I recently wrote a post about how I plan to tackle my ovarian cancer risk. I intended to have yearly blood tests and ultrasound scans, however my plans have now changed.

I had a tumour marker blood test and the pelvic ultrasound and these investigations were absolutely fine, very quick and not at all invasive. However a recent meeting with the geneticist at Newcastle Centre for Life has resulted in me declining these investigations. 
The Geneticist spoke with me about the effectiveness of these investigations; confirming what I already knew about the number of false positives and missed true positives. He also confirmed that my ovarian cancer risk is currently very low due to my young age. 

He ensured that I was very welcome to go ahead with the testing, and that it would be readily offered to me every four months on the NHS. Despite this, I chose not to accept.

This was a very personal decision and I'm sure most women would accept any screening offered, and rightly so. 
But I'm tired of the tests and the medical appointments, the constant screening and subsequent worry. For weeks after the blood test I thought that every letter hitting the porch floor was the dreaded results. 

And more than that, I feel like such a drain, I have had more medical appointments in the past 9 months that I had in the first 20 years of my life! I am not a cheap member of society at the moment and I am very aware of the money I am draining from my future employer...the NHS. I know that is ridiculous but it is how I feel.

I am a clinician, I base my decisions on the facts obtained from the research, this is how my future medical practice will work and it is also how I make decisions regarding my own healthcare. 
The research into ovarian screening isn't looking good...in fact there are questions as to whether it even works in young women. Regular screening causes emotional distress, not to mention the psychological impact of a false positive and subsequent unnecessary investigations.

So the research is telling me it will be of very little benefit and I really don't want to undergo unnecessary tests every four months! My ovarian cancer risk doesn't become significant until my late 30's and at that point I hope to have completed my family and be considering the surgical removal of my ovaries. 

So thank you but no, I will take 10 screening free years please, 10 years where I no longer have to worry about breast cancer and I don't yet have to worry about ovarian cancer. After the long and involved mastectomy process I think I deserve them. 

I had my pelvic ultrasound today, to have a closer look at the outer surface of my ovaries and check for any lumps and bumps.
I thought I would be having the abdominal ultrasound and then the internal vaginal one but I only had the external scan...which was great because I discovered I had run out of razors last night and couldn't shave my legs/bikini line! 

I had been given strict instructions to fill my bladder...to drink two litres of clear liquid an hour prior to the scan not to go to the loo. 
All I can say is I'm glad they were running on schedule because I was bursting! If they had made me wait I think I would have been sick!

The scan was absolutely fine, I didn't even have to take any clothes off. Its the same format as scanning a pregnant lady...the jelly was put on my tummy, under my belly button and the lady scanned for about a minute over my bladder...little bit uncomfortable due to needing a wee! 

She told me everything looked fine but I will get the official results together with the results from my blood test in a few weeks. 

Everything has quietened down at the moment...I seem to have got through the millions of medical appointments and I don't have to see my surgeon again until the end of April. I have to say I'm glad...I had no idea how involved this would be, what with all the appointments, it was really starting to get in the way of life!
I feel very calm. I think I have had so long to worry and then get used to the idea that I just feel ready to do it, there is no doubt in my mind that this is the right thing to do and that everything will be fine.

This morning I had my MRI scan; this is done within the 6 months prior to prophylactic mastectomy to ensure there are no cancerous cell changes in the breast. If there were changes detected these would need to be investigated before the surgery went ahead (if cancerous cells were found lymph nodes might have to be removed along with the breast tissue to ensure that the cells don't spread). 

I was quite excited about the scan; I have never had one before and it would make a bit of a change from my current schedule of cancer lectures, killing myself over assignment deadlines and seemingly constant medical appointments.
So off Sean and I went on our little day trip. 

I'm sure you all know this already but...an MRI scanner is a very big, powerful magnet that looks like a doughnut and makes an awful lot of noise.

You get wheeled into the hole of the doughnut and the magnet aligns the hydrogen atoms in the body...by some work of magic that I can only marvel at, this makes them detectable by the scanner and an image is produced. 
Quite amazing and I'm not going to even pretend that I understand how this happens (Wikipedia is a medics best friend).

I was asked to turn up for my appointment half an hour early as quite a lot of prep is required. 
I had been sent a questionnaire to fill in; this asked me various questions but was basically establishing that I had no metal in my body that might result in me being stuck to the magnet, which obviously wouldn't be good.

