When the Doctor Becomes the Patient

For breast surgeon Dana Holwitt, the diagnosis of breast cancer was a shocker; going through treatment, a revelation.

Dr. Dana Holwitt, a breast surgeon at the Montclair Breast Center, became a patient after her very first mammogram, at age 36, detected cancer in her right breast.
Photo by John Emerson.

It was a quiet Thursday afternoon at the Montclair Breast Center when Dr. Dana Holwitt decided to have her first mammogram done.

Holwitt, a breast surgeon at the center, says that test, in October 2009, probably saved her life.

“I could see on the screen that there was something in my right breast. I knew as soon as I saw it that it didn’t look good,” says Holwitt, who was 36 at the time. “The radiologist asked if I’d hit my breast on something, but I knew that I hadn’t.”

Dr. Nancy Elliott, the director of the breast center, reviewed the mammogram, then performed the breast exam and ultrasound.

“I said, ‘Nancy, I have breast cancer, don’t I?’ She was upset,” Holwitt remembers. “I was just numb. It all seemed so surreal.”

Ten minutes later, Holwitt had a biopsy performed. By the next day, it was preliminarily confirmed: She had stage one cancer in her right breast. (In stage one cancer, the tumor is less than 2 centimeters and the lymph nodes are negative for the disease.) Holwitt was stunned by the news.

As a surgeon at a center devoted to breast health care, Holwitt was used to being the one who had to give the difficult news. But this time, she was on the other side. That would prove to be a life-changing experience for her in more ways than one.

“Because of my diagnosis, I can identify with women who have breast cancer and give them some comfort,” she says. “They can come in and look at me and say, Yes, she was diagnosed with breast cancer and here she is working and doing well. We can even talk about the funny side effects of chemo, and I can say, ‘I had that, that’s OK, don’t worry about it.’ ”

Elliott remembers how well Holwitt handled the situation from the start. “She was so tough,” Elliott says. “We were all crying and trying to keep it together. We were in shock. It’s certainly not what we expected.”
Her parents were away, so Holwitt, who is single, spent the first night after her diagnosis alone, watching their dog, Bella. The dog, she says, wouldn’t leave her side the entire night.

The hardest part was calling her parents and brother to tell them the terrible news. “Everyone was crying but me,” she remembers. “I said, ‘Mom, I’m OK, don’t worry. I need you to be okay.’ She was silent. Then she said, all right.”

People around Holwitt told her they were concerned that she never cried. But she says she immediately went into doctor mode, trying to gather all the information she could about her condition.

Tests showed she had a 1.2 centimeter tumor in her right breast. It was considered low-grade invasive cancer. Still, Holwitt had to make some immediate, crucial decisions: Should she opt for a lumpectomy or a mastectomy? That decision, in part, would dictate whether she would be a candidate for radiation and chemotherapy.

After speaking with her family and consulting with the other doctors at the breast center, she opted for a double mastectomy.

“I made the decision that was best for me,” Holwitt explains. “I’m not saying every woman should have both breasts removed. It was a personal decision.”

She says that, as a doctor working at a breast center, breast cancer was a topic she could not escape. She feared going to work and thinking about having cancer. And she did not want to be distracted, thinking that she felt something in her other breast when she should have been concentrating on her patients.

Less than two weeks after Holwitt’s diagnosis, Elliott and Dr. Marcie Hertz, her colleagues at the center, performed the surgery to remove her breasts. Holwitt went home the same day and she was back at work within two weeks. She had no pain at all.

Holwitt is aware that her decision to have both breasts removed was controversial and wrote about it at length on the breast center’s blog in response to a New York Times story on the issue that ran in March. The article discussed the trend toward women with breast cancer wanting to remove their healthy breast—even though studies show that doing so does not improve overall survival rates.

“There are many other issues at play,” wrote Holwitt in her blog entry, adding that some women opt to remove the other breast so that the newly reconstructed breasts will look the same.

She also discussed the agonizing fear that many women go through at the thought of continued monitoring with exams, imaging, and the potential for multiple biopsies.

