In February, the hospital approached me about interviewing me for an article for the hospital newsletter. After giving it some thought, I agreed, hopeful that my story might help people, especially those concerned about radiation risks from mammography studies, feel that it is okay to get a mammogram. (As an aside...the first photo here is a selfie I took one morning before school after Tyler Smith, the article's author, asked me for a recent photo and I realized I didn't have one that included me.)
CU physicist fights back after odds-defying cancer
is stay vigilant, trust your instincts, check out abnormalities
Published: February 17, 2016
By Tyler Smith
Rebecca Marsh knows how to balance risk and benefit. A PhD
physicist by training, Marsh spends a portion of her time at University of
Colorado Hospital’s Breast Center clinics making sure the imaging equipment is
working properly and delivering the appropriate radiation dose. She also speaks
with women, in person and on the phone, who are concerned that the radiation
they receive from mammograms, CT scans and other imaging tests will endanger
their health and even possibly cause cancer.
Rebecca Marsh with son, Owen, and daughter, Lucia, after she began
assistant professor of Radiology at the University of Colorado School of
Medicine, does her best to counter their fears with facts. Despite splashy news
media reports, there is no evidence that radiation from imaging equipment
“I understand their concerns,” she said. “But there is a lot of
false information and I strive to send a consistent message that is accurate,
accessible and consistent.” For women considering breast cancer screenings,
Marsh added, “My job is not to convince them to get a mammogram but rather to
help them make an informed decision.”
Such risk-reward calculations are the stuff of everyday life.
But sometimes the odds break the wrong way. In March of last year, Marsh felt
what she describes as “a structure” in her left breast. Although her mother had
died at 57 from a rare abdominal cancer, there was no history of breast cancer
in her family, and Marsh was only 36 – well below the American Cancer Society’s
guidelines for a screening.
She mentioned it during her next regular visit with her primary
care physician (PCP) at a UCH clinic. You don’t meet the criteria for a
clinical breast cancer exam, her PCP said. But a medical student was observing
the visit, so the PCP took the opportunity to demonstrate how to conduct the
exam. Everything seems fine, the PCP said, calling the structure the result of
normal fibrotic changes.
“That coincided with what I had read online,” Marsh recalled as
she sat in her tiny interior office in Research Complex 2 nearly a year later.
“I wasn’t worried.”
But someone else was. In November, Marsh’s boyfriend told her he
was concerned about the small mass. It doesn’t feel right to me, he said. She
played down his worry and laid out her logic: She wasn’t considered high risk
for breast cancer, her PCP had told her there was nothing to worry about, she
had lots of responsibility in her job with CU’s Department of Radiology, and
she felt fine.
Her boyfriend held firm. I think this is different, he said.
“I told him, ‘If it will make you feel better, I’ll get it
checked out,’” Marsh said.
Shortly thereafter, she was in the Mammography area of the
Breast Center in the Anschutz Outpatient Pavilion. She pulled a tech aside,
related the background of the suspicious structure and asked for a
recommendation. The tech told her the clinic takes walk-in patients, so why not
get a mammogram?
Marsh did so, and the image showed a mass that on first review
looked like a cyst. She then got a follow-up ultrasound. A fellow radiologist
came in the room and delivered bad news. The mass he saw had different shades.
That meant it was probably not a cyst, which would be filled with fluid and
therefore would show up as an image with uniform brightness.
It was now early afternoon, and Marsh headed in for a biopsy,
which confirmed a 3-centimeter primary tumor. Her boyfriend and the tech who
had done the mammogram stood by as Marsh asked the radiologist a blunt question:
What’s your feeling about what’s going on? She got a numbing answer. The
chances are 99 percent that it’s cancer, the radiologist said. That’s going to
mean chemo, surgery and radiation.
A life detour
“In the space of four or five hours, I went from thinking the
worst-case scenario was that I had a cyst to ‘you very likely have cancer,’”
Marsh said. Twenty-four hours later, the 1 percent chance she’d hoped for
vanished. The pathology results showed two primary masses, both positive. Marsh
had an aggressive cancer that most commonly shows up in women under the age of
The next big question – and potential ray of hope – was whether the cancer had
metastasized. She emailed University of Colorado Cancer Center medical
oncologist Virginia Borges, MD,
for guidance. At Borges’ recommendation, Marsh got nuclear medicine and CT
scans the same week and found her silver lining. There were cancer cells in
several lymph nodes, but no evidence that the malignancy had spread to other
parts of her body. A subsequent test showed no known genetic biomarkers,
further decreasing the likelihood of a secondary cancer, particularly ovarian.
