When Michelle Eskengren-Brown was in the shower one evening in March 2008, she noticed a large lump on the underside of her right breast. It was odd, she thought, but she wasn’t especially concerned. At 38, Eskengren-Brown, a former model from Sweden who had become a successful New York City casting director and the mother of two young sons, was in sturdy good health. Breast cancer was so far from her mind that she waited almost a week before consulting her doctor.
Her physician examined the lump “and said it was way too big to be anything,” Eskengren-Brown recalls. “She told me it was probably because I drank too much coffee” — usually three cups a day — “which I thought was hysterical. But of course I was very accepting. ‘Yes! I drink too much coffee! Get me out of here!’” Still, she says, her doctor added, “You know what? Just go and have a mammogram and get it over with, just to feel comfortable that it was nothing.”
And so, on April 3, 2008, a reluctant Eskengren- Brown found herself sitting in a mammography office following her screening, waiting for her name to be called so that she could receive her results and leave. “They called names and names and names.... I was sitting there thinking, Oh my God, I have to get back to the office! What is going on here? It was irritating.”
Finally, her turn came, “and they said, ‘You have to come back into the room and do more pictures.’ And I’m like, ‘No, I’m not doing that.’ And they said, ‘You have to.’ So they did mammos, and then they did a sonogram, and then all the doctors kept coming in. And then this one girl handed me a box of tissues, and I was like, ‘What? What do you want me to do with these tissues?’”
Though the doctors told Eskengren-Brown that the lump in her breast looked suspicious and warranted a biopsy, she didn’t reach for the Kleenex. Instead, she headed back to her office and promptly resumed work after telling her husband the news. Today, she thinks her intense focus was not so much an extraordinary ability to compartmentalize, but simply disbelief that what she’d learned at the mammography office could be true.
Despite the diagnosis, Eskengren-Brown was still so deep in denial that when meeting her surgeon for the first time, she says, “I still was very optimistic that it was nothing. Finally the surgeon said, ‘Michelle, I’m a breast cancer surgeon. What do you think you’re doing here?’ And I said, ‘I don’t know. Maybe you’re checking my results?’”
As a woman in her 30s, Eskengren-Brown had only a 1-in-233 chance of having breast cancer, according to data from the National Cancer Institute; for women in their 20s, the chances are far lower. But breast cancers in younger women are often faster-growing and thus more aggressive, says Kathie-Ann P. Joseph, medical director of Women at Risk at Columbia University Medical Center. Detection in young women is relatively tricky, says Julia A. Smith, director of the breast cancer screening program at the New York University Cancer Institute. Premenopausal women have denser breasts, with a higher percentage of glandular tissue than fat, she explains; the X-rays of mammography don’t penetrate dense tissue, making the images there less clear. MRIs can be an additional test to help the screening process in high-risk patients, Joseph says, but these scans aren’t considered an alternative to mammograms on their own; their extreme sensitivity can result in a high rate of false positives.
Upon learning that she had breast cancer, Eskengren-Brown says, “I just shut down.” For months, she says, she went into a kind of emotional cocoon, numb to the world. Her husband, Ray, a photographers’ representative, and a handful of close friends shuttled her to and from doctors’ offices and helped her determine her course of treatment; her friend Faith Kates Kogan, president of the Next Model Agency and of the board of directors of the Ovarian Cancer Research Fund, provided introductions to sought-after local cancer specialists.
At one point, Eskengren-Brown’s husband asked her doctor what she would recommend if Eskengren-Brown were her own daughter. “A mastectomy” was the answer, and so, less than three weeks after her mammogram, Eskengren-Brown went to Mount Sinai Medical Center to have her right breast removed. Two months after that, she underwent the first of four chemotherapy sessions, each three weeks apart, to reduce the chance of the disease affecting her other breast.
"I didn’t even look the doctors in the eye. I couldn’t,” Eskengren-Brown says. “That was my way of dealing.” A self-described “control freak,” she was used to being on top of all the details of a bustling New York life. “But then I discovered that there are two types of cancer patients,” she says. “There’s the one that takes control and needs to talk to the doctors and understand — they want to see pictures, and they want to know what they’re doing in their breast. And then there’s the person that shuts down, and that’s me.”
“I didn’t care what [the doctors] did to me; I just wanted my kids to be OK. There are times when you’re so tired, you’re so sore, and you’ve got pouches of blood you have to drain,” Eskengren-Brown says, referring to the drains that are installed after a mastectomy to prevent buildup of fluids where the tissue was removed. “But you still have to be a mom. You still have to put them to bed and cuddle them. So I think that was the hardest thing. I could deal with a lot of stuff, but I could not deal with the idea that they’d be affected.”
