It is autumn here now and the brilliant golds, reds, and greens combine together for the showiest nature display of the year! The sunrises are gold against the charcoal sky, and the prairie hares are changing their fur color from tawny to whitish in preparation for winter snowfalls.

Rather than spending time outside enjoying the beautiful autumn weather, I am preoccupied with a new wrinkle in my health that may or may not be related to my multiple myeloma: a secondary cancer. It has been caught early, and I am hope­ful that it will soon be dealt with medically and I will be back to my new normal of just living with multiple myeloma.

It all started earlier this summer. Thanks to my reading and awareness about myeloma, I remembered to ask my family doctor about getting a mam­mo­gram again this year. I just had one done last year, and many more over the past 25 years, always with normal results. But something sparked my memory at my annual physical checkup this June, and I mentioned to my doctor that there is an increased risk of secondary cancers in myeloma patients who have been treated with Revlimid ^[1] (lenalidomide) either together with melphalan ^[2] (Alkeran), or after an autologous (own) stem cell transplant.

Regular readers of this column may recall that I received low-dose Revlimid for one year following my stem cell transplant. I was taken off the drug by my oncologist after the results of several major clinical trials showed an association between Revlimid and secondary cancers (or "second primary malignancies," as they often are called in the medical literature). That was five years ago, though, and I had nearly forgotten about it.

In any case, my family doctor agreed that I should have another mammogram this year. So I had the mam­mo­gram done in the first week of July, expecting the same negative results.

To my surprise, I got a call back from the radiology lab requesting a second mammogram on one side. At the time, I speculated that the second mammogram might be necessary due to a bruise I sustained after a nasty fall on a cement sidewalk earlier in the summer. However, the radiology technician told me that the bruising had nothing to do with the test. The radiologist had detected a change since the previous year in the area of the ducts.

After the second mammogram, I met with the radiologist. The doctor explained that there was a suspicious area of micro­calci­fica­tion in the ducts that needed to be biopsied and sent out to a pathology lab.

“Oh no, not another biopsy,” was my immediate thought. Bone marrow biopsies have left indelible im­pres­sions on my mind. However, my doctor explained that the biopsy was necessary, so four weeks later I was scheduled in for that test as well.

I reported for the biopsy the first week of August. My dear husband Dilip wanted to come in with me for the procedure, but he had to wait outside in the waiting room with other caregivers, who all had worried looks. The biopsy itself was not painful, since a lot of local anesthetic was used, but the core drill sounds were quite unnerving to me. The staff were super helpful and nice, though. I had stopped taking low-dose aspirin for a few days before and after the test, since that is a vascular area of tissue, and bleeding would be expected to occur.

After waiting for the pathology results to be sent to both my family doctor and my hematological oncologist, we went in to get the results at the end of August. Dilip was really hopeful that this area of micro calcification would be benign, but I had a sinking feeling. "If it looks like a duct, and quacks like a duct, maybe it is a duct with cancer!”

Turns out I have been diagnosed with ductal carcinoma in situ (DCIS), a condition in which cancer cells are contained within the linings of the breast ducts. In other words, the cancer cells have generally not spread out of the ducts into the surrounding tissue or to other organs of the body.

DCIS is the most common type of non-invasive breast cancer. Fortunately, it also is almost 98 percent curable if the patient receives the appropriate treatments.

The word ‘curable’ certainly caught my attention, since I have been dealing with an ‘incurable’ cancer for many years now. Treatments could include surgery, radiation, and hormone treatments.

As you can imagine, this new diagnosis threw me and my family into a tailspin, and we have been on a learning curve since August, finding out more about DCIS.

After the biopsy result came in, I was quickly referred over to a breast health clinic, where we met with a surgeon to discuss the results and determine a course of treatment. Because I already am a cancer patient, my treatment options were discussed between the surgeon and my oncologist at the hematological cancer department.

I should be fine. After the discussions with the surgeon and my oncologist, I have decided on breast-conserving surgery, to be followed by radiation treatments. I won’t be taking my usual myeloma treatment of Revlimid and dexamethasone ^[3] (Decadron) for three months while I go through these other treatments.

I owe a debt of gratitude to all of you at The Beacon – editors, other contributors, and readers – for the non-stop articles and forum postings over the years that have discussed secondary cancer. If I hadn’t re­mem­bered to ask for the extra mammogram, this non-invasive cancerous condition would not have been caught so early.

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The quotation for this month is an excerpt from the song "Over the Rainbow," music by Harold Arlen and lyrics by E.Y. Harburg, written for the movie The Wizard of Oz (1939): "Somewhere over the rainbow, skies are blue and the dreams that we dare to dream, really do come true."