Annick Gervais, 47, diagnosed with metastatic breast cancer at age 44
My mother died of metastatic breast cancer in 2006, so I was made aware of monthly breast examinations, and it was important for me to know my breasts, just in case. Because my mother was diagnosed at 52, I had to have a mammogram every year from the age of 40.
I was doing my usual self-exam when I felt a small lump on my left breast. It looked like the ones I had felt on my mother at the time; it was about the size of a dime. This was good timing, as I had a mammogram scheduled for a few days later.
When I went for the examination, I was told everything was fine and that I didn’t need an ultrasound. I trust the system, so I didn’t question it any further. The lump kept growing, but I wasn’t too worried. I had my last appointment with the family doctor who has been following me since I was 15, because she was retiring. She was not overly concerned either.
Time passed, and by late January the lump had become as big as a quarter. My new doctor was worried and wanted to investigate. She wanted me to have an ultrasound. Finally, after four calls during which I was told that there were no appointments available for ultrasounds at my centre, I managed to get one in the spring.
I managed to have an ultrasound in April. My lump was now as big as a golf ball. I also had pain in my left breast. The technician told me there was nothing abnormal, that it was just a lump of fat. She didn’t want to do a biopsy. I left there crying, feeling like I wasn’t being listened to. I know myself, and I am extremely intuitive. I knew deep down that there was something abnormal developing inside me.
In July I saw my family doctor again. The lump hadn’t really grown, but a hollow was forming on the side of my left breast. My doctor was very concerned and told me that the situation was not right. She referred me for an MRI and she arranged for me to be followed up at the breast clinic. On August 7, I got an appointment at the breast clinic at Cité-de-la-Santé hospital in Laval. From there, everything started to happen.
I met with a surgeon. When he saw my deformed and jaundiced breast, his face fell. No one understood why I hadn’t had any follow-up earlier. The doctor who did the biopsy also has questions. She explained to me that I had a diffuse, non-firm lump and that they had to take no less than eight samples to make sure to swab the right spot.
The surgeon told me that I would have a result within two weeks. Thirteen days later, I was told I had breast cancer, more precisely an infiltrating ductal Grade 2-3 carcinoma in the left breast. However, it was the MRI and later the PET scan results that turned everything upside-down: they saw metastases in the liver and lymph nodes, which elevated me to the dreaded Stage 4
I have a small family: a sister, a father and two daughters, in addition to my spouse. My spouse also has a very small family: a brother, his wife and their two daughters, but they are in Portugal. I don’t remember how I told my partner; it’s a bit of a blur and my memories are not clear. I remember that I announced it to everyone at the same time: we sat down in the living room to talk about it. My sister and father were obviously very aware of what such a diagnosis entails, having experienced it with my mother.
My daughters were aged 8 and 12 at the time. We have a lot of humour in the family, we like to laugh, it makes a lot of things easier. My oldest daughter said: “It’s cool that on Halloween you will be able to choose lots of wigs!”
They obviously asked me if I was going to die and the answer was: “We don’t know. The chances of me living to see the next year are slim. But we don’t know. It depends on the treatments.” My father was crying, but said it was because he had allergies. He has a lot of allergies in emotional moments.
I was taken care of quickly. I did not follow the traditional care protocol. Often at Stage 4 you go straight to palliative chemotherapy and continuing treatments without surgery. But my doctor wanted to do surgery. He fought internally, argued that I was still young and explained my history. The doctors on the committee he was talking to didn’t want to make an exception because they were afraid I would get false hopes of a possible cure. My doctor explained to them that I was very clear-headed, that I worked in pediatric palliative care, and that I did not believe in unicorns. So they agreed.
I started with traditional chemotherapy every three weeks for three months. The oncology teams are so friendly, really welcoming and caring towards the patients. After my first session, I felt fine. I left around 3 p.m., by 6 p.m. I was in great shape, and at 6:30 my body crashed. I was shaking like a drug addict in withdrawal. My daughters and my spouse were freaking out; I’ve known my partner for 25 years and he’d never seen me like this: he was distraught. Fortunately, the side effects diminished.
Obviously, I lost my hair. However, this was not an unknown for me, since I had experienced four years of treatments with my mother. I can’t say that it was reassuring, but almost… On a physical level, what bothered me the most was the loss of my eyebrows. I found that it made me look sick.
