​On an autumn day two years ago, during the full quarantine due to the pandemic, Nicoleta felt something hard in her right breast. Without delay, she ordered an ultrasound of the mammary glands, which was followed by other clinical examinations and the difficult diagnosis that every woman was afraid of – breast cancer. But with the help of the surgeon, whom she calls her guardian angel, Nicoleta overcame this episode and today, having recovered, she can talk about her experience and the importance of regular checkups.

Nicoleta Michale is 41 years old, she is an administrator of an import-export company and the mother of a 15-year-old boy. Since her grandmother died of breast cancer, Nicoleta had tests twice a year and also had her thyroid gland removed.

According to her, before the diagnosis of breast cancer, her life was “pretty normal, with all the everyday stresses”. But in 2020, he faced a much more difficult challenge.

“While staying in bed, I felt something very strong in my right breast and thought it was time for an ultrasound,” says Nicoleta Michale.

Nicoleta Michale. Photo source: Personal archive

He then mentioned that Ms. Dr. Silvia Barbulescu, a MedLife surgeon, specializes in breast surgery. Nicoleta knew Dr. Berbulescu because she operated on her cholecystitis, also at MedLife. “In 2018, after a crisis, I ended up in the emergency room at MedLife, where I also had a cholecystectomy.” The intervention and recovery was quick and she was back in the office in just two weeks.

That way, Nicoleta knew where to turn in two years when she needed it. “After that, it all started with an ultrasound, then a breast MRI and confirmation that something was wrong with my right breast, and after a biopsy I was diagnosed with a breast tumor.”

Dr Silvia Berbulescu, a specialist in general surgery with expertise in breast cancer, explains in detail the journey from ultrasound to breast cancer diagnosis:

“Ms. Michale scheduled a breast consultation at the clinic for an important change in regional consistency, at the level of one breast, with slow progressive development. Clinical examination of the mammary gland region confirmed the presence of a significant palpable tumor. Follow-up ultrasound revealed a dense mammary gland with a heterogeneous gland plate, with irregularly dilated ducts and at least five nonspecific solid lesions. So we found ourselves in a situation where clinical examination suggested a highly suspicious lesion, partially confirmed by ultrasonography, but not conclusive. In such situations, staging is established and MRI with contrast is discussed for a full scan, which is clearly superior to ultrasound.

Dr. Silvia Barbulescu. Photo source: MedLife

The surprise was great when, after describing and scanning the solid lesions in the affected breast, the score obtained was favorable for noncancerous lesions and lower than the score obtained at the initial evaluation. Therefore, all I had to do was encourage the patient to repeat the ultrasound. This time at least 2 lesions were considered suspicious and biopsied. The final result: a neoplasm of the mammary gland with at least 2 foci.”

The score Dr. Barbulescu is referring to is BI-RADS (Breast Imaging – Reporting and Database System). The acronym represents the risk assessment that becomes the basis of further diagnosis and therapy and stands for the protocol established by the American College of Radiology as the standard for breast cancer screening worldwide.

After the ultrasound of the mammary gland performed by Nicoleta, a BI-RADS score of 4 was established. The patient followed the established protocol, performed a repeat ultrasound examination and a minimally invasive biopsy procedure of two suspicious masses. Thus, the diagnosis of breast cancer was confirmed,” the doctor explains.

Once the diagnosis is confirmed, it is time to discuss treatment options and follow up with imaging studies to confirm or rule out the presence of distant metastases.

Fortunately, further research proved favorable for Nicoleta.

“I thought it was necessary to move on, and there was no time to waste”

The hardest thing for Nicoleta after learning the diagnosis was sharing it with her mother. “The moment I got the diagnosis was the hardest thing for me to tell my mother and that was the only moment of failure.” After that he stood up, shook himself and told himself that he must go forward without fear. “No matter how hard it is, nothing can bring me down. And my trust in Mrs. Dr. Barbulescu was boundless and made me believe that everything would be fine.”

