Breast cancer's 'dual citizens'

Debra Copit, Generosa Grana, and Marisa Weiss have much in common: all mothers, all Main Line residents, all doctors - all breast cancer specialists.

And they all have been diagnosed with breast cancer.

Their similar stories are both coincidence and cautionary tale - illustrations of breast cancer's indiscriminate nature but also its complexity, storming into the lives of patients with individual and unique markers.

Yet at least in one way, cancer has imparted a shared lesson to these women, all of whom are now in excellent health: Getting a diagnosis will change your life.

Debra Copit was watching American Idol in March 2011 with her son when the strap of her camisole slipped off her shoulder. Absently reaching to pull it up, she felt something - a lump in her left breast.

Her routine mammogram just seven months before was normal. At 47, she was feeling good. She regularly conducted self-exams.

"I do remember having an instant sixth sense that something wasn't right, that there was a change," said Copit, a radiologist and director of breast imaging at Einstein Healthcare Network.

In the crush of work the next day, she forgot her promise to her husband, Steven, to have it checked - until she did an ultrasound on a patient with a lump in her left breast.

A mammogram that day came up normal, but a follow-up ultrasound showed a mass: "I had a biopsy then and there, and went right back to work with ice packs in my bra."

That night at their Wynnewood home, Copit told her husband about the mass; the color drained from his face. He insisted on canceling his next day's appointments so he could be with her when she got the biopsy results.

As they busied themselves with errands, her cellphone rang, and Copit could tell her colleague on the other end of the line was crying. Immediately, the professional dynamic changed. The doctor became the patient.

"I remember exactly what I said to her: 'It's OK. You can tell me that I have cancer.' "

Copit arranged for an MRI to determine whether her cancer had spread. A lymph gland dissection followed. Both were normal. Copit also underwent genetic testing to determine whether she had the BRCA1 or BRCA2 genetic mutation, more common in women of Ashkenazi Jewish descent.

As it turned out, Copit did not have that gene, and she decided to have a lumpectomy followed by radiation.

Copit took two days off for the surgery and worked straight through her radiation. But it was definitely sobering, before she started treatment, to share her diagnosis with her children and parents.

Her mother and father, an oncologic surgeon, handled the news optimistically - a relief. For her sons, Scott, then 12, and Robbie, then 7, Copit told them by using two lentils.

"I wanted to make it visual for them . . . and explained that I'd felt a lump in my breast that was as tiny as the lentils. I assured them that I'd be fine, and that cancer wasn't contagious."

Robbie said: "Now can we go outside and play?"

Since then, Copit shares her experience with patients when she feels it's appropriate.

"My diagnosis of cancer actually took down the wall between us," Copit said. "When I share the information that I'm a breast cancer survivor, I see the change in their faces as they understand that, yes, I'm a sister, too."

Generosa Grana may be medical director of the MD Anderson Cancer Center at Cooper University Hospital in Camden, but she never had any illusions about her own invincibility, even with no family history of the disease.

"No one is guaranteed freedom from cancer - it doesn't care who you are," said Grana, who learned from a routine mammogram at 49 in September 2008 that she had breast cancer.

The news came from colleague and friend Lydia Liao, director of the Cooper breast imaging centers.

"I was so upset when I read Genny's mammogram," said Liao, "and saw immediately that it was suspicious." The two looked at the mammogram together and decided immediately to do a needle biopsy. The next day, the news came, and Grana felt incredibly lucky.

"My cancer was early and noninvasive, which made me feel like I'd been given a gift," Grana said. But it was still a shock. "Hispanic women like me have a lower incidence of the disease, I'd always had mammograms . . ."

Her husband was tremendously supportive, as were her three young adult children, twin sons and a daughter.

But telling her parents was the most difficult hurdle. "I'm an only child who grew up in a village of 50 families in western Spain. My parents are totally loving but like most parents, they worry."

It was helpful that they spent part of each year with her in Wynnewood, and they could see she was managing, despite the cancer.

Though Grana never hid her diagnosis from her patients, she doesn't discuss her own treatment for fear her patients would instinctively want to do the same.

"It's such a delicate thing - I made my own decision after consulting with the experts on my team. Each patient has to make a decision based on her situation, not mine."

As a radiation oncologist and president and founder of Breastcancer.org, Marisa Weiss always made time for annual mammograms.

So it wasn't unusual to get one in April 2010 at 51. But what followed immediately after was a call from a concerned colleague.

"I went back the following day for an MRI, which would offer additional views, and I'm reality-based. I knew I had reason for concern."

The diagnosis of breast cancer was, she says, obvious from the readings.

And Weiss, director of breast radiation oncology and breast health outreach at Lankenau Hospital, and known by friends and colleagues as invincible, focused, and strong, was cast into a new role: breast cancer patient.

Once she shared the diagnosis with her physician husband and her three children, who were all in college at the time, Weiss said, she became a "dual citizen" in the cancer world.

"I found myself amazed at how many decisions had to be made and how much information the patient has to absorb at a time when you're not necessarily functioning at your highest level."

From the start, she decided her final treatment decision would belong to her. "I knew patients might take my choices as prescriptive, that they might conclude that my way would be their way."

But she is extremely vocal about the continued need for patient education and lifestyle changes, especially if the patient hasn't been taking care of her health. Weiss herself has committed to a more fit and balanced life, with an exercise regimen, a commitment to healthy eating, and even getting more sleep. She also educates people through her cornerstone project, Breastcancer.org, and through interviews on TV, radio, and in print.

But there were sobering lessons about a cancer diagnosis, even for an expert.

"I recognized just how alone one feels when hit with this diagnosis. I'm no different - I had some tough emotional times, and it's definitely made me feel more compassionate and connected to my patients.

"Cancer is a wake-up call about how precious life is. I've stopped looking in the rearview mirror. I'm too busy living for today and all the tomorrows I have."