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Brain Cancer Pictures

Capt. Leslie Picht was about to fight the battle of her life against an enemy she couldn't see, but could feel.

The first battle shot was fired the night she performed a breast self-exam--her first--and discovered a lump in her right breast. She had just watched a television drama dealing with breast cancer.

"You know you're supposed to do it," said Picht, a KC-135 pilot with the 93rd Air Refueling Squadron at Fairchild Air Force Base, Wash. "That night I went to bed and did my first exam. The lump was large enough that any idiot would have found it.

"I had the normal flashes of death," she recalled of the discovery. "I sat there very upset and had these horrible thought processes. The next morning I went into the flight surgeon, and he said, 'Yep, that's a lump.'"

The captain had undergone her annual breast exam six months earlier while attending pilot training at Columbus Air Force Base, Miss. Nothing was found.

The flight surgeon at Fairchild referred Picht to a doctor in the general surgery clinic.

"Of course it's a Friday afternoon, and I couldn't get in until the next week, so I sat over the weekend with [more of] those bad thought processes," she said.

Her thoughts were made heavier by the fact her maternal grandmother had died of breast cancer at age 42. The captain was 29.

One thing she didn't think about was her career as an Air Force pilot.

"I was more worried about my health than my career," she said. "At that point, it wasn't 'I'm not gonna fly,' it was 'I'm gonna die.'"

Had she been thinking about her career, she would've remembered that day back in seventh grade when she realized she wanted to be an astronaut.

"Recruiting folks came to my school," the captain recalled. "My brain snapped, and I said, 'That's it, I'm going go to be a pilot. I'm going to go to the [Air Force] Academy. I'm going to be a test pilot, and I'm going to be an astronaut.' The whole agenda was just laid out."

Although the agenda didn't go exactly as planned, she was slowly fulfilling her goals. She graduated from Embry-Riddle Aeronautical University in Prescott, Ariz., and became an Air Force officer, but spent her first six-and-a-half years as a communications officer before being accepted for pilot training. After pilot training at Columbus, she attended aircraft training at Altus Air Force Base, Okla.

The battle begins

She arrived at Fairchild in late October 2000 to start mission qualification training and discovered the lump in early November.

Picht had an ultrasound, and a couple days later it confirmed a complete solid mass. The doctor recommended waiting a month to see if there were any changes.

On Dec. 13, doctors removed the mass and did a biopsy. "On the 15th I went in, and the paper with the results was upside down [on the desk]. I knew it wasn't good," Picht remembered. "[The doctor] told me it was cancer extending to the outside edges--there was more [cancer]."

The battle had just become a full-fledged war, and the enemy was playing dirty.

Picht, who's single, knew it was time to call in reinforcements.

"I immediately went back to the squadron and called my mom," the captain recalled. She told her mom the news and asked her to travel from Huntsville, Ala., to Fairchild as soon as possible.

"Again, it's a Friday so she has two days to pack for what we thought at the time would be six months," Picht said. "Kudos to her. Not only was she in shock, but she transplanted her whole life in the span of two days."

Picht started her own "war college." Her sister Jeanne, a lawyer, visited for two weeks at Christmas, and the three women learned all they could about cancer.

"We gathered as much info as we could so we could go to consultations armed to ask intelligent questions," the captain said.

Air Force doctors gave her the option of having surgery on- or off-base. She chose off-base treatment.

"Statistically speaking, success depends on how much experience a doctor has in a specific procedure," Picht explained. "And experience correlates to numbers, You can be the best general surgeon in the Air Force, but, statistically speaking, how much experience could you have with this, because how many women are in the military under the age of 35 with breast cancer? It's got to be small. And those women would have to go to the same surgeon for him or her to get the experience.

Picht believed her survivability would be directly related to the number of cancer-specific procedures a doctor had performed.

"I immediately said, 'I don't want it done here on base."

It was back to the library to look for the best cancer centers, looking up procedures, and reconstructive surgery options such as implants or using her own tissue. Because of her size, the latter wasn't an option because she didn't have enough fat.

"It was the only time in my life where being thin was a disadvantage," she said.

She met with a plastic surgeon about reconstructive surgery just in case. That was probably her worst experience.

"It was awful," she said. "There I was looking at these pictures in portfolios of folks who he had worked on. And to me the pictures were just awful. One, because I was still in shock, and two, because the pictures were of people who didn't look like me. I wasn't intelligent enough or in the proper state of mind at the time to recognize that a large percentage of these women were 60 or older. The older you are, the more scarring you're going to have because you don't heal as quickly.

"I told the doctor, 'I don't mean to offend you but these are hideous! We can send a man to the moon, but we can't reconstruct a breast?' Obviously I wasn't in the right state of mind. It was one of the few times I just cried."

