The phone rang on a Friday, and I already had a gut feeling before I answered it. Not because anyone had told me anything. Just because I have been through this once before, and there is a particular kind of stillness that settles over you right before bad news arrives. You feel it coming the way you feel a storm coming before the sky ever turns.
It was the same news. Breast cancer. Second time in two years.
I want to tell you the whole arc, not just the headline about my second breast cancer diagnosis. When it happened to me the first time, I felt very alone in a room full of people who loved me. And I have a feeling some of you reading this know exactly what that room feels like.
The First Breast Cancer Diagnosis
Two years ago, it was my left breast. ER and PR positive, HER2 negative. If you have never had to learn the alphabet soup of a pathology report, that basically means the cancer was fueled by hormones and responded well to the treatments built specifically for that. I went through what you go through. Appointments stacked on appointments. Learning words I never wanted to know. And eventually, coming out the other side.
I was so proud that I completed my last radiation treatment on the last day of the year! I could start 2025 off with a healthy slate.
Then life did what life does. It kept going. I got back to my business, my family, and my Auburn football Saturdays. The scans stayed clear. I let myself believe I was past it.
Now here is the thing about cancer once it has found you. It does not ask permission to come back. And that is not what I wanted.
The Second Breast Cancer Diagnosis
I went in for my routine mammogram. Not a care in the world. Life was going in the right direction. Emma graduated from Auburn. She got a job teaching 7th grade social studies and the junior high that Michael went to as a kid. We were settling in to be empty nesters. Life was great!
Just a few hours later I got the dreaded phone call. There is some irregular tissue that we need to rescan and do an ultrasound on. Can you come back on Tuesday? Of course I can go back! What am I gonna do? Say No? But the blood drained from my face, and I sobbed! NOT AGAIN! It’s not fair.
Tuesday rolls around, and the technician does the diagnostic mammogram and is able to recreate the same image, but when we go to do the ultrasound, the technician cannot find it. Interesting. What does that mean? Well, the radiologist wants to do a biopsy. And let me tell you, I learned this is NOT your standard needle biopsy. This is a stereotactic needle biopsy.
If you have never had a stereotactic biopsy, let me walk you through it, because knowing what is coming makes it a whole lot less scary than imagining it.
You are sitting in a chair that wheels you right up to a mammogram machine that is set up with an extension that has a LONG needle pointing at the side of your BOOB. Meanwhile, your boob is in one of the little pancake poses they like to do to take the pictures. The machine snaps a few mammogram images from different angles, and a computer uses those pictures to pinpoint the exact spot they need to reach. Think of it like GPS for your body. It is not guessing. It knows precisely where to go.
Once they have that spot, they numb the area, make a tiny nick in the skin, and pull a few small samples, well, 10 to be exact, of tissue with a needle. You feel pressure, not pain. They leave behind a tiny marker clip so that spot is easy to find again later if anyone ever needs to.
The whole visit takes about an hour. The actual biopsy takes minutes. And here is the part I want you to sit with. Most of these biopsies, more than seven out of ten, come back with good news. The key phrase is “most of these.”
The call came on a Friday. The diagnosis came with its own report: invasive mammary carcinoma, Stage 1, ER and PR positive, HER2 negative. Read that again and you will notice something. It is nearly identical to my first one. Same hormone profile. Same early stage. My oncologist also gave me one more number, called a Ki-67, which measures how fast the tumor cells are dividing. Mine came back at 3 percent, which is low, meaning this cancer was not in any hurry. That is something, right?
I did not know what to do with all of that information at first. So I did what I always do when I do not know what to do. I started asking questions.
Where My Brain Went First
I will be honest with you. The moment I heard “second time,” my mind jumped straight to the biggest, most drastic option there was; a double mastectomy. Just take it all, I thought. Take away the chance of a third phone call. I wanted it GONE! Still do, but I am taking a breath and doing my research. You can read more on that research here.
That is a very human place for your brain to go when you have a second breast cancer diagnosis. It is also not necessarily the right answer, and it took some digging for me to understand why.
What I Learned About Genetic Testing
Here is something I did not know until this now: having a second breast cancer diagnosis, on its own, qualifies you for genetic testing. No family history required. And when I added in that my mother had DCIS (a form of breast cancer caught early) about five years ago, that made the case even stronger.
Genetic testing these days is not just the one BRCA gene you have maybe heard about. It is a whole panel, often fifteen, twenty, sometimes more genes at once, each one connected to a different pattern of risk. Think of it like a family recipe box passed down through generations. Most of what is in there is harmless, ordinary, nothing to worry about. But every so often, there is a recipe tucked in the back that keeps reappearing generation after generation, and it is worth knowing it is there.
That is essentially what this testing does. It looks for the recipes worth knowing about.
And it turns out research backs up what my gut already suspected. When a woman’s first breast cancer comes back hormone-positive like mine did, her second breast cancer diagnosis matches that same profile about 82 percent of the time. It is not just coincidence. It is closer to a fingerprint. I have investigated genetic testing more in depth here.
Why the Timing Matters
Now here is the part I almost missed, and I want you to hear it clearly if you are standing where I am standing: getting your genetic results back before surgery matters. If a mutation shows up (something like BRCA1, BRCA2, or a gene called PALB2), it changes what your surgical team recommends. It can even open the door to certain medications, like a class of drugs called PARP inhibitors, that are only offered to patients who carry those specific mutations.
If you have the surgery first and the results come back after, you may be making that big decision twice instead of once. So if you take nothing else from this post, take that.
About the Double Mastectomy
I dug into the actual research on this, not just the fear talking. And what I found was more nuanced than I expected. There is real data showing a survival benefit tied to removing both breasts, but that benefit shows up most clearly in women who carry one of those inherited mutations, or whose tumors share my hormone-positive profile specifically. Without a known genetic reason behind it, doctors say it becomes much more a question of what helps you sleep at night, not a clear medical mandate either direction.
There is no wrong answer here. There is only the answer that lets you live with the choice.
What Comes Next for Me
I have an appointment with a genetic counselor coming up, and I am walking in with a short list of the questions that matter most to me:
- Should my surgery wait for these results, or can they move forward together?
- If a mutation turns up, how does that change what my surgical team recommends?
- Does a positive result open up any additional treatment, given my specific hormone profile?
- How quickly can we get answers, since timing affects my surgery?
- If something is found, what does that mean for my mother and my family?
I do not have the ending to this story yet. I am not going to pretend I do, because that would not be honest, and honest is the only way I know how to write to you.
Why I Am Telling You All of This
I am not a doctor, and nothing in this post is meant to replace one. Please talk to your own care team, your own genetic counselor, before you make any decision based on something you read on a blog, even mine. What I can offer you is what I wish someone had handed me the day that phone rang: the actual questions to ask, the actual research behind the fear, and proof that you can walk through this with your eyes open instead of your hands shaking.
If you are sitting with a second diagnosis right now, or you love someone who is, I want you to hear this plainly: you are not the first person to stand exactly where you are standing, and you will not be the last. There is a whole quiet community of women who have heard that phone ring twice and kept walking anyway.
I am one of them. And now, so you know, you are not walking alone either.