Denise Washington

Denise Washington found the lump herself on a Sunday morning in February, in the shower, running her hand across her left breast in the absent-minded way she always had. She was forty-four years old, healthy, active, and utterly unprepared for the possibility that what she was feeling was cancer. She stood in the shower for a long time, not moving. The following morning she called her GP. By the end of that week she had had an urgent mammogram, an ultrasound, and a biopsy. The results came back positive for invasive ductal carcinoma. Denise was referred to the breast oncology service at Silvaris Cancer Institute in San Diego. She sat in the car park before her first appointment and told herself that she would not let fear make the decisions. Then she walked in.

The breast care team — her surgical oncologist, her medical oncologist, and the breast care nurse specialist who would become her most consistent point of contact — met with Denise together at her initial consultation. The surgical oncologist explained the imaging and pathology results in clear terms, walked her through the surgical options, and discussed the role of genomic profiling in determining whether she would need chemotherapy. "The Oncotype DX result was the turning point," Denise says. "When it came back low-risk, and they explained that it meant chemotherapy would add very little benefit, I felt something enormous lift. I had been steeling myself for chemo. Knowing I might not need it changed everything." The multidisciplinary team reviewed her case formally before confirming the treatment plan.

Breast-conserving surgery — a wide local excision and sentinel lymph node biopsy — was performed three weeks later. The sentinel nodes were clear, confirming that the cancer had not spread to the lymphatic system. The operation was day-case: Denise was home by evening, sore but intact and deeply relieved. The histopathology confirmed clear surgical margins, meaning no further surgery was required. Radiotherapy followed — three weeks of daily treatment, twenty sessions in total — targeting the conserved breast to reduce the risk of local recurrence. The radiotherapy team prepared Denise meticulously for the skin reactions and fatigue she might experience, and the actual side effects were well within what she had been told to expect.

Tamoxifen was prescribed for five years — an oral tablet taken daily that significantly reduces the risk of hormonal recurrence in oestrogen-receptor-positive breast cancer. Denise's breast care nurse explained the medication in detail, including its side effects and the importance of compliance, and arranged a follow-up call one month after initiation to check how she was tolerating it. The early side effects — hot flushes, disturbed sleep, some joint discomfort — were managed with practical advice and, eventually, a dosing adjustment that improved her tolerance significantly. "She never dismissed the side effects," Denise says of her nurse. "She always had something helpful to suggest, and she remembered what we had discussed before."

Two years on from her diagnosis, Denise attends six-monthly breast clinic follow-up and annual mammographic surveillance. Every clear result is met with a moment of private gratitude that she does not share with many people. She has returned to her career as a secondary school principal, runs a breast cancer peer support group that meets monthly at a local community centre, and has become one of the most vocal advocates for routine breast screening that her community has. "I found mine myself," she says. "And I was lucky it was early. But the team at Silvaris did everything right once it was found. The surgery, the radiotherapy, the planning — it was meticulous. I am here because of them, and I intend to make good use of that."