Making progress

But she kept on marching and searching for the right surgeon. Fortunately, her research led to the leading surgical oncologist in eastern Washington, Dr. Ryan Holbrook. But he had to pass her test first.

This was war, and Picht wanted her battle commander to listen to her.

"When it comes to medical treatment, you are your strongest advocate, period. End of story. Some people choose to abdicate that," she explained. "But I'm the one who comes in with the checklist of 20 questions, and the doctor will answer every one of them before I leave.

"I know my mind, and I know my spirit better than anybody else. It's a team effort. Between the two of us we can do this, do it safely and aggressively, taking care of business. I would never ask myself to do surgery, but I would never ask him to fly a plane either. There's a mutual respect there, but there's not an awe and reverence."

Fortunately, she found a doctor who accepted those conditions.

"My doctor knew to expect the checklist," she said. "He gained energy from it."

The captain went in for a lumpectomy Jan. 3. Battle plans called for her consultation before any other drastic measures were taken. She told the doctor, "If you get in there and all hell breaks loose, then you're going to wake me up, and we're going to discuss this. Then you knock me out, and we'll do the rest."

All went according to her checklist.

"He did a nip, a tuck and rearranged here and there, and lucked out with a lumpectomy. With a sentinel-node biopsy, he took out 10 nodes instead of 25."

She focused on recovering and her family while waiting for the pathology report.

The captain didn't realize how anxious she was until the report came back negative.

"I nearly dropped the phone. I didn't realize until then how relieved I was that the cancer was gone. They didn't think it had spread."

But then there was chemotherapy.

"I found out the University of Washington in Seattle was the best place around when it comes to chemo," she said.

She decided on a six-month chemo protocol and remembers radiation treatment as being "anti-climatic."

"It takes longer to get undressed than to go in there so they can zap you on one side, flip you over, and zap you on the other side," she said.

She did lose her hair, so she wore a wig. Also, she took a drug that made her eyes water so she constantly seemed on the brink of tears until finally her eyes just overflowed.

Getting back in the air

Following all her treatments, Picht's Air Force career was in the hands of a medical board. She wrote a letter explaining she wanted to stay in the military and fly.

"So many people go through something like this and come out of it, and they have to make so many changes because they weren't doing what they wanted to be doing in the first place," she explained. "I was fortunate. I was doing what I wanted to be doing."

The board approved her for military duty, but not flying.

"The rule is, you have to wait a year after your last chemo treatment because the drugs are so toxic, and they do so many things to your body and have so many side effects," she said. "I couldn't even be aboard [a KC-135]."

She continued her duties as an executive officer, which she had been doing since her diagnosis.

After that year, she met a flying evaluation board and came away with the piece of paper she needed to fly. She signed the paperwork and then scoured the log for a flight where she could just climb aboard. The next day Picht was in the jump seat.

Today her prognosis is good, and she receives checkups every three months. After five years cancer-free, she will be considered cured. She marked her second year in January.

Picht is once again flying for the Air Force.

She's at the point where she doesn't think about it every day. The normal stressors are coming back, and that's part of the process.

"When you start worrying about the stupid stuff again, that's a sign of health."

Picht believes the best thing she can do now is educate people.

"I have an excellent cancer library," she said. "I'm a walking textbook. If people want to ask me a question, just ask because that's how people are going to learn."

One of her biggest lessons is the importance of self-exams.

"Women don't do their breast exams like they're supposed to. Some of them are afraid; some of them are lazy like me."

She believes her job as a pilot helps spread the word.

"I'm in a better position because I'm in a male-dominated business, and I think men have a significant impact on women," she explained.

"There's so much to be said when your husband pulls you aside and says, 'I want you to be here. I want to spend the rest of my life with you and I prefer that it's longer than shorter, so I think it's important that you do your breast exam.'"

RELATED ARTICLE: What to do if you find something unusual

Finding the lump:

* Be familiar with how your breasts feel, and examine them regularly. Lumpy breasts are common, so not every lump is breast cancer. However, any new breast lump that doesn't go away within a few weeks, or a familiar lumpy area that seems larger or feels different than it did before, should be examined by a medical professional.

* Have a medical professional check any other breast symptom that seems abnormal, new or appears on one side only, and that doesn't go away within a few weeks. Symptoms may include skin dimpling or puckering, nipple discharge, a nipple that turns inward, or breast swelling or pain not associated with normal monthly cycles.

* If you have a personal history of breast lumps or cysts and/or a close family history of breast cancer, you may want to be examined initially by a breast surgeon.

Further evaluation may include the following:

* A mammogram. You may be referred to a radiologist for this X-ray

image of the breast, particularly if you've never had a mammogram or your last mammogram was more than a year ago.

