When Breast Cancer Chose Tricia, Tricia Chose Optimism

When it comes to breast cancer, every journey is different because every cancer is different.

“After cancer, I went back to living my life again, but I also think about it every day. Not the details so much, but just that I survived it. I am a very positive person and so thankful that I am now cancer free, but I do wonder why I was spared,” said Tricia Barker, Associate Professor of Clinical Dental Hygiene at LSUHealth School of Dentistry.

It’s not unusual for those who have overcome breast cancer to feel a sense of consciousness about those whose outcomes may not have been as fortunate. But while cancer itself has no value, every story does.

Diagnosed with breast cancer at age 42, Tricia credits herself as a health-conscious, active woman with no history of breast cancer in her family. Her first mammogram at age 41 came back negative. The next year, she had her second annual mammogram in the summer of 2019, and it also came back negative.

Later that summer, she was relaxing in bed and felt a lump in her left breast. It was small but distinct. She hadn’t noticed it before. It wasn't painful, but she wasn't comfortable with the discovery, so she went to see her ob-gyn, who, sensing the urgency, sent her for an ultrasound. A significant finding appeared on the ultrasound, so a biopsy was immediately scheduled just before Labor Day. The following Tuesday, Tricia’s physician called her with the news that it was breast cancer.

“It’s actually breast cancer,” she told her husband, Heath, as she recounts how he was so supportive and there for her every step of the way. Then, one by one, she shared the news with her family. In particular, her sister, Kristen, was such an inspiration to her because she had been through a lot with her own health issues. “I felt like if she can fight and be so strong, so can I”, Tricia remembered.

A couple of weeks later, while driving her kids to school during breast cancer awareness month, her 9-year-old son, Sam, and her 6-year-old daughter, Lorelei, asked what the pink ribbon represented. At that point, she knew “where she was in the game” as she put it, and explained to them about the symbol, what cancer means, and her breast cancer diagnosis.

For whatever reason, Tricia said she never let the thought that she may die cross her mind. There were so many feelings to deal with, questions to be answered, and decisions to be made. She focused on making the right decisions. For Tricia, she went into “business mode,” as she called it. She was on a mission to get through it, starting with a list of specialists.

She was given the names of cancer specialists, oncologists, and plastic surgeons to choose from; three were surgical oncologists. She did her research, but something about Dr. Alfred Colfry, III and his team made her feel comfortable.

“I don’t know how to say it other than I just felt spiritually guided to them. Not only had Dr. Colfry been highly recommended as a breast oncologic surgeon, but I also remember being impressed with his whole team. I decided I didn’t need to look any further,” Tricia recalls. “Through my whole experience with Dr. Colfry and his team, every single person was just so patient, and it was like they had all the time in the world for me. They were so thorough.”

With Heath by her side and her sister-in-law, Heather, who volunteered to take notes at her appointment, Dr. Colfry explained the possible surgical options: a lumpectomy of the tumor (which would require radiation therapy along with it), a single mastectomy of the left breast, or a double mastectomy. But more investigation and tests were needed. He ordered a more detailed ultrasound and an MRI at Touro Radiology. The tests discovered a second tumor in the left breast, almost under the arm. So, a second biopsy was done, and it turned out to be the same type of tumor as the first one, invasive lobular carcinoma. Specifically, the tumor pathology was HR+, HER2-.

HR+ means the cancer cells have hormone receptors which suggest that certain hormones attach to the cancer cells and promote growth. Roughly two out of three breast cancers test positive for hormone receptors. HER2- means that the cancer cells contain little to no HER2 protein, so they tend to grow more slowly. Knowing the hormone receptor status is important in deciding treatment options.

Even though the tumors were in one breast, Tricia had to decide how aggressive she wanted to be. Because she was only 42 and had no guarantee that she wouldn’t develop cancer in the right breast in the future, she chose the double mastectomy. Going with her instinct may have been the best decision in her journey.

Tricia scheduled her mastectomy, and her next step was finding a plastic surgeon for her breast reconstruction surgery. She was a good candidate for tissue flap reconstruction, which would happen at the same time as her mastectomy. Tricia met with Plastic and Reconstruction Surgeon John Guste, MD. Again, she took a notetaker along, her older sister, Rhonda. Tricia felt an immediate connection and comfort level with Dr. Guste. Again, another good decision, she believes.

The reconstructive surgery called Deep Inferior Epigastric Perforators (DIEP) is an intricate vascular surgery that took skin, tissue, and blood vessels from Tricia’s abdomen to reconstruct her breasts with the goal of regaining sensation in the breasts. DIEP also looks and feels more like the natural breast tissue than the breast implant option and is preferred if radiation therapy is needed. Unlike implants, tissue flaps will change like any other tissue in your body, getting bigger or smaller as you gain or lose weight. Recovery time is also longer than with implant surgery. A follow-up revision surgery is needed to remove the excess skin, correct asymmetry of the breasts, and improve the incision’s appearance.

“During surgery, a sentinel node biopsy was done near my left breast and sent to pathology. This determined there was no lymph node involvement,” Tricia explained, “which means it hadn’t spread beyond the breast and into the lymph nodes. It was Stage 1.”

At the same time, the tissue removed from the non-cancerous right breast was sent for analysis. The pathology report revealed widespread lobular carcinoma in situ, an uncommon condition in which abnormal cells form in the milk glands (lobules) in the breast. While it’s not cancer, it can indicate an increased risk of developing breast cancer, and it doesn’t appear on a mammogram. That instinct that Tricia had to remove the non-cancerous breast may turn out to be her best decision in the long run.

“Since I had three surgical sites, the two breasts, and the abdomen, it did take a long time to heal,” Tricia said. “But since cancer had not spread beyond the breast, I would not need chemotherapy. I always believed I was going to be okay. Dr. Colfry had a lot to do with that,” she added. “He was so comforting.”

Overwhelmed by the outpouring of support from family, friends, co-workers, and her students, it kept her optimistic through the cancer challenges. So many people jumped in and lightened the load by bringing meals to her family, taking over her teaching duties, putting together personal care packages, and sending prayers.

Her regimen is simple now that Tricia has reached the other side of her cancer journey. Since she no longer has breast tissue, no annual mammogram is needed. She sees Dr. George Zacharia, her oncologist, every six months and is prescribed a daily dose of Tamoxifen. This drug attaches to hormone receptors (specific proteins) in breast cancer cells and stops the cancer from accessing the hormones they need to multiply and grow.

“And while the daily grind has returned,” she said with a laugh, “I feel healthy. I am focusing on stress reduction, mindfulness, and mental and spiritual enlightenment. My goal is to really know myself and reflect on each day and take the time to fully understand the purpose of my journey.”