Should I give up graduate study because of my BC???

TammyKh

Hi everyone,

I'm a single lady who is living in Canada and having a full-time job. I was diagnosed with BC last October and had a mastectomy in Jan, 2019. Now I am taking Tamoxifen in 5 years and waiting for my implant reconstructed surgery scheduled in June. My boss and my company are very supportive during my illness by allowing me to go to the appointments with my doctors in my working days, work from home when I don't feel okay... In general, I feel I am very blessed and lucky for living in Canada where I get free healthcare, drug coverage and super nice supports.

I was admitted in a Master program at an university in the US in 2018 but I asked to defer it to 2019 due to my financial incapability. I am supposed to start the academic year in the Fall 2019. However, my cancer diagnosis, an upcoming surgery and yearly check-ups may affect to my moving to study in the US. I told the university about my cancer and they said that I will not able to defer next year because I already did it and I am just allowed to defer up to one year. It means that I only have 2 choices: either starting the academic year in the Fall 2019 or withdrawal and can re-apply later if I still want to pursue my graduate study that I am really interested in and it is also very difficult to be admitted if I re-apply.

Since I had cancer, I am always insecure about my health and my future. I also have experienced depression every time I think of my future plans ruined by my cancer diagnosis. I don't know how hard my life would be, how long I can live, how my future would be... So, I'm taking advantage of every chance/time to do whatever I like and plan a life I want to live in. Pursuing graduate study, exploring a new country, experiencing a new culture are among.

I am seeking your advice. Please share with me your recommendations and thoughts that are truly useful for me. Much appreciated! Thank you!

AliceBastable

You HAD cancer. Allow yourself to move on from that diagnosis and don't let it define the rest of your life. You could very well give up the program and find yourself ten or twenty years out with NO RECURRENCE and for what? I've had three cancers and if I thought about it every day I could cower in a corner waiting for the cancer boogyperson to leap out at me. Nope. I plan to live until I have no other choice.

Good luck!

TammyKh

Dear AliceBastable

I'm so sorry to hear your situation. Definitely, you are braver, stronger and more optimistic than me a lot. I can't believe that I had cancer at 32, so it's hard for me to accept it but I think I have to. I need more time. But I am very grateful for inspiring me though.

I really want to pursue my graduate study but my mom disagreed with me as she said my health should be most important at this moment.

vlnrph

If your mom tends to be a bit over-possessive perhaps she just doesn't want you to move...

You had early stage disease (although with a 4cm tumor, 1A is not accurate) and with tamoxifen, immediate recurrence is not likely. There is no reason your follow-up could not take place in the US. Most universities make group health insurance policies available to grad students who are generally young and healthy. Since underwriting is not required, your medical history does not need to be disclosed and cost should be minimal.

At such a youthfu age, was genetic counseling suggested?

moth

I went back to school in September 2018 after chemo and while still doing rads. Physically it's definitely doable.

Talk to your provincial health plan. In BC, we can leave abroad to study if it's at a recognized program and you can maintain full coverage. You'd just need to fly back and forth for follow up appointments but I think you could arrange to do that between semesters. If you have the finances to make this work, I'd do it.

Did you have oncotype test done? I'm a bit curious why someone so young is not getting chemo...
(edited out query about staging because I find the new system confusing so I shouldn't be commenting on that at all)

hapa

I am trying to get into a MS program for this coming fall. I say do it. My undergrad alma mater had a student health plan which covered all full time students and included services at the on campus medical center - mainly urgent care, well woman care, contraceptives, primary care, optical, and a few other things. You could also buy student supplemental insurance from the school pretty cheaply. See if your US university offers some kind of medical plan for students.

NancyHB

I had just started graduate school and had received a graduate assistance scholarship which couldn’t be deferred, when first diagnosed. I completed chemo and radiation during a critical semester with internship and clinical work. It was hard, and I was sometimes tired (and maybe my papers weren’t always the best), but I appreciated the challenge, and distraction, and excitement. And I was 47 when I did this.