“When I say [these women are] paralyzed with fear, I mean [they] must take medication to even perform their activities of daily living. These women are always waiting for the other shoe to drop, and frankly, that is no way to live when there are other options available,” she wrote on the blog.

Holwitt says she learned through her own experience that doctors have to try to understand their patients, not just the disease.

“Until you have walked in their shoes and had a diagnosis of breast cancer… how can anyone say the decision you made is the wrong one?” she says. “You don’t know what it does to someone’s psyche—not being able to do their job or being distracted all the time. These aren’t decisions that people enter into lightly.”

Holwitt has since had both breasts reconstructed (by Dr. Valerie Ablaza of the Plastic Surgery Group in Montclair). “My breast reconstruction was a two-stage procedure,” she says. “At the time of mastectomy, I had tissue expanders placed behind my chest-wall muscles to slowly expand the muscle and remaining skin. When I completed my chemotherapy, I had my final implants placed and nipples reconstructed.”
Holwitt adds that she is delighted with her reconstructed breasts. (“I like them better than my real breasts!”)

On New Year’s Eve 2010, Holwitt started chemotherapy. Like most patients on chemo, she lost her hair and felt fatigued and nauseous at times, but nonetheless, she was able to continue working steadily.

By then she had recognized her special mission: to help other women going through the same experience, and to let them know that, if you have breast cancer, it’s not a death sentence—you can have a full life, too.

“These are the things that you don’t learn in medical school training,” she says. “I thought it was hypocritical to hide my experience and not share it with these women—my patients—who are going through the same thing.”

There are some ongoing annoyances, like discomfort with her wig. “I take my wig off ten times a day,” says Holwitt. “I have hot flashes. It’s scary. You don’t know what’s coming down the road. But I’m very up front with my patients. And if I can help alleviate the anxiety of what to expect, then that might make me a better and more understanding doctor.”

Holwitt took only a day off each week from work for her five months of chemotherapy at Saint Barnabas Hospital in Livingston. After being given a special genetic test on the tumor cells, she was administered the drugs Adriamycin, Cytoxan, Taxol, and Herceptin.

On the morning of her last chemo treatment in late May, there was a celebration of sorts in her private outpatient room in the infusion center. Her mother, Betty, who attended most of her daughter’s treatments, was there. Also present were a best friend from Holwitt’s childhood and her mother.

Holwitt sat in a plush recliner, tubes hooked up to her arm as the medication dripped into her body. Her companions snacked on pastries while providing her with big doses of love and support.

Her friend, who is 37 and now lives in New York, is also a breast cancer survivor (she did not want her name used). They lost touch over the years but reconnected when she learned that Holwitt had been diagnosed with the disease.

“That’s where I was a few years ago: bald, no lashes or eyebrows. And I’m still here,” she says with a smile.
Her friend’s mother smiled at the playful exchange: “When you get cancer, you have to have a sense of humor.”

Then she looked at her daughter, choked up, and tearfully gave her a tight hug.

Meanwhile, Holwitt’s own mother, Betty, sat watchfully next to her daughter, checking on her every few minutes to make sure she was comfortable.

Betty Holwitt says she was the one who started the “whole cancer thing.” In May 2009, she learned she had pre-invasive cancer cells in her breast and had a lumpectomy and radiation.

It was stage zero breast cancer—not considered a big hereditary risk factor, says Dana Holwitt. Besides her mother, she had no family history of breast cancer. Still, the news inspired her to have an early screening performed.

Betty Holwitt talks of her daughter’s exceptional strength throughout the experience.

“I don’t think I would have been able to handle it as well,” she says. “She only shed a tear once throughout this, and that was about something else. She’s my hero.”

Her friend agrees: “She’s been incredible. She never asked, ‘why me?’ It’s so important for her to see patients and to be able to say with a smile on her face, ‘Look at me, I’m fine.’ ”

The women reminisced. Soon, the talk turned to men and dating. As a breast cancer survivor, how does Holwitt, who turned 37 in September, feel about going out with men?