“I just thought that I need to move forward and that there is no time to lose,” says Nicoleta, who says that she received a diagnosis from an oncologist in November 2020, and the operation took place on December 29, 2020.

About the doctor who operated on her and who was by her side throughout this process, Nicoleta says that he is her “guardian angel”.

“My family, friends, colleagues were by my side. Ms. Dr. Berbulescu took complete care of my intervention, my trust in her is limitless, I call her my guardian angel on earth because she saved my life twice.”

Nicoleta’s surgery was a bilateral mastectomy with immediate reconstruction, and the decision was made by the surgeon together with the oncologist as well as the patient.

What does it mean?

“In view of the biological profile of the biopsy tumor foci and on the basis of imaging studies, which refute the presence of distant metastases, it was decided that the first stage of treatment should be surgical. Taking into account at least the multifocal nature, the previous data of the patient, but especially the age of the woman, a radical procedure was considered in favor of a conservative one with the possibility of immediate reconstruction. In addition, it was about the need for genetic testing (which the patient, by the way, also did later), as well as about a preventive mastectomy for breasts that are considered healthy,” explains Dr. Barbulescu.

Therefore, we are talking about a single surgical intervention consisting of two parts.

“At the first stage of the intervention, which is coordinated by an oncologist, most of the breast tissue is removed, along with the tumor center and the tissue of the axillary lymph nodes (more precisely, the sentinel node), preserving as much breast skin as possible. as possible.

The second part of the intervention, perhaps the most pleasant, falls on the shoulders of the plastic surgeon, who reconstructs the breast area using an implant, autologous tissue or a combination of them for each individual case.

After the operation, Nicoleta underwent several sessions of radiation therapy. He also underwent Oncotype DX testing with a recurrence score, which led him to choose hormonal treatment, explains Dr. Silvia Barbulescu. In Nicoleta’s case, chemotherapy was deemed inappropriate. In addition, oncological monitoring after any surgical intervention is established by the oncologist depending on the specifics of each individual case.

For Nicoleta, the whole process was based on the relationship with the doctors, which she describes as “extraordinary”. “I have no words to thank them,” she says.

What is a tumor board for?

Dr. Silvia Barbulescu explains that, ideally, the decision regarding one or another type of treatment for any patient diagnosed with a neoplasm should be made by the Tumor Commission, which includes doctors from various specialties: oncologists, radiotherapists, surgeons. , pathologists, etc.

“At MedLife, we have a Tumor Board made up of doctors with extensive experience in breast cancer, doctors with whom I have consolidated my knowledge over the years, and patients can always benefit from the best treatment strategies,” says the doctor.

“I am convinced that with the use of this concept of the oncology board, the concept of “treating doctor” will disappear, and patients will be at the center of care and attention of doctors of various specialties. Combining the different opinions of the Commission on Tumors leads, thus, to the establishment of the best treatment strategy.”

Advice to women: “Let ultrasound and mammography be holy”

Today, Nicoleta’s life has returned to normal, but she says that she is trying to be more careful and attentive to her health.

Of course, she is forced to conduct regular investigations. “Every three months I go for check-ups, every 6 months for ultrasound, tests and computer tomography, as well as other studies at the request of the oncologist.”

Dr. Barbulescu recommends that all women lead a healthy lifestyle as much as possible and consider prevention: “do any type of physical effort – the equivalent of 10,000 steps every day; balanced nutrition; give up alcohol; try to fight excess weight and consult a nutritionist; undergo periodic senological and gynecological examinations, the frequency of which must be determined according to individual risk factors; immediate senological consultation of a specialist in the event of the appearance of a tumor node or any abnormalities in the breast area.”

“I am convinced that a timely senological consultation, followed by a timely correct diagnosis and subsequently the correct treatment strategy are often of decisive importance,” the doctor notes.

What advice would Nicoleta give to other women?

“There should be as little stress as possible, ultrasound and mammography should be done regularly and regularly, and if this diagnosis is confirmed – head up and go into battle with all your weapons, because this diagnosis does not mean condemnation.”

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