Do what feels right for you. If you try and it doesn’t work out, you won’t have missed an opportunity. If you give it up out of fear or worry about “what if,” you may regret it down the line. This sounds like the chance of a lifetime; don’t let cancer rob you of an opportunity to try

On another note, with a 4cm grade 3 tumor, I’m surprised you haven’t done chemo. New staging guidelines can be a little confusing, but you would be at 1b:

https://www.cancer.org/cancer/breast-cancer/understanding-a-breast-cancer-diagnosis/stages-of-breast-cancer.html

Salamandra

Under the new guidelines, she could be stage 1A even with the large high grade tumor - if her oncotype score was I think 11 or below. Our stats don't show the oncotype score.

SuQu31

Please don’t let cancer rob you of your dreams. Do your homework on health coverage, but try to make it work! As NancyHB said, you can always drop out if absolutely necessary, but you probably won’t need to. What would be much harder is dealing with the regret that you gave up without even trying. You are alive, you are a fighter, so go live the life you want for yourself.

Bright55

hi Tammy

Keep up the studies

Sounds doable I had mastectomy first year in for my masters..i had just retired and elected to complete over two years. Th ecourse allowed me to focus on something other than my recovery and treatment. No chemo so progressed well.

Some unis differ in time taken to complete course

All thebest

Bright in hope

TammyKh

Hi moth

I just checked Ontario provincial health plan - OHIP and it's good that I still can get coverage while studying abroad. However, the Ford government is proposing to end the Ontario Health Insurance Plan's limited coverage of emergency out-of-country medical costs in this year (link below), so it's kinda risky for me to leave out of province at this time. Maybe I need to wait until the end of the year to see if any decision is made.

https://www.cbc.ca/news/canada/toronto/doug-ford-ohip-out-of-country-emergency-coverage-1.5109027

For those who are confused about my diagnosis. Let me make it clear. Primarily I was diagnosed with DCIS, grade 3 (high) and the tumor was 4,95cm in my left breast by biopsy but my cancer diagnosis was IDC (2mm) after the surgery and stage IA is confirmed in my final pathology. My profile is made based on information provided to breastcancer.org's forum. When I asked my oncologist about rads and chemo, I remembered he said that I had a whole breast removed, it means no more invasive cancerous cells stayed in my left breast but my right breast is still remaining and it's breast cancer with positive ER/PR, so the risk of recurrence is still high in my right breast. To be honest, I have no idea about staging guideline. All information provided is from my final pathology.

I am not told about my oncotype test yet but thank you for reminding me about this. Absolutely, I will ask my oncologist in my next appointment.

TammyKh

Bright55, NancyHB, hapa- I admire you a lot and thanks for giving me this great inspiration.

"Do what feels right for you. If you try and it doesn't work out, you won't have missed an opportunity. If you give it up out of fear or worry about "what if," you may regret it down the line. This sounds like the chance of a lifetime; don't let cancer rob you of an opportunity to try" - It's exactly what I am thinking now, so can't agree with you more. It is a great chance to be admitted to a grad school that I should catch it up. I'm not sure whether I would be admitted again if I re-apply next year. It's hard and very competitive program. It can be the only chance in this life of mine.

However, this is a choice that I have to sacrifice something: my job and my income (it helps me get drug coverage and pay mortgage of my to-be-soon house), extra expenses for medical insurance in the US. Master program costs me a lot of money, I want to minimize my expenses as less as possible.

Beesie

Tammy, as a student, I believe you will be a non-resident alien in the U.S., which means your official primary residence and tax jurisdiction remains Canada. As such, you will be able to maintain full OHIP coverage. I was in that situation for almost 3 years when I lived in the U.S. on a work visa. I had to get a new OHIP card with different letters at the end (OHIP numbers are always followed by two letters) that signified that I lived out of country but retained my OHIP coverage. I mostly went to my doctors in Toronto but occasionally would see a doctor in the U.S.. I was lucky that I didn't have to deal with OHIP directly, but the basic process was that I paid, I submitted the expense to my company, they paid me back and then they went to OHIP to be reimbursed. The OHIP site has a form to use for re-imbursement.

