Life after cancer

As early as age 27, Dr Kisha Mitchell-Richards had a premonition she would have breast cancer.

Of course, she wasn't able to predict the date, time or place, but she felt it was inevitable. She told Outlook, "I was a resident in pathology, and came across the biopsy of a 27-year-old woman that we diagnosed with breast cancer. She and I shared the same first name - including the spelling (most iterations of Kisha have an 'e'). The thought arose in the back of my head and never left."

Mitchell-Richards, a forensic pathologist, who is currently an assistant professor at the prestigious Yale University in Connecticut, received her confirmation of the life-threatening disease seven years later, at the age of 34.

The former Montego Bay High student has no history of cancer in her immediate family, which could have been one of the reasons the first doctor she went to with the findings of her self-examination was sceptical.

"She knew I was a physician, she gave me what I would call a cursory exam and said, 'No man, I don't feel anything.' I said, 'Are you are sure?', she said she was."

Mitchell-Richards tells Outlook that, at the time, she was going on vacation for two weeks and told herself she would deal with it when she returned. In two weeks, the lump in her breast had grown. "I went to my obstetrician and she agreed and that set everything in motion."

Since that day, the doctor who was trained at the University of the West Indies, Mona, and who went on to become the only forensic pathologist with a Jamaican passport, has warned others never to ignore their instincts. "Don't allow others to tell you that you are too young, you crazy or you don't have any family history. You have to take control of your health to a great extent," she advises, having followed her gut feeling.

She was quick to point out that there are some wonderful physicians who will be able to give their patients the right diagnosis, but there are some who are going to tell you otherwise.

She remembers that receiving the diagnosis was not easy, but once it was established, the reaction was more about mobilising and getting through it.

For her, mastectomy was the best surgical option for the affected right breast. However, she didn't stop there - within months, she had removed both breasts.

"I removed the left one, too, mainly because I had dense breasts and would likely have to have MRIs and be undergoing biopsies for some reason or other on that left breast fairly often. By the time I made the decision, I was on the verge of my third biopsy to determine whether that breast had also been affected, and opted to do the bilateral," she revealed.

She advises other women who may become stricken with the disease to choose the treatment option that best works for them. "Therapy is not one size fits all. What may be right for Angelina Jolie, or me, may not be right for you."

She says the best thing you can do is find out the likelihood of recurrence.

It's also very important for victims to take one step at a time and try to ascertain from their caregivers what needs to be done. "You have to be able to trust your physicians and understand their plan. Ask questions until you fully understand. In the end, these decisions affect your life and your well-being. Also, take someone with you - at least in the beginning; because it can seem like a blur," she says.

She notes that it is sometimes difficult in our country to know the options available and be able to exercise them, but don't be afraid to ask about them. Women, she said, should also remember that although family history is a strong risk factor for breast cancer, more often than not persons who are diagnosed have no significant family history.

Moving On

Mitchell-Richards has been able to move on with her life after surgery, but she admits that, once in a while, when she feels a little lump and a little extra pain in the back, she begins to wonder.

The disease has given her perspective, but has not become the focus of her life, "It makes you remember that there are some things you have no control over. You embrace life while remembering that things can happen to you".

Seven weeks ago, Dr Mitchell-Richards gave birth to a bouncing baby boy whom she and her husband, Amarfio, named Yves. After having her son, the reality of not being able to breastfeed did initiate some regret about her decision to remove both breasts. She told Outlook that, after her diagnosis, her ability to have children wasn't at the top of her list. "It wasn't a primary thought actually, I put a contingency plan in place (adoption was an option), but my main focus was on treating the disease at the time."

She says, "In the end, one of the best things I can do for my child is to be in the best mental state to be a mother, and my prior decision certainly helped with that."

fertility preservation

One of the realities, she says, is that young women who are diagnosed need to think about fertility preservation, which is one of the things that nobody tells you about until you are in it. "Fertility is largely age dependent. If chemotherapy is necessary, then there is the risk that the ovarian function that may be lost during therapy does not return. This is more likely in women over 40 at the start of treatment, and, anecdotally, I know a few women who completed chemotherapy therapy, have their ovarian function return, and go on to have children. There's also good data that suggests that a subsequent pregnancy decreases the risk of death in women with a history of breast cancer and previous breast cancer treatment does not seem to increase the risks of congenital diseases in the baby. "

She told Outlook that, eventually, she would like to have two children.

Mitchell-Richards did breast reconstruction and chemotherapy for four months, losing her hair in the process. A woman of immense confidence, she did wear a wig, but only once. "I had a little bob, and someone said, 'You look like Mary J. Blige,' but I didn't want to look like Mary J. Blige, so I never placed another wig on my head."

She describes being bald as very liberating and, today, she is a member of an organisation called, 'Being Bald for the Cure', which raises funds for cancer. The group is made up of pathologists and other medical practitioners.

Mitchell-Richards is an sports enthusiast and an avid tennis player. She did surgery in January 2004 and started playing again in September.

"I had a rich life before, cancer has just shaped a lot of things. It is not an experience that I would want, and it is unlikely to come back because of my stage, but I have got back to where I was and beyond."

She told Outlook that being a pathologist does not help her to understand death more than anyone else.

"I don't think I understand more about death than anyone else, really. I think being a physician and, in particular, a pathologist, I probably have a better idea of the implications of some diagnoses and their potentially negative aspects. I am confronted with illness and death more than the average person, which I think helps me not to dwell on it, but to reorganise and acknowledge that often things happen over which we have little or no control."

She notes that it is generally easier to stay healthy than it is to fix yourself, "If there are things you can do to prevent illnesses, or try and catch them early, you are better off that way - in the end it can be very stressful," she says.