Slight skin changes lead to cancer diagnosis

At first, Amy Fox, a nurse practitioner in the pulmonology department at Sharp Rees-Steely Medical Group, didn’t think much of the slight skin changes on her breast that she experienced after her workouts. They were barely noticeable. She felt no discomfort or pain. She was only 39.

But Amy decided to err on the side of caution. She spoke with Cheryl Clements, her OBGYN nurse practitioner at Sharp Rees-Stealy, who performed an initial exam and suggested Amy get an ultrasound. The ultrasound did not reveal any issues, so Amy underwent a mammogram, which detected calcium deposits in her left breast. A stereotactic biopsy — which gathers X-ray images from two different angles — found that Amy had high-grade ductal carcinoma in situ (DCIS). DCIS is the presence of abnormal cells inside a milk duct in the breast, and is the earliest form of breast cancer.

“I was definitely surprised,” says Amy. “I’m 39 years old and have no family history of breast cancer. If I did not have minor symptoms, I wouldn’t have known about my cancer diagnosis until I turned 40, the age when women are advised to start getting mammograms.”

After Amy received her diagnosis, she consulted with Dr. Mohan Krishnamoorthy, a surgeon who is affiliated with Sharp Rees-Stealy and Sharp Memorial Hospital. DCIS is noninvasive, meaning it does not have the capacity to spread at this stage. However, if not properly treated, it can progress to invasive cancer that can spread to different parts of the body. As a preventive measure and for peace of mind, Amy decided to have a double mastectomy and breast reconstruction surgery.

“Amy had several personal factors when it came to ultimately choosing a treatment option. She considered her age, her young kids and returning back to work,” says Dr. Krishnamoorthy. “While it is true that Amy is young to have breast cancer at age 39, it’s not unheard of for people under age 40 to receive a diagnosis. That’s why it is imperative that individuals practice breast self-awareness.”

During the double mastectomy, Dr. Krishnamoorthy discovered that Amy also had Paget’s disease of the breast, a rare form of breast cancer that involves cancerous skin cells. Amy’s nipple was removed during the procedure, and she had a biopsy taken of her lymph nodes. Thankfully, the cancer had not spread.

Amy still remembers the compassionate team who cared for her as she recovered in the hospital. “Sharp’s anesthesiology team did a really good job helping me with pain management by providing a nerve block for me before my surgery,” she says. “The care I received was amazing. They made sure I was well taken care of, and everyone carefully took their time supporting me.”

Dr. Krishnamoorthy adds that Sharp was like a second family for Amy, as her colleagues often visited while she recovered. Eight weeks after her surgery, she was able to gradually start enjoying hobbies again, such as hiking, bike riding and reading books.

“For me, being active again not only helped me recover physically, but emotionally as well,” she says. “Running provides me with mental clarity, and I’ve learned that practicing spirituality and having good mental health are important for the recovery process.”

During recovery, Amy also reflected on her work caring for patients, now that she had become a patient herself.

“I truly understand what my patients are going through, and having that perspective has made me a better nurse,” says Amy. My recovery reminded me that during stressful moments, going the extra mile caring for and listening to a patient really counts.”

Today, Amy is back to living an active lifestyle, finding joy in playing with her children and caring for her patients at Sharp. She will visit Dr. Alfonso Camberos, a plastic surgeon who is affiliated with Sharp Rees-Stealy and Sharp Memorial Hospital, this fall in preparation for her reconstructive surgery — the last step on her journey with cancer.

Clements, Amy’s OBGYN nurse practitioner, feels delighted that she was able to help Amy, and that her cancer journey is nearing its close with a happy ending.

“I’m grateful to have been part of her care because early detection is crucial. I encourage all of my patients to trust their gut and not dismiss changes to their bodies,” she says. “Amy kindly called me recently to express her gratitude as she looks back on her experience. I am so glad she is well and using her knowledge to pay it forward.”

From her experience, Amy encourages others to be a self-advocate for their health.

“Speak up if you notice something wrong or a little off about your body,” she says. “I’m thankful that I did, and for my nurse practitioner, Cheryl, who advised me to get tested. I’m happy my cancer was caught early and that I’m now cancer-free.”

The American Cancer Society recommends breast cancer screening beginning at age 45 for people of average risk, with the option to begin at age 40. Talk with your doctor about your own risk profile to determine the appropriate screening age for you. Learn more about breast cancer screening at Sharp HealthCare.