By Staff Sgt. Erica Picariello, 30th Space Wing Public Affairs
/ Published March 21, 2014
VANDENBERG AIR FORCE BASE, Calif. -- Editor's note: This is the third story in a four-part series on inspirational Vandenberg women.
Many people hum when they're happy or bored, but not many people have hummed because their life depends on it.
The 30th Launch Group commander did just that while getting an ultrasound on a suspicious lump in her right breast tissue.
"I can still remember when the doctor performing the ultrasound had this worried look on her face and said, 'hum,'" said Col. Shahnaz Punjani, 30th Launch Group commander. "I thought she was talking to the resident but she was talking to me... she was telling me to hum. So I hummed, and it turns out that sound doesn't attenuate through a tumor. You can see little sound waves bouncing around the circumference of a tumor. So I was told I needed to come in for a biopsy the following week."
In February 2011, Punjani had found a lump on her breast, but wasn't concerned. She had been down this road before.
"I had a lump when I was in my twenties, earlier in my career, and when I had it examined it was a cyst that eventually went away, so I didn't think anything of this lump," Punjani said. "Just to be sure, I went to a breast cancer surgeon and he told me not to worry about it. It was just a cyst."
The ultrasound technician and civilian doctor disagreed. They told Punjani they saw something they didn't like, and she would need a biopsy.
"I was told I needed to come in for a biopsy the following week," the Punjani said. "So I was still sitting there thinking, fat, dumb and happy -- no big deal, right? They did the biopsy and the idiot that I am, I went by myself. I know that my husband would have gone with me, but I just thought it was no big deal."
In March 2011, Punjani was teaching at the Dwight D. Eisenhower School for National Security and Resource Strategy at Fort McNair, in Washington D.C. when she received a call that would change her life.
"The woman on the phone said, 'I'm sorry to tell you...' and then everybody that gets a cancer diagnosis tells the story the same way," Punjani said. "All I heard was, 'blah blah blah you have cancer blah blah blah...' that's all you hear. You are stunned. I walked out of [class], grabbed my stuff, went home and cried on my husband's shoulder. I didn't even make it out of the garage."
The medical professional told Punjani that she had stage one, triple negative breast cancer.
According to the American Cancer Society's website, triple negative breast cancer used to describe breast cancers whose cells lack estrogen receptors and progesterone receptors.
"Triple negative is the most aggressive form of breast cancer, and it has a greatest likelihood for recurrence," Punjani said. "Other breast cancers have a recurrence rate of one percent, mine was 10 percent. The only treatment that exists for triple negative breast cancer is surgery, radiation and chemo. For some of the other breast cancers out there you can take a drug after your treatment is done to reduce the likelihood of it returning by reducing whatever it is in your body that feeds it. Cancers feed off different things: For example, ER positive cancer feeds off estrogen - so they'll give you a drug that reduces estrogen so that the cancer can't grow and feed off that. There isn't any drug like that for triple negative because they don't know what it feeds off yet. So there is no treatment to prevent or reduce the likelihood of recurrence other than surgery and chemotherapy."
Knowing she was facing surgery, Punjani chose a surgical option that would eliminate all risk of the cancer reoccurring in her breasts.
"For surgery you can do a lumpectomy or a mastectomy," Punjani said. "Long term prognosis for both is about the same - but since my cancer was more likely to recur and there is no long term drug that could prevent recurrence, I went with double mastectomy because [the cancer] is also more likely to occur in the other breast."
According to the American Cancer Society website, a lumpectomy removes the tumor whereas a mastectomy is surgery to remove the entire breast including all of the breast tissue, sometimes along with other nearby tissues. Punjani felt like this was the best option for her future goals and family.
"I talked to a friend who had done a preemptive mastectomy because she had two close relatives who died of cancer before the age of 30. I decided to go with the double mastectomy so I wouldn't have to undergo the six week radiation treatment and to reduce the likelihood of recurrence," Punjani said. "Also, being a mother, I wanted to give myself peace-of-mind."
After the double mastectomy, Punjani underwent eight, one-week sessions of aggressive chemotherapy.
"I underwent dose-dense chemotherapy because you I don't have a lot of 'core morbidity' meaning that I was young and my body could handle the high-dose chemicals," Punjani said. "Chemotherapy was exhausting. The nice thing about when this all hit - I was diagnosed in March. Surgery in April and I had chemotherapy over the summer when class wasn't in-session so I didn't have to miss much work."
Unlike other cancers, Punjani didn't have to wait years for her cancer-free diagnosis.
"The other thing that's weird about cancer is that even though it's limited to the breast there could be microbiotic bits of cancer left in your body... and there would be no way to know. So after the tumor is removed through surgery, we do chemotherapy to basically kill any little bits of cancer that could be hanging around to get it all," Punjani said. "So I consider myself cancer free because there is no way to tell me otherwise."
Punjani credits her positive attitude through cancer diagnosis and treatment to support from helping agencies and family.
"My experience with cancer is one of the reasons I'm so supportive of mental health treatment," Punjani said. "I went monthly to a support group that focused on women my age. To me, [the support group] was a way for me to get feedback from other people. It helped me know what to expect and to get encouragement from other people who were going through what I was going through or had already been there. Also, I was so lucky because my husband Frank was really there for me. I was very thankful for him. He took everything, he did it all. He was amazing."
Punjani has committed over 20 years in service to the military and didn't let the disease stop her, and she wants others to know that this diagnosis isn't a means to an end of a military career.
"You feel isolated, like you're the only person in the world that's going through it even though you know you're not," Punjani said. "That's why I'm so open about [what I went through] because I want other people to know you can continue to serve after cancer. It inspired me when people told me that they had cancer and continued to serve. Plus, I want to tell people, no kidding - do your appointments when you are supposed to do them. For Airmen out there who may have cancer now, remember: This is totally beatable. Your career is not over, and your life as you know it is not over. It will get better."