* A sonogram or ultrasound. A radiologist may use sound waves to image the breast without radiation. A sonogram can help distinguish a solid mass--a lesion or tumor--from a cyst--a fluid-filled mass--and often is used instead of or before performing a mammogram in women younger than their mid-30s.

* A needle aspiration. If the lump seems to be a cyst, the doctor may insert a small, hollow needle into the breast to draw out fluid. This causes most cysts to collapse and disappear. With a solid lump, a needle aspiration can sometimes obtain a minute amount of breast tissue for testing.

Possible diagnoses:

* The lump was, or is, a cyst. Breast cysts are very common, and are generally benign. If fluid was not withdrawn, your doctor may want to see if the cyst "resolves" or disappears, and have you come back for a checkup or more imaging in several months. If fluid was removed, it's usually sent to a lab for analysis.

* The lump is "fibrocystic tissue," a "fibrocystic mass," or a "fibroademona." Fibrous tissue or lumps in the breast are common, especially in younger women, and are generally harmless. However, any subsequent change in size, position, symmetry or sensitivity should be rechecked.

* The lump appears to be benign on a mammogram. If so, you will probably have a mammogram at your next scheduled interval, or possibly be asked to return for your next X-ray earlier than usual

* The lump appears "abnormal" or "suspicious" on a mammogram. If so, you may have more or different mammographic views taken, have some breast tissue removed for a biopsy, or the doctor may compare past mammography films and written results with the most recent results.

(Source: National Alliance of Breast Cancer Organizations, http://www.nabco.org)

No flash of glory

Capt. Leslie Picht changed her views on dying while battling breast cancer. Here, in her own words, she shares her feelings:

"I got to spend so much time with my mom and my family. We're so much closer now.

"I used to think that dying of a disease was the worst way to go. I always thought, 'Hey, I'm a pilot. I'll go out in a flash of glory like in the movies and songs.' I'll go out in an instant doing what I love--flying.

"But as I was going through chemo, we lost the first person from our pilot training class. An F-16 pilot. I went to his funeral in Arlington and saw how my classmates reacted and how his family reacted.

"It's only a blessing for the individual that they die that quick. It is a selfish desire to want that to happen because you don't want to hurt, you don't want to be in pain, you don't want to drag it out. But it's so much harder on the people who are left because they don't get the chance to say goodbye.

"I don't view dying of a disease as bad because I had a chance to get my affairs in order and take care of the people who I needed to, and say the things I needed to say--and they had a chance to do the same. I wouldn't have learned that lesson had my classmate not died.

"There I was standing in the hot sun in my service dress uniform, in my wig, fresh out of a chemo treatment. I thought I was going to be the first one to die."

Thoughts en human nature

Capt. Leslie Picht learned an important lesson about human nature while battling breast cancer. Here, she talks about extending a helping hand or cordial greeting:

"I've learned things about other people. [Before the cancer], I was in a phase where I wasn't looking very kindly on humankind in general. I thought people were in it for themselves and that it's only about the 'me' factors.

"People were incredibly selfish--not willing to help. Look out for yourself because no one else is going to do it. It was a horrible feeling. Some days you just want to scream, 'Who else wants a piece of me?'

"But as I got sick, I learned that people are just looking for an excuse to help other people--but to be able to do it without losing face. Because when you're in a wheelchair, on crutches or bald and people know it's because you're sick, they're opening doors, they're talking to you, they're friendly, they're always willing to help.

"But it's not like that when you're dealing with healthy people, so my question was, 'Why is that?' Is that because the person feels sorry for you? I think it's because our society has prided itself so much on independence, and we are self-centered compared to others. It helps us in some respects and hurts us in others. I think that people want to help, but they don't want to be perceived as weak or overly sensitive. This isn't true about everybody.

"It's a sad statement. It almost seems like it's not the honorable thing to help people unless there's a visible need. There are so many things that aren't visible. Open the door for the lady - who knows, maybe she was abused last night. The man who said 'hello' to you who you just blew off - maybe his mother just died. I believe people want to help, and they want to do nice things, but it's sad that they think they need an excuse.

"When people are rude and doing mean things, I feel bad for them because it's a sign of fear or insecurity."

Capt. Leslie Picht, a KC - 135 pilot, is back in the air following a breast cancer operation and chemotherapy treatment. Picht discovered a lump in her right breast when she performed her first self-exam two years ago.

Picht (left) and her mother, Brenda, in the captain's home in Spokane, Wash. Brenda spent several months living in Spokane while her daughter battled breast cancer.

After winning her baffle with breast cancer, Picht is back to enjoying an active life. When she's not Flying a KC- 135, she can be found competing in a women's ice hockey league in Spokane, Wash.

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