Marsh began a regimen of eight chemotherapy treatments for Stage
3C breast cancer on Dec. 17, 2015
and completed the fifth Feb. 11. She’ll finish chemo at the end of March, and
then have a four-week recovery period before her surgery – a lumpectomy, not a
mastectomy, because of the specifics of her genetic testing and the size and
location of the tumor. A six-week round of radiation is slated to begin the end
She has a path forward, but her life with cancer follows no
straight lines. Bad news is mixed with good, fear with hope. For example,
cancer cells tend to be more aggressive in women under 40, but they also are
often ideal targets for chemotherapy precisely because the tumors are growing
rapidly. Marsh deals with fatigue, illness, and mental lapses caused by the
chemo, but that’s been cushioned a bit by 10 weeks of leave she had piled up.
With her department’s strong support, she keeps a flexible work schedule.
The lines of life are the most blurred when it comes to her
young children – Owen, 8, and Lucia, 5. One thought emerged from the confused
swirl the day she confronted cancer: What am I going to tell the kids? She
called her three sisters and ex-husband to give them the news, then waited for
her children to come home from school. Marsh told them she was sick, waited for
their questions, and got the big one in about a minute: Are you going to die?
Her disease isn’t black and white, and neither was her answer.
“The goal is no,” Marsh told them. “I said there are plenty of people with the
same illness I have and many of them get treatment and live a long time.”
Seeing her son’s concern, she talked about what would happen as she went
“I told them about the long-term plan,” Marsh said, “and that I
was going to get medicine that would kill the cancer cells but that it would
make me feel sick and tired and that my hair would fall out.” They went out
together to pick out head scarves. When her son worried about people making fun
of her for losing her hair, Marsh gave him a simple reply: “Tell them, ‘My mom
is sick,’” she advised.
Marsh enjoys time with Owen and Lucia before her diagnosis.
When Marsh’s hair began to fall out after she started
chemotherapy, her daughter asked, “Why would you take medicine that makes your
hair fall out?” Marsh explained that she could either take the medicine that
kills the tumor cells and wait for her hair to grow back, or keep her hair but
let the tumor cells spread to the rest of her body.
“I think you made the right choice,” her daughter replied.
Rather than hide her periodic lapses in mental focus, she lets
them know it’s something that comes with the chemotherapy. On one such occasion
her daughter said, “You did that because of the medicine,” a line that has
become something of an inside joke.
One step at a time
Marsh also tries to be pragmatic about the cancer and the
limitations it has imposed on her life. She accepts that there are days the
chemo will leave her physically sapped. “My perspective now is that when I’m
not feeling well, I just have to wait it out.” She takes advantage of the good
days and works as much as she can. She’s now preparing a presentation of her
research for a March meeting in Salt Lake City and has made it a goal to make
“Because of the chemo, I’ve had to pull back on other
professional involvements,” she said. “I need this one thing I know I can do.”
Rebecca Marsh still knows the importance of balancing risk and
benefit. But her cancer has also given her a new perspective on the limits of
knowledge. She trained at MD Anderson Cancer Center and spent nine years there.
She did graduate work in radiation therapy physics. But cancer pays no
attention to such qualifications.
“Cancer treatment is not foreign to me,” she said. “But there is
a false impression that ‘smart’ people can catch cancer early. I’ve worked in
mammography, and part of my profession is working with breast imaging. I have a
master’s and a PhD – and I still had stage 3C breast cancer.”
Marsh’s “public service message,” as she puts it, is simple. “If
you notice changes and have concerns and suspicions, go in and check it out –
even if it hasn’t been a year, or you’re too young, or you’re not in a
high-risk category. Women in their 30s and early 40s are really busy, and it’s
easy to put a mammogram off. But figure out a way to fit it in.”
And listen to your loved ones, she said. “If my boyfriend hadn’t
said anything, I might not have gone in for months,” Marsh said. “That might
have made a big difference in how this all played out.”