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Timing is Everything

 

Timing is Everything

It’s easy to delay or avoid routine screenings. But Cynthia Hayes knows all too well that these pesky appointments can be life-saving.

Nobody likes cancer screenings. Whether it is the boob-smashing mammogram, the gut-wrenching colonoscopy (prep), the cough-required finger poke, the bare-all skin exam or the scraping of cells from one’s most tender inner parts, they all come with an invasion of privacy and a fair amount of discomfort. Depending on health insurance coverage, they also could come with a budget-busting price tag. So, it’s not surprising that we would be in no rush to schedule these invasions, look for reasons to postpone them and find excuses to never partake in the joys of adult self-care. 

I was guilty. Listening to the mixed messages in the news about the optimal frequency of gynecologic health checks, I let my sense of urgency slip. New guidelines published by the American College of Physicians in 2014 had said it wasn’t clear if there were enough benefits from annual pelvic exams to recommend them for healthy, non-symptomatic women. That was all I needed—an invitation to be somewhat lackadaisical in scheduling my next exam. I’d call next month, I told myself, already a few months post due. After Labor Day I would do it for sure.

But before I had a chance to call, my doctor chased me. She had known me for years. She had delivered my daughter 22 years earlier, and seen me through all sorts of changes, knew intimate details of my body and my life. “I don’t care what the protocol says, Cynthia,” she told me. “You need annual checkups. Get yourself in here.” Yes ma’am. I scheduled an appointment for September and didn’t give it another thought.

It was an unremarkable exam. I survived the indignities of the pelvic and everything looked fine. Yes, I complained of being tired, but who wasn’t at my age? Maybe I was working too hard or pushing the exercise too much, or maybe it was just menopause. She took some extra blood to make sure. We chatted about life, our kids, work, vacations and she sent me on my way. “You look good, Cynthia,” she said. “See you next year.”

So, when her name came up on the display of my ringing cell phone a week later, I assumed it was someone calling about a billing issue. My daughter and I were headed to a neighborhood salon for manicures on a beautiful blue-sky September day and I answered as we continued walking. But I stopped short when I heard her say I had flunked my Pap smear––it had detected “atypical glandular cells.” Probably it was nothing, she said, but I needed to come back in for more tests. I didn’t quite know what to make of her call. My daughter and I were on a mission with a deadline––we were going out in two hours and our nails were not yet red—so I carried on without giving it much thought. 

There are times when it might be better to not be such an insatiable internet researcher. I had just a few minutes to use my phone before succumbing to the manicurist and I quickly learned that “atypical glandular cells” were the warning signs for a particular type of uterine carcinoma that had grim survival statistics. I went from unconcerned to terrorized in an instant. Cancer already had a grip on my emotions, and it would be a long weekend of grappling with the possibility that I had a life-threatening disease.

“Everything is going to be fine,” my husband assured me, feeding me the same line I had taught him to say years before when he tried to solve a problem that needed only solace. But this problem needed more than a comforting arm around the shoulder. What if I did have cancer? At 57 years old, I was too young to think about sickness and death, but it seemed unlikely that the Pap smear was a false positive. I wanted to talk to someone who would understand my fears, but my best friend, the one who would have known exactly what to say to acknowledge the intensity of my feelings and be with me in the moment of foreboding, had passed away only nine months earlier from cancer itself. I felt isolated and alone.

The endometrial biopsy the following week was excruciating, but not as bad as the wait for results. It was a week of suppressed terror––putting up a brave front and a false smile while inwardly on the verge of tears or frozen with panic. I was home alone when my doctor called with the news. “I am very sorry to tell you this, Cynthia,” she said, “but the biopsy results confirm that you have cancer.” 

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The news hit with the force of a tornado, depriving me of air and upending my life. Instantly, my head ached and my heart raced. I had cancer. And not just any old cancer, but uterine papillary serous carcinoma (UPSC), an aggressive, fast-growth cancer. The nightmare I had kept under wraps for two weeks was real.

I was in shock but needed to act quickly. I needed scans. I needed to find a surgeon and schedule pre-op testing. Most of all, I needed my husband, who at that moment had a mouth full of cotton in the dentist’s chair. It all happened so fast, I barely had a chance to think, let alone cry. Phone calls and emails, recommendations and confirmations. By the end of the day, I was scheduled for a morning with the radiology team for scans of my entire torso and had appointments with two surgeon candidates. The scans would give us further insight into the depth and breadth of my cancer, but not until a surgeon had probed my inner organs and removed many of them would we know the stage of my disease, a prognosis and a treatment plan.

I was lucky, destined to join the ranks of those who survive. Although UPSC historically carries a survival rate of less than 40 percent, thanks to that timely pelvic exam, my cancer was caught early: after surgery, and another anxious week waiting for the pathology report, my doctor was able to give me the good news that it was stage I, consisting of a small, single tumor, confined to the uterus and barely dug in, which significantly increased my odds. It helped, too, that I was in New York with a top-notch care team, expert in my type of cancer. Surgery and six chemo treatments later, I was declared cancer free. Five and a half years after the diagnosis, the terror is as faded as my surgical scar. But I don’t take cancer screenings lightly anymore. That pap smear saved my life.


Cynthia Hayes is the former vice president and chief marketing officer at Montefiore Medical Center. Her book, The Big Ordeal: Understanding and Managing the Psychological Turmoil of Cancer, comes out tomorrow. Click here to purchase it.

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