnosed.

“As a physician, my experience is widely known in the community. All my patients are aware – I never hid anything that was going on,” she says. “Some people come to me because of it.”

Breck has also found – and given – help through Casting for Recovery, other organizations and an international Facebook group for women with metastatic breast cancer. “I try to be there for support and encouraging words,” she says.

This article was supported by the Grant or Cooperative Agreement Number 1 U58 DP005403, funded by the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services.

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