Pediatrician faces own cancer diagnosis with courage, but heart remains with pediatric patients
Dr. Sandra Peak calls for increase in pediatric cancer funding while fighting her own battle
"Dr. Peak we need to do a diagnostic ultrasound of your breast..."
Those words haunt me. I do not remember what was said next, mainly because a wave of fear and dread engulfed my body. The day I was diagnosed with breast cancer my life changed, forever. The greatest change, the greatest loss, is the sense of invulnerability you have when you are healthy, when you are not in pain.
What followed was a rapid fire series of tests, decisions, surgery, chemotherapy. The speed at which I felt my "normal self" being consumed by the world of cancer was overwhelming. Through it all, I kept thinking of all my patients and their families who have battled cancer through the years. I relived every moment of those cancer conversations. The anticipatory nausea I had prior to walking into a room to deliver the results every parent dreads. The shock and tears and anger that followed the horrific news I had just given.
And every time, I watched my sweet patients and their families turn and face their battle with a grace and dignity that astounded me.
Now that I am a cancer patient, I am even more astounded. I am lucky. I have breast cancer. I knew going into treatment that my cancer, Breast Cancer, receives the highest proportion of research funding by both the government and the private sector.
I knew that although my particular type of cancer tends to be aggressive, because of the hundreds of millions of dollars poured into breast cancer research each year that new chemotherapeutic, hormonal, immunologic and targeted agents now exist that raised my survival rate to 99 percent at 10 years. I also knew that amazing new medications exist for adults that make the side effects of chemotherapy far more tolerable than they were previously.Children with cancer are not as fortunate. Pediatric cancer is grossly underfunded. Last year alone, the National Cancer Institute (NCI) spent 96 percent of its budget on adult cancer and only 4 percent on childhood cancers.
The NCI funded $584 million for breast cancer and only $26.4 million for ALL pediatric cancers combined. This doesn't even begin to take into account private sector and pharmacologic company sponsored funding, which largely goes to support adult cancer research. In fact, research and development of new drugs from pharmaceutical companies makes up more than 60 percent of funding for adult cancer drugs and almost zero for pediatric cancers.
Because of this lack of funding, in the past TWENTY YEARS there have only been two chemotherapeutic agents approved by the FDA for the use in children. More than half of the chemotherapies used in children are over 25 years old. I cannot begin to imagine the COURAGE it would take to fight a cancer battle armed with the knowledge that my best weapons are more than 25 years old.Some people argue adults get cancer more frequently than children and that's why the funding is greater. But when you stop to consider productive years lost by a cancer diagnosis, the effects aren't even close to equivocal.
The average age for adult cancer diagnosis is 67 with an average number of years lost to cancer of 15. The average age of diagnosis for a child is 6 with the average number of years lost to cancer of 71 years.
SEVENTY-ONE years lost.
Imagine if we could have the HEART to change those numbers. Children with cancer could grow up, fall in love, and have their own children. Imagine if we used our BRAINS to find new ways to fund childhood cancer research. These young cancer survivors could go to college, create beautiful art, make new discoveries that could change our world and perhaps find a cure for cancer.
It's October and in case you haven't noticed the world has turned pink for Breast Cancer Awareness month. I am a breast cancer survivor. This message is for all the women in my life. My patients, their Mommies, my colleagues, friends and family. And, for all the women in their lives. One in eight of you will get breast cancer.
Many women think that because there has not been a case of breast cancer in their Family they do not need to be concerned. This is not true. Only 20 percent of breast cancers are familial. You are at risk for breast cancer if you have breasts.
- Thanks to research and funding we have unbelievable resources at our disposal to help prevent, detect and cure breast cancer.
- Studies now show that women who exercise routinely have a marked decrease in breast cancer and breast cancer recurrence . EXERCISE daily, not just to get into your skinny jeans but to decrease your risk of breast cancer. The standard recommendation is at least 150 minutes of aerobic activity a week or 75 minutes of vigorous exercise plus 2 days of strength training.
- We also know that even small amounts of alcohol increases your risk. So limit your alcohol consumption to less than 1 glass a day.
- Control your weight. Especially if you are post-menopausal. There is a direct correlation between being overweight and developing breast cancer.
- Avoid smoking, radiation and environmental pollutants which have all been implicated as causal factors.
- If you have just had a baby...Breast feed!! Breast feeding is protective against breast cancer.
- Limit dose and duration of hormonal therapy and use the lowest doses possible. Although birth control pills are protective for ovarian and uterine cancer, there is a slight increased risk for breast cancer. Discuss with your doctor all forms of birth control and what your risks are.
- It is imperative our daughters do not start their menstrual cycles early. There is a marked increased risk for girls who experience their first period before the age of 11. Stress the importance of healthy nutrition and exercise and teach them to be stewards of their health.
- Self-exam monthly and if you notice any changes alert your doctor. Even better, set a specific day of the month and call your best friend, sister, mom and remind them to check as well. This is called the Buddy Check System.
- The advice on mammograms can be confusing . The standard recommendation is a baseline at 40 and then yearly at 45 and every 2 years at 55. There has been some debate about delaying screening until after 50. I followed the standard recommendation and had multiple normal mammograms until my breast cancer was detected at age 47. If I had waited until age 50 I would not be Stage 1 which has a good prognosis. I strongly encourage you to get your mammograms.
- You also have a choice between the standard 2D mammogram and the newer 3D mammogram also called Digital Breast Tomosynthesis (tomo). although the procedure will seem essentially the same to you, the imaging is markedly different. In both 3D and 2D mammograms, the breast is compressed between two plates. In 2D mammograms, which take images only from the front and side, this may create images with overlapping breast tissue. If you have dense breast tissue this may further obscure the image. Because 3D mammography provides images of the breast from many different angles in thin slices this allows for clearer imaging. This is especially important for women with dense breast tissue. Using 3-D mammography makes it easier for doctors to catch breast cancer early. And just as important, it reduces the chances of doctors seeing a false positive. I had a 3D mammogram and my doctors noted that because of my breast density the small tumor I had would not have been easily visible on a traditional 2 D mammogram.
- If you get called back on your mammogram, do not panic! Radiologist will occasionally call back if the image is not clear or if they have a concern. Most of the time the call backs are for benign reasons.
- If you do have a suspicious mass, the radiologist may recommend a biopsy either performed by them or a breast surgeon. Again, stay calm. I know it's easy to say this but you have to try to distance yourself so you can take notes and ask questions. If you simply can’t focus, take a friend or your significant other and task them with note taking, asking your questions and helping you remain calm.
- If you end up having a positive biopsy, you will feel confused, lost, scared. THESE ARE NORMAL FEELINGS. Everyone handles this news differently. Because of research and funding the outcomes for breast cancers that are found early are very good. That is why early screening and detection is so important.
- Take care of yourself. Follow screening recommendations and encourage your family and friends to do the same. Your efforts may save your life.
About the author
Sandra Peak, M.D., is a Cook Children's pediatrician in Lewisville. She earned a B.A. degree in English and psychology from Baylor University, which helps her communicate with the children she treats today. After Baylor, she followed her passion and attended medical school at University of Texas Health Science Center in San Antonio. Her pediatric residency was at Arkansas Children’s Hospital in Little Rock, where she participated in Angel One emergency helicopter transport service. While there, she also received the Jocelyn Elders Award for excellence in community service. Dr. Peaks returned to her home town of Dallas in 1998 and established a Pediatric Practice in neighboring Carrollton, Texas. She joined Cook Children's Physician Network in Lewisville in 2004.