She admits that having had breast cancer and a mastectomy will be challenging in terms of dating. “I did think, Which date is the appropriate date to tell someone that you’ve had breast cancer?” But after a moment, she adds: “If someone doesn’t like me because I have breast cancer, then I don’t think they’re the right person for me.”

Yet she does worry a little about whether she’ll be able to have children, since chemotherapy can shut down a woman’s ovaries.

Although she has finished with her chemo treatments, Holwitt will return to the hospital for Herceptin, an antibody that targets the HER2/neu receptor in the breast cancer cells, every three weeks until February. And she will remain for five years on Tamoxifen, a drug that is given to premenopausal women with estrogen-positive tumors, which Holwitt had. Tamoxifen blocks the effects of estrogen in certain parts of the body, such as the breasts, and has been shown to decrease the chances of developing another breast cancer by up to 50 percent.

Holwitt says she is fortunate that she has been able to work throughout her treatment. She had been at the center for only a little over a year when she was diagnosed with breast cancer.

She first met Elliott, the breast center director, when she went to see her about a pain in her breasts five years earlier. It turned out to be nothing, but the two women kept in touch over the years. Holwitt was a surgical intern at the time, and Elliott told her to let her know if she chose to become a breast surgeon.
“When someone comes along who you really feel is excellent and a good fit for your practice, you should hire that person,” says Elliott, who herself was diagnosed with stage zero breast cancer three years ago. “I automatically bonded with Dana. She was the right person.”

Elliott says that, with about 30 women working in the center, they all knew that, statistically, someone was bound to get breast cancer. But they were shocked that it turned out to be Holwitt, who is so young.

“She’s just shown incredible personal strength,” says Elliott. “She’s been able to handle working and seeing patients and chemotherapy.”

Elliott says going through a grueling surgical residency probably helped Holwitt to better deal with having breast cancer: “You have to be thick skinned, able to handle tough times, work hard—it’s not for the faint of heart.”

After completing a fellowship in breast surgical oncology at Washington University School of Medicine in St. Louis, Holwitt did her residency at Virginia Commonwealth University, where she was elected surgical intern of the year.

Holwitt, whose father, Kenneth Holwitt, is a cardiothoracic and vascular surgeon in Montclair and Denville, grew up in Montclair and now lives in West Orange. These days, when not on the job, she keeps busy staying healthy, working out, and taking care of the two rambunctious black Labrador puppies she recently adopted, Ziva and Zadie.

A witty, outgoing woman with warm brown eyes, she wears modern, geometric-shaped eyeglasses and a wig of long, pin-straight, brown hair to work. She says that when her hair started to fall out from chemotherapy, she bought the hair she always wanted. (Before chemo, she used to have her curly hair blow-dried straight and flat-ironed once a week.)

Holwitt says that having an early mammogram was the best thing she could have done. She disagrees with the new guidelines issued in November 2009 by a government task force that said women do not need mammograms until they turn 50, and then should only get one every two years. It was a surprising and controversial break from the American Cancer Society’s longtime recommendation that women should have annual mammograms starting at age 40.

“That baseline mammogram absolutely saved my life,” she says. “I did regular breast exams, and I couldn’t feel the tumor. I never would have known I had it without the test. If I hadn’t gotten the mammogram then—if I’d waited until I was 50, as the government task force suggested—I probably wouldn’t be alive today.”

Her experience convinced Holwitt to raise awareness about the importance of having a baseline mammogram between the ages of 35 and 39 and yearly screenings after age 40.

And she’s determined to make something good out of what started out not so great.

“I’m living it and I’m happy and I feel great,” she says. “Sure, it stunk to lose my hair and everything. But it’s kind of like the most unimaginable thing has happened to me, so from now on, whatever you throw at me, I know I can handle it.”

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    Dana, I live in Montlcair and grow up here too…did you go to MHS? Your story is moving, I’m glad you survived the beast. I’m a recent survivor, getting my mastectomy on 12/3. I’m glad you are educating women about breast health, as well as treating women. I blog about my experience at http://www.beautythroughthebeast.com and also try to educate women. #sistersurvivor