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Breast Cancer/Pregnancy, Chemotherapy/Surgery

McGowan 620

When her mother was diagnosed with breast cancer in 1985, Megan was just 14 years old. Sadly, she would never know the outcome of the cancer treatments since her mother died tragically in a car accident shortly after the doctors made the diagnosis. The accident left Megan without her mother and without a clear understanding of what her family's history with breast cancer would be.

So, from the time she was a young teen, Megan (now 39) always felt it wasn't a matter of "if," but rather "when."

The "when" for Megan occurred in 2006, late in her first pregnancy. Megan rationalized the lump she felt in her breast assuming it was a side effect of being pregnant. Despite regular pre-natal visits with her obstetrician, Richard Mansfield, MD, Megan did not say anything to him for about a month after she first noticed it.

Her Diagnosis
Familiar with her health history, Dr. Mansfield of Chester County OB/GYN Associates ordered an ultrasound and needle biopsy immediately, and gave her the results of the tests.

Her breast cancer diagnosis came swiftly on October 20, 2006 during her 37th week of pregnancy. Within one week's time, Megan received the diagnosis, was induced to protect the baby, had a c-section to deliver a healthy daughter - Elliot, and had a lumpectomy.

"I went for all of my radiology scans in my pink maternity unit hospital gown with a box of tissues, sobbing and crying everywhere I went," she admits. Between being a new mom and being a new cancer patient, Megan was emotional and terrified. "My doctors and nurses knew the situation, and they were all so supportive. They were very specific about my diagnosis and completely thorough with my care."

Shortly after the diagnosis, the multidisciplinary medical community met to discuss a plan of care for Megan. The team that reviewed her case was comprised of radiologists, pathologists, surgeons, medical oncologists, radiation oncologists and gynecologists. Working with her physicians, Megan's course of treatment began.

By Thanksgiving, Megan returned to the Hospital for a re-excision to remove extra tissue and to have her lymph node margins cleared, and then following Christmas, she began chemotherapy. The ensuing three years have been filled with huge decisions and great challenges.

Options and Decisions

As a life-long resident of Downingtown and a 12-year employee of the University of Pennsylvania Health System's Home Infusion Department, Megan was familiar with Chester County Hospital's affiliation with the Penn Cancer Network. Prior to starting chemotherapy, she traveled to Penn for genetic testing. She ultimately tested positive for the BRCA1 breast cancer gene, which determined that she was at an increased risk for both breast cancer and ovarian cancer.

She chose to receive her care at The Cancer Program of Chester County Hospital because she wanted to be closer to home, knowing that the care she received would be the same quality as what was offered in the city.

Knowing the risks and thinking about her family's future, Megan began chemotherapy with the guidance of her medical oncologist Michele Tedeschi, MD, of Chester County Hematology Oncology to reduce the cancer and to prepare for a double mastectomy with her surgeon Donelle Rhoads, MD, of Surgical Specialists and to eventually undergo breast reconstruction. Fully understanding the consequences of her decisions, she opted this past April to have her ovaries removed as a proactive measure to protect her long-term health.

"All the decisions I've made have been with my daughter in mind," she says. She's thankful for having the support of her husband, who assumed a great deal of the parenting when their daughter was first born. By choosing a double mastectomy and ovary removal, Megan wanted to decrease the chances of cancer reoccurring, knowing that she was giving up the ability to be pregnant again. "Hopefully, the decisions I made will allow me to be around for Elliot."

Looking Forward

With three years of medical appointments now behind her, Megan's course of care is to return for follow-up visits every three months. She feels like she has her life back again.

She is currently participating in a five-year clinical trial called Suppression of Ovarian Function (SOFT) Study offered by The Cancer Program of Chester County Hospital, which studies the affects of Tamoxifen or Exemestane compared with Tamoxifen alone in treating pre-menopausal women with hormone-responsive breast cancer.

What's next for Megan? "Hopefully, nothing," she says, other than enjoying her family and living a long life.

Reflecting upon her story, Megan appreciates the complexity of the timing and the attention and compassion she received from her healthcare team. She knows that if her cancer was diagnosed earlier in her pregnancy, it could have put baby Elliot at risk. If her cancer had been diagnosed a few weeks later, it could have put her own health at greater risk.

Coordinated Approach

She felt reassured that her obstetrician, surgeon and medical oncologist worked well together to coordinate her care, ensure that the services she needed were provided expeditiously. They each took the time to prepare her for what she would experience and the care plan that would be needed to achieve recovery. Even though Megan works in healthcare, when it is about yourself, it is good to know that your caregivers are connected to you, know you, and they are working with you for the best possible outcome.

There is no universal right answer for all patients with cancer, she says, and although she believes the decisions she made were the right decisions for her, she wouldn't assume they are the right decisions for anyone else.

"There are some people who want to wear the ribbons and do the walks. Others want to hide and pretend it isn't happening. You have to walk your own path, be your own best advocate and not be scared to do the things you need to do," she offers.

In regard to her own cancer, Megan says, "For the worst possible situation, I think it worked out in the best possible way.

Richard J. Mansfield, MD

Dr. Mansfield completed his undergraduate training at Lehigh University in Bethlehem, Pennsylvania and received his medical degree from UMDNJ-New Jersey Medical School. He completed his residency in Obstetrics/Gynecology at the University of Maryland, in Baltimore. Dr. Mansfield is a Fellow in the American College of Obstetrics and Gynecology and is Board Certified by the American College of Obstetrics and Gynecology. He is a Clinical Assistant Professor at the University of Pennsylvania and has special expertise in High-Risk Pregnancy, Infertility, Advanced Operative Laparoscopy and Urogynecology. Dr. Mansfield practices in West Chester, Dowingtown and Lionville.

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