Because you will be living full time in the U.S. as a student and will maintain OHIP coverage, I don't think your time in the U.S. is considered "travel", so I don't know if the emergency out-of-county medical program will apply to you. As I interpret the following page, the Student Program is separate from the Out-of-Country Traveller's Program. So you may get full coverage of all medical expenses in the U.S.. I don't know for sure, but you should definitely check it out. https://www.ontario.ca/page/ohip-coverage-while-outside-canada#section-6

With regard to both your diagnosis and your profile on this site, the size of a DCIS tumor and an invasive tumor should not be added together because they are very different diagnoses. So your Stage IA is correct, and you have a T1a 2mm invasive tumor. You separately have 4.95 cm of DCIS, which does not count towards your staging. This is because DCIS on it's own is always Stage 0, no matter how much there is. However when a diagnosis includes both DCIS and IDC, the staging is based on the IDC only. Using the profile tool on this site, some people end up with what looks to be two separate diagnoses, one being Stage I (or II or II or IV) IDC, and the other being Stage 0 DCIS. This is not accurate if the IDC and DCIS were part of the same tumor. In that case, while the pathology includes DCIS, there is no separate Stage 0 DCIS diagnosis, only the Stage based on the invasive cancer. The profile tool on this site unfortunately sometimes leads to misleading/inaccurate descriptions (like the fact that last I checked, there is still no DCIS-Mi option).

As for the Oncotype test, I believe a 2mm invasive tumor is too small for the test. There is a separate Oncotype DX DCIS test, but it is a different test and is only used for those who have a Stage 0 pure DCIS diagnosis. The Oncotype test for invasive breast tissue does not consider the presence of DCIS and only the invasive cancer tissue is tested.

TammyKh

Bessie, Thank you so much for your info regarding to OHIP coverage and breast cancer stages. Much appreciated.

It's great to know that I still can maintain my OHIP coverage while I study abroad. It's definitely a great news for the Ontario people if nothing is reformed or changed under the Ford government.

I will have a couples of appointments with my plastic surgeon, breast surgeon and oncologist in the end of May and will discuss about my study abroad plan so that they can know how to address my situation. If my study abroad plan can be made, I need to be in Washington DC in August to start my academic year 2019 while my reconstruction surgery is scheduled in June 21st, followed by follow-up appointments. In case of they don't recommend me to leave out the country but necessarily stay until I finish my first year of diagnosis and treatment, I guess I have to listen them. Apparently, time is not okay for me.

Beesie

Tammy, one additional thought about your residence and OHIP status. In order to be a non-resident alien in the U.S. and to continue to get OHIP coverage by claiming Ontario as your permanent residence (even if living full time in Washington while you go to school), I believe you will need to have an Ontario address. If you still have your current residence, that would be easiest, but otherwise you could perhaps use the address of family or a friend.

Those where the rules when I held non-resident status while living in the U.S.; the rules may have changed but you should check it out. The rationale during my time was that although I was living in the U.S. full time, it was temporary, and as evidence of that Ihad a residence to come back to in Ontario.

TammyKh

Hi Bessie, Thank you so much for your useful information about OHIP. I got all information provided on the website of OntarioService and from you. Much appreciated. Do you mind if I ask you something about the medical insurance you have bought while living in the U.S? Thanks again

Beesie

Tammy, I'm afraid I can't help on that because my employer provided the supplemental insurance and I never had direct contact with anyone except someone from my company.

TammyKh

Hi Bessie, I understand. Anyway, thank you so much for your information that really helps me a lot. Take care!