Advocate for Your Health: How Breast Cancer Inspired a Nurse’s Career in Oncology

Erin Zajac, a registered nurse, was in the last trimester of pregnancy when she found a worrying lump in her right breast. She spoke to her doctor and was assured that the lump was the result of her milk coming in. Once Erin’s daughter was born, she asked her doctor again about the lump. Erin had every reason to be concerned — she inherited the BRCA gene mutation from her mother who had died from ovarian cancer when Erin was still a teen.

BRCA1 and BRCA2 genes help keep DNA healthy and control cell growth. If these genes change, they can stop working properly, leading to uncontrolled cell growth and potentially cancer. People with harmful mutations in these genes have a 45-85% likelihood of developing breast cancer, and a 10-46% chance of developing ovarian cancer. It also increases your likelihood of developing the following cancers:

• Fallopian tube cancer
• Primary peritoneal cancer
• Pancreatic cancer
• Fanconi anemia
• Prostate cancer

Pushing for an Action

After Erin’s mother died from ovarian cancer, her father had her tested to see if she also carried the BRCA gene mutation. The test came back positive, so from an early age Erin was aware of her need to be screened and to perform breast self-examination.

As soon as Erin turned 30, she started breast screenings every six months which included either a mammogram, MRI, or ultrasound. During pregnancy Erin stopped the screening as it was a busy time for her, but she continued breast self-examination in the shower. She found the lump less than a year after her last breast scan, at 34 years old.

At her second post-partum visit in December 2017, Erin told her doctor that she was having problems breastfeeding her baby and was still concerned about the lump. She was referred to a lactation specialist and Erin pushed her doctor to set up a breast ultrasound to investigate the lump. After two weeks of not hearing about an ultrasound appointment, Erin reached out to former colleagues at a breast center, and they scheduled her for an immediate ultrasound.

“You have to advocate for yourself and listen to your body when you know something is wrong,” said Erin.

After the ultrasound, the mass was biopsied, and Erin was given the news she dreaded — she had invasive ductal carcinoma Stage 2B triple-negative. This diagnosis meant that the cancer had started in the right breast ducts and metastasized to the lymph nodes.

The standard of care for invasive ductal carcinoma Stage 2B triple-negative is the combination of chemotherapy, surgery, and radiation.

Understanding the Diagnosis

A tumor is classified as stage 2B when it is either:

• Between 2-5 five centimeters in size and has spread to 1-3 nearby lymph nodes
• Larger than five centimeters but hasn’t yet spread to the lymph nodes

Triple-negative breast cancer (TNBC) means the cancer cells lack estrogen receptors, progesterone receptors and HER2 protein, making it aggressive and harder to treat than other forms of breast cancer. Common hormone therapies and drugs that target HER2 are not effective against TNBC.

“I knew cancer was in my future,” Erin said. “I just didn’t know it would happen as early as it did.”

Erin knew she wanted to be treated at OU Health Stephenson Cancer Center and she met with breast medical oncologist, Dr. Wajeeha Razaq, M.D., associate professor in the Department of Hematology-Oncology at the University of Oklahoma College of Medicine. Dr. Razaq and another oncologist formulated a personalized treatment plan and Erin had a port placed for the infusions.

In early 2018, two weeks after being diagnosed, Erin started treatment. She had a good response to chemotherapy but with her genetic history, she had surgery to remove her right breast and the affected lymph nodes. This was followed by three months of radiation to ensure any underlying tissue was removed, and in November 2018, Erin had her left breast removed and a total hysterectomy.

It was a tough time for Erin who not only had a baby to care for, but she also worked as an emergency room nurse and was undergoing treatment for cancer. Her husband, family, and friends helped as much as they could, and she had a lot of support at work.

“My friends celebrated every milestone — finishing chemotherapy, finishing radiation, providing meals and childcare — with a party,” said Erin. “I could not have done as much or been as successful without my husband, family and friends.”
Treatment was finished in August 2018, so after taking some time to recover, Erin and her family moved to Colorado for a fresh start. She is now in survivorship and only needs to see her doctor once a year.

“Erin completed all her chemotherapy before surgery as she had lymph node positive disease, and had an excellent response,” said Dr. Razaq. “She had a complete pathological response. After radiation she has been doing very well and is under surveillance.”

A Change in Specialties

Erin watched her mother go through treatment for ovarian cancer and that piqued her interest in oncology. However, oncology nursing can be challenging to get into as a new graduate, so Erin spent her first years of nursing in the ER.

With the experience she had gained as a cancer patient, Erin started working as an infusion nurse in an oncology practice in Colorado. After a year she accepted a supervisory role looking after four infusion clinics, and she worked in that position for three and half years.

When Erin’s daughter was ready to start kindergarten, the family moved back to Oklahoma so she would be close to her family support network. Erin knew that she wanted to work at Stephenson Cancer Center, offering her expertise to others undergoing cancer treatment.

“Oncology is an area where I knew I could really make a difference,” Erin said, “and I wanted to work at Stephenson Cancer Center. The experience I have as a patient means that I understand what people are going through and that helps me in my role.”

Stephenson Cancer Center Oncology Services

“The doctors at Stephenson Cancer Center are experts in their field and have been treating cancer for a long time,” said Erin. “The opportunity for research is a large part of why I wanted to go to Stephenson Cancer Center — it is the largest cancer research group in Oklahoma, and it’s important to me to be part of something that can help future generations. Being an academic healthcare system means that there is collaboration between so many specialties, providing a higher level of care, and I recommend it to everyone seeking cancer services.”

Stephenson Cancer Center is the largest and most comprehensive oncology practice in the state, delivering patient-centered, multidisciplinary care for every type of cancer. It is the only center offering Phase I clinical trials in Oklahoma.

“Stephenson Cancer center is the only National Cancer Institute Designated Cancer Center in the state and our breast program is the only National Accreditation Program for Breast Centers (NAPBC) accredited center in Oklahoma,” explained Dr. Razaq. “This accreditation is very important as the reviewers from NAPBC review our program and patients and ensure that breast cancer treatment is according to the current guidelines. We have a weekly tumor board where all surgeons, medical oncologists and radiation oncologists discuss all new patients and come up with a plan. This way, many brains are working on each patient’s treatment plan.

We have state of the art radiology and radiation oncology equipment including proton therapy to provide the best care to our patients. Last but not the least, we have access to many drugs before they receive approval by the FDA through clinical trials. We have a very robust clinical trial office, and many patients get enrolled in them and get the benefit of new drugs before they become standard of care.”

OU Health Stephenson Cancer Center provides expert multidisciplinary care for the most complex cases. Learn more about our cancer services and treatment and breast cancer care, request an appointment or get a second opinion.