As a breast pathologist, receiving a breast cancer diagnosis changed Kim Allison's perspective on the disease forever. Later, emerging from treatment as a survivor, she found that writing about her experiences helped her process their impact. Her book, Red Sunshine: A Story of Strength and Inspiration from a Doctor Who Survived Stage 3 Breast Cancer, has since provided comfort, answers, and hope to other patients with breast cancer around the world.
Here, Allison shares the impact of breast cancer on both her life and career.
What first led you to specialize in breast pathology?
During training, I had great mentors in both breast and gynecologic (GYN) pathology and was drawn to both specialties. I enjoyed getting to know the variety of mysterious entities in the GYN work, whereas the breast work felt more like a puzzle-solving process.
Eventually, I decided to specialize in breast pathology, drawn to its multidisciplinary nature and the direct influence of the pathology report on a patient's treatment pathway.
What do you love most about your work?
I intentionally chose an academic pathology route that would allow me to ask questions with a big clinical impact, and then set about trying to answer them. Academia also opened up teaching opportunities, which I enjoy. For me, it's as much about educating our clinicians as well as our trainees.
I still love the pattern recognition and puzzle-solving aspects of the work, which attracted me to pathology in the first place. But now I've added a new dimension to my work through developing diagnostic standards and guidelines. It feels like that aspect of my work is really saving lives, and I find it very rewarding.
When did you first suspect that you might have cancer?
It was in 2008. I was 33-years old, and not long out of training – a newly minted faculty. During maternity leave with my second child, I was slowly reducing breastfeeding, and I noticed something was different on one side.
Being young, and having no family history of breast cancer, I wasn't expecting that to be my story. I figured I should have it checked out, and maybe get to look at my own biopsy in the lab, expecting to see benign cells.
What actually happened was my colleague read the biopsy, and advised me that it was cancer. The diagnosis was a big shock.
What went through your mind when you looked at your own biopsy under the microscope?
I didn't want to look at it right away. It took a few weeks till I was ready. Once I did, it felt surreal. I was looking at a piece of myself that had gone bad and was doing nefarious things. It was simultaneously intellectually interesting and terrifying.
But the experience was also empowering. It allowed me not only to face my enemy, but to confront it – to give it a good talking to – and understand it.
Subtle details in the sample can indicate big differences in the potential treatment pathways. Looking at mine, I could see it was big, bad, and aggressive – a stage 3, HER2-positive tumor. That knowledge set my expectations for the treatment I would receive.
Herceptin (trastuzumab) had been approved in the non-metastatic setting just a couple of years before my diagnosis. As a monoclonal antibody therapy that was targeted to HER2 receptors, it had proved to be a game-changer. I knew that young patients with aggressive disease, like me, were being cured, and I clung to that knowledge.
What was the treatment pathway?
My neoadjuvant therapy began with chemotherapy. I had Adriamycin (doxorubicin), which is nicknamed the red devil due to its vivid color and potentially tough side effects. The tumor responded; it seemed like it was shrinking a little.
It was when I received the second half of the neoadjuvant therapy, which was Herceptin and Taxol (paclitaxel), that the tumor appeared to be visibly shrinking. But I still needed surgery. The tumor was 8 centimeters in length, I needed a mastectomy to remove it, and had a full axillary dissection to remove all my lymph nodes. We have learned to be less aggressive with axillary lymph node removal today to reduce arm lymphedema risk, but a full axillary dissection was still pretty standard at the time for a stage 3 diagnosis.
Another part of my treatment plan was to continue with post-mastectomy radiation therapy and complete my year of Herceptin infusions after surgery. Reconstruction was an additional part of my plan, since I chose to manage my long-term future breast cancer risk with bilateral mastectomies.
After my surgery, I was anxiously waiting to learn my final pathology to see the response of the cancer to the neoadjuvant treatment. If it was completely gone – a complete pathologic response – it meant I was most likely cured.
I was very grateful that my surgical pathology confirmed a complete response, with no cancer remaining in the tissue or lymph nodes!
What helped you through your treatment and recovery?
At first, I found it difficult to identify with other breast cancer patients, the majority of whom were much older than me. But after a while, I discovered some young cancer survivor support groups in my area that gave me some comfort.
Friends and family would visit me – sometimes from far away – which helped me feel incredibly supported. If they weren't sure how to help, I would assign them little tasks, like making me a playlist to listen to during chemotherapy, so they could feel empowered over their contribution.
I think it can be really helpful to tell others what kind of support you are looking for during an illness – people want to know what you need. Plus, then you don’t end up with hundreds of pink ribbons and too many casseroles if you don’t want them.
How did your book come about?
My kids were really young at the time of my diagnosis – I had a baby and a toddler. I thought, "I might not survive this. I need to chronicle what's going on, so I can leave something permanent for my children."
What started as an exercise in journaling grew into something more.
At first, I didn't know what to do with it. People with an MD after their name usually write about the medical side of cancer, but I had written about the raw, emotional experience of the cancer journey. It was a very personal story. I wasn't sure how it would land with people in my own field.
In the end, I went ahead and published it, and I'm so glad I did.
How was the book received?
There are a lot of breast cancer memoirs on the shelves today, but back then there weren't as many. It wasn't so easy to find information on what to expect as a patient, and I think my book helped answer a lot of questions. It helped that I was able to pass on medical knowledge from my work, but mainly it was just a very honest and personal account of a cancer journey.
I think it's helpful to hear stories that feel like a piece of what you or your loved ones might experience. My book seemed to open up connections with other patients who felt like my story resonated with them. Every time someone I don't know emails me to say, "I read your book, and it really helped me," it feels good.
What impact did your experience as a patient have on your work as a pathologist?
I became very interested in HER2 testing, and that quickly became a key focus of my research and clinical study involvement.
That work led to my involvement in the ASCO-CAP guidelines for HER2 testing. It made so much sense to me to do that because, naturally, I want every patient who could benefit from HER2-targeted therapy to receive it, and those who won't benefit to get on the right pathway for them.
Since then, I have helped develop a number of guidelines and standards in that area. It feels important to standardize how we define parameters in pathology: What defines a positive or negative result? How should we name this entity? How should it be graded? If we don't, then treatment will vary depending on where a patient is diagnosed.
Some of the work I do with CAP is on reporting standards, particularly in how biomarkers should be reported. As we continue to fine-tune companion diagnostics and other biomarkers, we need to be able to guide pathologists in their interpretation and how to deal with unusual results. Contributing to standardizing best practice has been really rewarding.
What is your message of hope to patients with breast cancer now?
Any new diagnosis can be very frightening. But once you understand what you are dealing with better, and have a treatment plan, it gets more manageable. We really do a great job treating this disease today, so I think it is important to keep living your life to the fullest possible. There is a lot that can feel out of your control, so focus on the things you can control, that bring you meaning and joy.
Your pathology is your personalized roadmap for treatment recommendations. I would advise you to be curious, and have your doctor walk you through your pathology report. Ask what aspects of the pathology and your presentation affected their treatment recommendations. Ask if there are any gray areas in the diagnosis or treatment to help you understand if you might benefit from a second opinion.
And finally, remember that treatments are improving all the time. Today we know about ways to target cancers based not just on what we see under the microscope, but what targetable genetic abnormalities a cancer might start with or acquire with progression. Even the story of HER2 targeting has continued to evolve with new antibody-drug conjugates that can target lower and lower levels of HER2 expression. It has been amazing to see the progress since my own diagnosis eighteen years ago, including the options for less aggressive treatments with the same great outcomes.
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