TRANS WOMAN SOUNDS ALARM ON BREAST CANCER Ordeal yields new data for M.D.s
A transgender woman who beat a rare form of breast cancer in a case that helped enlighten mystified medical experts wants to make sure no other member of the trans community waits as long as she did to ask questions, or ever feels discouraged seeking medical care.
When Connie Fleming, 54, underwent surgery for breast implants in 2000, the associated risks of cancer were barely an afterthought.
“At the beginning, when I first got them, they said that mammograms weren’t really helpful or useful because they couldn’t see around the bag itself to really get a clear diagnosis,” the Brooklyn woman told the Daily News. “The true risks of cancer were never fully explained.”
Years later, Fleming said she ignored persistent itchiness in her lower right breast, brushing it off as no more than irritation caused by an underwire bra. And when the symptom subsided, she said she forgot all about it until the itchiness returned “with a vengeance” in 2015.
“Then I started to play witch doctor at home, and would do like eucalyptus oil and tea tree oil,” she said. “It went away again for a little bit until the summer of 2017. Then it shifted to on top.”
During this period, the itching became so bad it woke Fleming out of her sleep one night.
“I itched and I felt a lump— and that’s when I was like, ‘OK, let’s get out of Dodge.’ ”
Fleming went for her firstever mammogram at Mount Sinai’s Center for Transgender Medicine and Surgery and was diagnosed with advanced Anaplastic Large Cell Lymphoma (BIA-ALCL), caused by breast implants.
Dr. Richard Bakst, Fleming’s radiation oncologist, said her case is unusual because she experienced a rare type of cancer as part of an even rarer patient population.
“These tend to occur in people who have breast implants,” Bakst told The News. “The unique thing about her is she’s transgender.”
In March 2018, Bakst and Dr. Alice Yao of Mount Sinai Hospital removed Fleming’s textured saline implants and performed a capsulectomy, taking out the surrounding scar tissue around the implants where atypical cancer cells had formed.
Postsurgery, Fleming underwent chemotherapy and radiation to treat a cancer-positive lymph node discovered during surgery.
In July, Fleming received her first cancer-clear test result in a two-year testing period. Her next checkup is in December.
Recent figures suggest one in 30,000 people who have textured breast implants are at risk of developing BIA-ALCL lymphoma, according to Yao. Many people elect for textured implants over their smooth counterparts based on their teardrop form.
One in 3,000 people who have implants made by Allergan, a major pharmaceutical manufacturer, are at risk, the data shows. Allergan issued a nationwide recall of textured implants in August.
An astonishing 481 of 573 cases of BIA-ALCL were reported to have Allergan breast implants at the time of diagnosis, according to the FDA.
“It’s pretty rare,” Yao told The News. “It just shows you the importance of surveillance after implants, and in the transgender community.”
Fleming, born in the nation Jamaica and raised in Flatbush, is a Jane of many trades: fashion illustrator for designers such as Patricia Field, runway coach and choreographer, former supermodel and infamously no-nonsense door girl at the Standard Hotel High Line.
She said her experience growing up as a transgender woman of color — she made her transition during her late teens — led to feelings of self-blame and exclusion she said stopped her from seeking medical attention sooner.
“Because you hear stories from other trans women that are like, ‘Oh they’re horrible — [doctors will] tell you to leave,’ or, ‘Oh, we don’t do men here.’ It’s that kind of way that we are dismissed as being a nonentity,” she said. “I internalized it at the beginning of my diagnosis, you know. I had to stop that self-blame and seek out my own health no matter what kind of obstacles there are.”
Dr. Joshua Safer, the executive director of Mount Sinai’s transgender center, said Fleming’s case shines a light on the importance of selfexamination.
“It’s not known how aggressively we need to watch for certain cancers in transgender people,” he said. “Until we have transgender-specific data, the wisest thing is to monitor for cancer risk and other diseases the same as everybody else.”