I then went into a changing room to undress from the waist up. You will be asked to turn up wearing trousers that contain no metal zips/buttons etc. I wore leggings (also make sure that your knickers don't have little metal buttons/bows/faffy bits!) but if you didn't have anything suitable you could just take your trousers off as well...You have to put a hospital gown on and this covers you down to your knees anyway.

Once I was dressed up in my hospital gown I had a cannula put in my arm (a needle with a port that the contrast can be injected into). It was placed in the crook of my elbow...where blood is normally taken from. This wasn't any more painful than having blood taken, the needle is secured and remains in the arm throughout the scan.

I then went into the scanning room; two nurses were present, one was setting up the contrast liquid that would be injected into the cannula half way through the scan and the other was sticking cod liver oil capsules on my nipples...no really.
Apparently this is a neat trick they have developed...it allows them to locate my nipples on the MRI images. 
Sean thinks they were winding me up...send your answers on a postcard!

Once the nurse had finished with her cod liver oil I had to get on the bed, I kept the hospital gown on and just let it fall open at the front. For most MRI scans the patient will be lying on their back but for the breast MRI you have to lye on your front.
The table has a hole for your face...much like a massage table...but it also has two holes for your boobs!
Once I had manoeuvred into position the contrast fluid was connected to the cannula in my arm (ready to be injected by remote control later during the scan), an emergency squeeze ball was placed in my hand (I was told it squeeze it if I felt unwell and someone would come rescue me) and some headphones were put over my ears (the machine is very loud so music is played into these as a distraction, the operator of the MRI also talks to you over these). 

Everyone then cleared out and the scan began. It wasn't as loud as I though and didn't last very long...I only got through the first five songs on the Now 80 album!
About ten minutes from the end the contrast was injected though the cannula by a remote control...this was really weird...the liquid felt cold and I could feel it spreading up my arm through my veins. This wasn't unpleasant...it was just a bit novel and quite a good lesson in vascular anatomy (I know I'm a sad medic).

The two nurses then came back into the room, helped me off the table and removed my new cod liver oil nipples. 
Apart from being a bit stiff from laying still I felt fine and as soon as the cannula had been removed I was free to go.

The results will be logged by this evening and will be with my surgeon within the week, if nothing is wrong the surgeon will discuss the results at our scheduled appointment in April. I presume if they find anything abnormal I will be notified much sooner.

I'm not going to worry about what the scan might reveal...it would be a waste of emotion and quite pointless. 
It will more than likely be clear but, as I'm only 20, my breast tissue will be quite dense so it might be that something looks suspicious but is actually nothing to worry about. There is also the chance that I have cancerous cells present...this is unlikely at such a young age but not un

I will just have to wait and see...and remember that no news is good news.

BRCA1 doesn't only increase my breast cancer risk; I also have a lifetime ovarian cancer risk of about 60%. 
This is the statistic that scares me, ovarian cancer is a silent killer; it is notoriously hard to detect and patients with ovarian cancer are far less likely to survive than those diagnosed with breast cancer.
But there are things I can do to tackle this risk.

Today I had an appointment with the gynaecologist. I really didn't know what to expect from this; would we be talking about my options? or going straight in for the internal exam?
Turns out it was a bit of both, the clinic was running 45 minutes late so the gynaecology registrar seemed to take advantage of my medical knowledge and kept explanations brief. I was fine with this; I know my risk, all the options available to me, the risks and benefits of each and I know exactly what I want to do. 

It was reassuring to have the registrar agree with and support my plan for tackling my ovarian cancer risk. 
I will have yearly blood tests and internal ultrasound examinations. The blood test is a tumour marker and the ultrasound will allow the doctor to view my ovaries and detect any anatomical changes. 

I will have my ovaries removed aged 35-40, at this time I will have completed my family and won't be inducing menopause too long before its natural onset. 


After our little chat the gynaecologist asked if she could conduct an internal exam.
This involved me undressing from the waist down and laying on a medical couch with a blanket over my lower half.
The registrar then looked inside my vagina with the aid of a speculum (a plastic tool that looks like a duck bill and opens up the vagina, making it possible to see inside). After this she used gloved hands to feel my ovaries by placing one hand inside and the other on my lower abdomen, this allows her to press my ovaries again my tummy and fell their shape and size.

This wasn't something I would like to do every day but it wasn't all that unpleasant. It was never painful, the speculum was slightly uncomfortable but over very quickly.

I had my blood test straight after my appointment with the gynaecologist and now I just have to wait for an appointment to have the internal ultrasound scan.
I don't really know how I go about getting the results...I presume, because of the sensitivity of the information, an appointment will be made to discuss them? I guess I will just wait and see!