I finished chemotherapy on February 14 and we waited until April 7 for the double mastectomy. After my chemotherapy, I had no trace of cancer left. In the meantime, I got the result of my genetic test and discovered that I carried the BRCA2 gene. So I had a mastectomy and two months later, my ovaries removed. I refused radiation. Being Stage 4, I was still lucky enough to have a traditional protocol, but the radiation was too much. I also had lymphedema in my left arm and the radiation oncologist confirmed that this could be aggravated by the radiation. There were also several long-term effects that I preferred to avoid.
I recovered very well from the treatments and the operation. I didn’t take any painkillers except for Tylenol, and a few days later I started walking again.
I was offered full reconstruction, but I chose flap reconstruction. This means no excess skin on the chest and no implants. Unfortunately, there is still some excess skin on the side and I’ll have to have another operation, but that’s not a priority. Right now, my daughters say I have wings.
I didn’t want implants because I hate surgery and body alterations; I don’t even have pierced ears! And I wanted to limit the risk of mistakes too… My mother had a reconstruction and her body rejected the implant. I’ll spare you the horror story.
I used to have a complex about wearing a bathing suit, but now there are some with a little ruffle in front of the chest that work well for me.
My treatments continue every three weeks and I take ribociclib, an inhibitor, plus a hormone blocker.
My aim is to raise doctors’ awareness. Yes, there will always be hypochondriacs who want biopsies just to reassure themselves, but it seems to me that it goes without saying that you should have one when you’re being monitored for prevention and you discover a lump. Unfortunately, it depends on who you end up with… it’s such a random process. We should listen to patients more.
When I was diagnosed with metastatic cancer, I didn’t react. Afterwards, my doctor told me that he had wondered if I had fully understood. I had to assimilate it, but I had understood very well.
There was an incredible mobilization of my friends: a nurse friend came to the first appointments to help me better understand the treatment choices, two friends accompanied me for my treatments, a friend and her mother cooked me meals, some brought me to their cottage… One came every Tuesday to take care of my children: homework and potluck, another every Thursday to do the housework and spend time with my daughters. I even have a childhood friend who paid for my snow removal for the next two winters, who would plan family time and little meals for us. My dad would drive me to appointments, he lives 5 minutes away. It feels good, and I can understand when people say that support makes a big difference.
I think there is a big difference between Stages 1, 2, 3 and Stage 4. What these women fear most is being like us. I realize that people with the same diagnosis as me are connected, even though there are always different realities depending on the location of the metastases.
When I heard that the Breast Cancer Foundation was creating the “Club Stade 4/Stage 4 Club” Facebook page, I was so happy! It came at the right time, as I had just been diagnosed. I received so much support, in a very caring way. Some people around me didn’t—and still don’t—understand my situation. Because my condition is stable, they think I am in remission. But my treatment continues. Some people live for many years with Stage 4: it’s quite an unpredictable reality.
Once women with Stages 1, 2 or 3 cancers have done all their treatments, they don’t really get any support: I find that difficult too.
When you are diagnosed with Stage 4 breast cancer, there is a 30% chance that you will live for another five years. Every year you survive increases that percentage. This year I marked three years since my diagnosis, but my anxiety is off the charts. A case like mine with no trace of cancer is rare but I never feel at peace. I tell myself that if I make it to five years, I’ll have had that, and the rest is a bonus.
I laugh, I work full-time; I’ve always been like that. I stopped working the day before my chemotherapy on September 5, 2019,and started again on October 18, 2020.
A little over a year ago, I saw on the Quebec Breast Cancer Foundation’s Facebook page that they were looking for people with breast cancer to support women who are in pre-diagnosis. I thought it was a good idea. I listened to the women I had the chance to meet, and guided them through the process. They want to have a place to release their anxiety and fear. My role is to listen, to understand and to inform them about the services available to them, depending on the region and where they live.
We also get calls from women who detect an abnormality but who don’t have a family doctor, or don’t come from here. We have resources available to help them.
I decided to get involved in the Foundation’s October campaign because when you are personally affected by the cause, you understand their mission and the importance of it. Breast cancer affects a lot of women, and more and more of them are young. My goal is to raise awareness.
I think it’s important to talk about it, because the results of doing as much prevention as possible can only be positive. It is also important to raise awareness about the realities: there are many women living with breast cancer. I also feel that we don’t hear much about Stage 4s like me, so it was important for me to shed light on my diagnosis and its reality.
Since my diagnosis, I have learned to live in the moment. Life is precious and fragile. I’ve often had this thought: I’m alive right now and I’m still moving forward. I see myself as being on a treadmill: I’m moving forward, no matter what’s happening around me.
We know that a diagnosis of stage 4 breast cancer is life changing. Please feel free to learn more about our Metastatic Breast Cancer Program, developed to provide support adapted to the reality of this community.