Dr. Kristi Funk

On Tuesday, we met with Dr. Kristi Funk, surgical oncologist and founder of Pink Lotus. It was the first time we met her (when we went to Pink Lotus before, right after my diagnosis, she was on vacation, so we met with her colleague Dr. Miller instead). Dr. Funk became a celebrity of sorts two years ago when the New York Times published an op-ed by Angelina Jolie describing her decision to have a prophylactic double mastectomy due to her BRCA-positive status. Dr. Funk was her surgeon (also, earlier, Sheryl Crow's), and she became a household name in the breast cancer community as a surgeon to the stars. Not being a star myself, I probably would not have even considered her except that my OB had mentioned that I might want to look into Pink Lotus, where several of his patients had been treated. Our initial consultation with Dr. Miller was exactly what I needed at the exact time that I needed it - so I continued to be intrigued by Pink Lotus even though I planned to use Dr. Giuliano for my surgery.

When you Google Dr. Funk, you get a lot of glossy profiles in magazines like Los Angeles and Town and Country, with a lot of glamorous photos to go along with them. Based on that, I was a little apprehensive that she would be inaccessible and intimidating, the Anna Wintour of breast surgery. Instead, like Drs. Miller, Hurvitz, and Grunwald (a reconstructive surgeon I met with recently), I immediately felt comfortable and even familiar with her. 

She started with a thorough breast exam and ultrasound - and she confirmed that my tumor had shrunk significantly since my last appointment at Pink Lotus (her estimate of the shrinkage was 70%). Then we talked for a long time about my surgical options. She recommended bilateral mastectomy for all of the reasons that I had been thinking, which I had printed out and brought for her to review (the same points that I outlined here). She also made two new points. One was that any cancer that occurs in a 35-year-old is necessarily genetically based, because 35 years of life isn't long enough to develop cancer through environment or lifestyle, especially since my environment and lifestyle haven't included any known risk factors anyway. Although my genetic panel came back negative, that only means that the seventeen genes that they tested for were normal - not every gene in my DNA. That being the case, it is likely that my risk of recurrence is higher than average, even though there is no way of knowing by how much. The second new idea that Dr. Funk raised is my risk of developing contralateral breast cancer (cancer in my other breast). To be honest, I had been focused on having a double mastectomy mostly because of the cosmetic disadvantages of a single mastectomy. However, what Dr. Funk explained is that if I had a lumpectomy with radiation in my left breast, my risk of developing breast cancer in my right breast is actually much higher than my risk of a recurrence in my left breast - as high as 40%, although that number is cut in half with the hormone therapy that I plan to have. These are two more strong arguments in favor of bilateral mastectomy. 

Dr. Funk also gave me the answer I've been looking for about why recurrence and survival rates are roughly the same with lumpectomy and mastectomy. One reason is radiation - lumpectomy alone would not be nearly as effective as mastectomy, but lumpectomy is always followed by radiation, which is extremely effective. The other reason, she said, is that the studies tracking long-term results are necessarily looking at patients whose surgeries took place a long time ago (in the 80's and 90's), when there weren't many surgeons who specialized in breast cancer only, and the studies didn't control for the quality of the surgeons. Although there is no reason to think that these general surgeons weren't competent and conscientious, a doctor who removes appendixes and gall bladders as well as breasts probably isn't going to be as skilled at it as surgeons who only work with breasts. She said that ten years from now, she expects the findings to change to reflect the success of these breast specialists - for instance, she has performed over one thousand mastectomies with only two recurrences (and in one of those two cases, the cancer was so aggressive that she said it probably recurred "before the patient was even off the operating table"). That's less than 0.2% - many times less than the 10% that I keep hearing.

In addition to her knowledgeability and personal charisma, Dr. Funk made me feel the way that I want to feel - respected, understood, and positive. More than just that she was considering this decision from my perspective (which would have been good enough), it felt like we had the same perspective - as young women, as mothers, as people who will spend the rest of our lives thinking about breast cancer. Although she is the doctor and I am the patient, I felt that she felt that I was entitled to know everything she knows about my disease, and that we are in this together. Rather than reinforcing my fears - of the pain of surgery, of the long recovery, and most of all of recurrence - she made me feel empowered to determine my own fate, and she made me feel confident that I am taking the right steps to end my disease.