By Marcia Simon
Just another routine mammogram.
That”™s how the day began as playwright Suzanne Mernyk reviewed her calendar. Her breast cancer odyssey was about to begin. It was March 2009.
Inside five years she would come to write a play inspired by her ordeal.
Mernyk will produce and direct her new play, “Serenade in C,” for the upcoming Manhattan Repertory Theatre”™s Stagecraft Play Festival. Her successful treatments at the Breast Center at Smilow Cancer Hospital”™s Greenwich Hospital Campus factor only as backstory. The cancer in the play and the larger terror it symbolizes stand on their own.
But in 2009, the curtain had yet to rise on her cancer story. The mammogram showed a very clear growth that concerned her doctor enough to recommend a biopsy ”” and further, a breast surgeon.
Mernyk”™s internist referred her to Breast Care Services of Greenwich, affiliated with Greenwich Hospital.
“Monday I had the test and Tuesday I got the call,” she said. “It wasn”™t the cyst my doctor had expected. It wasn”™t my hormones doing weird things as I”™d expected. I had invasive ductal carcinoma,” Mernyk said.
Cancer at age 47. Wasting no time, Mernyk got several medical opinions. Based on her research, she decided her best option would be lumpectomy surgery to remove the cancer and surrounding tissue.
But first, she would get chemotherapy to shrink the tumor so she would have a better cosmetic outcome.
Meanwhile, a new piece of medical history came to light. Mernyk knew her mother had been successfully treated for breast cancer in her 50s, but then she discovered an aunt on her father”™s side had been diagnosed with breast cancer in her 40s.
Due to her young age and family history, Mernyk agreed to genetic testing. That”™s when the bomb hit. She tested positive for an inherited mutation in the BRCA1 gene, which greatly increases the risk of developing both breast and ovarian cancer.
“This was more devastating than getting the cancer diagnosis,” she said. If she went ahead with the lumpectomy as she initially envisioned, she still had a strong chance of getting cancer in her other breast.
“Being a single woman with hopes of meeting a mate and having this history was a terrible emotional hit.”
For women who test positive for the BRCA1 and BRCA2 gene mutations, the risk of breast cancer can jump as high as 80 percent.
Breast surgeon Laura Lazarus, notes preventive surgery can reduce the risk of breast cancer by 90 percent to below the “healthy gene” average. Lazarus worked with Mernyk on a care plan that would start in May 2009 with chemotherapy.
Treatments were on Fridays so family members could stay with Mernyk on weekends. Mernyk considered herself lucky.
“When I was feeling sad about going through this alone, I”™d go to my support group. I met married people who felt more alone than I did because their partners weren”™t there for them. These types of illnesses reveal all sorts of things about the nature of relationships.”
If she allowed it, Mernyk was well aware cancer could cripple her emotionally. Her corporate job wasn”™t bringing her the joy she expected, so she began leaning more on her longtime passions ”” performing and writing.
In September ”™09, it was time for surgery. “I was distraught about what I knew I had to do,” she said. “Dr. Lazarus introduced me to Dr. David Greenspun, a reconstructive surgeon who told me about the DIEP flap surgery they were doing at Greenwich Hospital.”
The DIEP (deep inferior epigastric perforators) procedure follows mastectomy surgery. Excess skin and fat from the patient”™s abdomen are used to create a new breast without using implants. “The option to have nipple-preserving mastectomies in combination with natural-tissue breast reconstruction allows a woman to achieve breasts that appear and feel natural,” Greenspun said.
For Lazarus, collaboration with reconstructive surgeons in planning the mastectomy is critically important. “This allows me to give each patient the best opportunity to have a natural-appearing breast by preserving the skin of the breast and, when oncologically safe, the nipple and the area around it, so that there is as little scarring as possible,” she said.
The surgery to remove and reconstruct Mernyk”™s breasts took nine hours. “I had breasts when they put me out and I had breasts when I woke up,” she said.
A great majority of mastectomy patients are able to undergo immediate breast reconstruction without compromising their cancer treatment, according to Lazarus. Not only are the aesthetic results better compared with delayed reconstruction, the emotional benefits can be significant: better body image, less depression and improved quality of life.
DIEP flap surgery was relatively new at Greenwich Hospital when Mernyk was treated. In the four years since then, hundreds have been performed.
Other options now include LAP (lumbar artery perforator) flap surgery, which uses fat from “love handles” at the waist, and TUG (transverse upper gracilis) flap surgery, which uses tissue from the inner thigh.
Also, newer breast reduction procedures done before mastectomy surgery now make nipple-sparing surgery possible for very large-breasted women.
Today Suzanne Mernyk is active and healthy. Living in Manhattan, she”™s a playwright, actor, writers”™ workshop leader and a stand-up comic who has entertained audiences at Caroline”™s, Gotham City and other comedy clubs in the city.
Mernyk, 52, admits that at times she can still feel insecure about her body. Emotional scarring and other aftereffects of treatment are not unusual for cancer survivors, whether or not they have had extensive surgery.
As the number of survivors grows, cancer rehabilitation services have become the new and final step of treatment.
“From the beginning, Dr. Lazarus told me to pick a team I felt comfortable with and confident about, because these are people you”™re going to have a relationship with for years and years,” Mernyk said.
“Greenwich Hospital has a very supportive group of professionals. It doesn”™t feel like an institution. Everyone really cared about my progress.”
Smilow Cancer Hospital is affiliated with Yale Cancer Center ”” a National Cancer Institute Comprehensive Cancer Center, one of only 41 nationwide. As part of its commitment to research, the center has numerous clinical trials available, many now offered to Greenwich patients.
“Serenade in C” opens at The Manhattan Repertory Theatre”™s Stagecraft Play Festival, 303 W. 42nd St., Oct. 30, 7 p.m., and runs Nov. 1, 7 p.m., Nov. 3, 6 p.m. and Nov. 8, 7 p.m.; tickets $20.
This article was adapted from Greenwich Hospital”™s Health Extensions magazine.
