Dr. Deepa Halaharvi had just finished her training as a breast cancer surgeon when she got news that would change her life.
Dr. Deepa Halaharvi remembers exactly when she knew she wanted to be a breast surgeon. She had gone to medical school to become a trauma surgeon, but in her fourth year of surgical residency she met a stage-four breast cancer patient who changed the course of her career: “She was my age and had kids who were the same age as my kids,” says Dr. Halaharvi. “I knew she didn’t have very long to live. I felt such empathy for her, knowing that her kids were going to lose their mother. Then she suggested I would make a great breast cancer surgeon, and my residency mentor agreed.”
Dr. Halaharvi defies all the stereotypes about the lack of bedside manner among surgeons. “As a breast surgeon, I get to build long-term relationships with patients. I like to spend time with patients, get to know their stories,” she says. “I meet them when they’re diagnosed, and then take them through the journey of survivorship. It’s exciting to be part of that.” While much of this empathy stems from Dr. Halaharvi’s personality, a series of personal tragedies also play a huge role in how she understands what her patients are going through.
“I took care of my dad off and on for 16 years — he had a stroke during surgery for a brain tumor,” says Dr. Halaharvi. Her father passed away just a few months after she finished her surgical training. “Four months after he passed, I had a dream about my father. I was telling him that the right side of my chest hurt, and he said, ‘you need to get a mammogram.’”
The recommended age for a first mammogram is 40, but Dr. Halaharvi had been putting it off while she was busy in training. Now 42, she decided to take the dream as a sign. Her doctor found a mass in her right breast, and within 24 hours of getting a biopsy, she learned that she had breast cancer.
“This was my specialty, and I still couldn’t believe it,” says Dr. Halaharvi. “I had no family history. I had never smoked, rarely drank, had no risk factors, and had my children when I was very young. So it was quite a surprise.”
Dr. Halaharvi had hormone receptor-positive invasive ductal carcinoma, which is one of the most common types of breast cancer in women, and it was caught early. She was just starting her career and didn’t want to have to miss work, so she opted for a double mastectomy and reconstructive surgery. She was able to continue working and her reconstruction was completed a year after she was diagnosed.
Dr. Halaharvi says she did not hesitate when choosing to undergo a double mastectomy but stresses that the choice is extremely personal. “There is no survival benefit from removing the normal breast,” she explains, “but many women get PTSD (post-traumatic stress disorder) from this experience, and if I had opted for a lumpectomy, which is just removing the cancer, I would have had to have radiation treatment, and I decided that was not for me. But every woman in this situation needs to make the decision that’s right for her.”
Regardless of whether she chose to have a lumpectomy and radiation or a mastectomy, Dr. Halaharvi knew that she was not likely to benefit from chemotherapy. This is because she got a test that she prescribes to her own patients with early-stage, invasive breast cancer (hormone receptor-positive, HER2 negative), the Oncotype DX Breast Recurrence Score test, offered by Exact Sciences. As a physician, Dr. Halaharvi knew that only a minority of women with breast cancer benefit from chemotherapy, but that for years it had been the first course of treatment for most patients. That is, until the Oncotype DX test, which involves testing a sample of the tumor, either directly after surgery or from a biopsy, was included in clinical guidelines for the treatment of breast cancer. The test looks at the individual biology of a tumor and can predict whether a woman will benefit from chemotherapy, as well as the chance of her cancer recurring.
“Breast cancer treatment is not ‘one size fits all,’” Dr. Halaharvi explains, “and the Oncotype test helps determine how much each individual patient will benefit from chemotherapy, if at all. Just yesterday, I spoke to a woman whose test showed that the benefit of chemotherapy for her would be less than 1 percent. I was able to tell her with absolute confidence, I do not recommend chemotherapy.” She explains, “Before the Oncotype DX test and the related research, that patient would have probably gotten chemo. Being able to identify which patients will and won’t benefit from chemo, not only improves outcomes and spares women exposure to potential side effects of chemo like neuropathy and hair loss, but also reduces healthcare costs. We are so lucky to be alive in this age where we can actually utilize this test for our patients.”
As a patient, after receiving the results from her own Oncotype DX test, Dr. Halaharvi’s treatment team determined that she would not benefit from chemotherapy.
Although her cancer diagnosis was devastating, Dr. Halaharvi says one good thing did come from it: “It made me a better physician. Because who can learn more from having breast cancer than a breast cancer surgeon?”
Dr. Halaharvi had always told her patients that one in eight women will develop breast cancer. Now she was part of that statistic, and she understood the emotional weight that came along with it. “I finally understood that feeling I had heard before from so many patients: why me, and why now? I had put off my career for so long to take care of my dad, I had just finished my training, and I felt like my life was just starting when I was diagnosed. I felt the denial, and anger, and bargaining, and depression, and eventually acceptance.”
Now, when Dr. Halaharvi sits across from her patients and they express their fears about the decisions they will need to make, she knows what it’s like to be in their shoes. “It allowed me to gain a unique insight and perspective into what it’s like to face cancer,” she says, “and the fear that comes along with it. The fear of am I going to live long enough to see my kids grow up? What does this mean for my future?” But her cancer diagnosis has also added another great tool to her arsenal: hope. “I only had stage one cancer, but I went through the surgeries, the complications, the pain, and the anxiety. My patients know that, and I think that reassures them. They think, ‘She got through it. She’s healthy. So I can get through it, too.’”