Change in hairstyle
Eskengren-Brown began cutting her long, brown hair in radically different ways before beginning chemotherapy, aiming to make its side effects less alarming for her boys. She cut it shoulder-length, then very short, and then bleached it blonde. It’s an idea she now recommends to other mothers undergoing cancer treatment when they have young children. “Kids want their mom to be just the way she is; they don’t want her to change,” she explains. “So it gets them used to just a bit more change than usual. Then, when the hair falls out, it’s just another crazy thing that Mom did.”
Eskengren-Brown says that her hair loss from chemotherapy — which led her to wear a blonde wig — was much more unnerving than she had anticipated. “I thought it would be a walk in the park to lose the hair, but it was the hardest thing,” she says. Her hair would fall out in clumps, and she dreaded the thought of that happening in front of the models she worked with: “I’m surrounded by beautiful people .. .to go from having long, beautiful hair to not having hair was more of an identity crisis than losing my breast.”
Her mastectomy did worry her, though, especially the prospect of losing the nipple on her right breast. Her doctors believed that it was unlikely to survive the procedure and that a large scar would be left in its place. She was told the likelihood of being able to spare her nipple was about 2 percent, but she begged her doctors to try. She says, “For me to have one nipple and one not-nipple would not be acceptable for me, because then my boys would ask, ‘Why isn’t there a nipple there?’ Or, ‘Why does that nipple look weird?’”
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During Eskengren-Brown’s mastectomy, her surgeon carefully removed her nipple, scraped away the tissue behind it, and then reattached it. “Sometimes they sew it back on and then it dies, so you have to have another surgery to remove it,” Eskengren-Brown explains. But in her case, she says happily, “it’s just, like, a perfect nipple, and they did such a wonderful job, and any surgeon or doctor that looks at it, they can’t believe it. The scars are just minimal.” (Success with skin-preserving techniques is now leading doctors to reconsider routine nipple removal.) Last November, she had another surgery to receive a silicone breast implant, and the result is “more beautiful than my other breast,” she says.
Because her cancer was hormone receptor (HR) positive, involving breast cancer cells that grow in response to estrogen, Eskengren-Brown is taking the estrogen-blocking drug Tamoxifen for five years to help prevent recurrence. She began to get her period when she was 10 years old and has suffered from endometriosis since the age of 13, both of which suggest that high levels of estrogen were cycling through her body; before her diagnosis, she had never been told that these things could put her at higher risk. “Estrogen is one of the drivers of breast cancer,” Smith says, noting that “every month, the breast is exposed” to the hormone during the menstrual cycle. She adds that estrogen is stored in body fat, and since exercise and weight management reduce the percentage of fat, they’re thought to decrease risk, although this link hasn’t been firmly established.
Researchers are still investigating other contributors to breast cancer, including the potential role of diet in preventing or prompting its development. For now, alcohol consumption has consistently been implicated. A 2009 study from the Journal of the National Cancer Institute found that with each additional alcoholic drink that women consume per day, their risk of breast cancer increases by 12 percent. But folic acid appears to counteract this effect, other research has shown; the recommended daily amount, 400 micrograms, is available in a multivitamin. As for coffee, there is no link between caffeine consumption and breast cancer, according to a large, 22-year study by researchers affiliated with Harvard University.
Now, many months after her treatment and recovery, Eskengren-Brown is friendly, funny, and seemingly in ideal health. With her cropped hair pinned back — “It’s still short, but I have hair,” she says — she is as effortlessly pretty as the teenage model she once was.
“Today, I don’t mind talking,” she says, adding that she loves speaking with people who have just found out that they have breast cancer. “I need to tell them that everything’s going to be OK.”
Her recovery inspired her to take up fencing, tennis, and golf to get back in shape. After her implant surgery, she found that fencing helped dispel fear about her fragile-seeming new breast, since “the attack of the foil is supposed to go straight to one’s chest. I freaked out in my first class, but soon got used to the idea and realized how much it actually helped me in the healing process.”
She credits her cancer experience with putting her job into perspective. “Work used to stress me out so much — but now I will say, ‘Stop!’” she says. “If I look at myself today and a year ago, I like the person I see today much better,” she attests. “I feel I am stronger, more confident, more patient, more understanding, but most important: I’m here.”
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