Tamara Mack lives with a death sentence hanging over her head. Diagnosed seven years ago with terminal cancer in her brain, she has dared to challenge an initial diagnosis that her life would most likely end within a year depending on her response to treatment.
Defying all odds, Mack continues to live a quality life that has provided inspiration to everyone around her.
Mack has Stage 4 metastic HER2-positive breast cancer, according to Dr. Sara Barnato Giordano, assistant professor at the Medical University of South Carolina’s Department of Medicine, Division of Hematology/Oncology. This diagnosis, said Giordano, takes the life of 40,000 women each year.
Initially, Mack met cancer head on in 2004 facing a breast cancer diagnosis that ended with a mastectomy. A French teacher at Socastee High School, she did well until 2009 when she developed a “little cough” that she thought was pulmonary. After a battery of tests, nothing could be found until Mack’s left arm began to swell.
“That was a Monday and I went to MUSC on Tuesday,” Mack said. “Monday was my last day of teaching. It was a shock. The cancer had spread through my body.”
Her Stage 4 diagnosis meant her breast cancer had grown elsewhere. For Mack, said Dr. Giordano, it meant the cancer had metastasized in her brain, bones and lung. While treatable, metastatic breast cancer (MBC) is incurable with between 20 and 30 percent of women with early stage breast cancer developing MBC, Giordano said.
With her husband John, son and daughter-in-law all there by her side when she heard the devastating diagnosis, Mack said she remained calm.
“We were all there and I told the doctor ‘you’ve got to be kidding me,’” John Mack said. The doctor recommended chemo and radiation starting “sooner rather than later,” he said. They actually took her into another room and began treatment on the spot, he said.
“It was that scary and that critical,” he said. “I said what if she doesn’t respond to it, how long then? The doctor looked at me and said maybe one good year if she responds and 90 days if she does not respond to treatment.”
For Tamara, the news was a shock but she recalls feeling very calm while her family grew upset. A very religious person, she said, “I think it was the Holy Spirit keeping me calm. I felt really blessed because I knew I probably had a year and that year has turned into 3, 4, 5, 6 and now 7. I could have stepped in front of a car and not had time to prepare with my family.”
The family had tickets to visit France in January. Tamara Mack had lived in France for 10 years and had taught English at a technological university there. She wanted her family to enjoy a visit so they moved forward with their plans. She would not allow cancer to interfere with her life’s plans then and she still does not now.
“She will tell you the reason she is still here is because of the Almightly and that God has plans for her,” John Mack said. “I can see in the last seven years what an inspiration she has been, especially to one person who is struggling, but she’s been an inspiration to all of us.”
John Mack said his wife is handling her illness better than he is. She has been there for him during the loss of his daughter almost two years ago. For the last 12 years, the couple has also been part of a small church support group at Trinity and the group has been there for them in their times of need.
“I would hope for other cancer patients or survivors out there to have Tamara’s positive attitude about life and death. I think back about Coach Jimmy Valvano’s speech about never giving up. There is always hope. Tamara has told me she is going to miss me when she dies but that she cannot wait to see her parents in heaven. She just has a very positive, positive attitude about life and her cancer,” John Mack said.
Tamara Mack said living with a death diagnosis makes her truly appreciate every day. “I prayed for strength in my faith. God has a plan for me,” she said.
Dr. Giordano said Mack’s case is the exception, both in the length of time she has survived through treatment and the fact she has continued to do well on her first line therapy with few side effects interfering in the quality of her daily living.
But the doctor hesitates to give false hope to others battling this condition, saying Mack’s situation is “really like one in a million.”
“Breast cancer is a common cause of brain metastases, with metastases occurring in at least 10-16 percent of patients. Longer survival of patients with metastatic breast cancer and the use of better imaging techniques are associated with an increased incidence of brain metastases,” Giordano said. “Unfortunately, patients who develop brain metastases tend to have poor prognosis with short overall survival. Brain metastases in breast cancer patients represent a catastrophic event that portends a poor prognosis, with a median survival that ranges from 2 to 25.3 months despite treatment. In addition, brain metastases are a major cause of morbidity, associated with progressive neurologic deficits that result in a reduced quality of life.”
Giordano said she wishes she knew why and how Tamara Mack has done so well.
“She has completely overcome her odds,” the doctor said.
Speaking of the therapies used to treat the disease, she said, “Lapatinib, a small molecule with potential ability to cross into the brain, has been extensively tested in the treatment of HER2-positive brain metastases. As a single agent, lapatinib has shown response rates in the brain ranging from 2.6 to 6 percent in heavily pre-treated patients. However, when added to capecitabine, response rates increase to 20 to 33 percent. The highest efficacy is observed in previously untreated patients, where the combination of lapatinib and capecitabine produces an objective response rate of 65.9 percent, with a median time to progression of 5.5 months and a 1-year survival rate greater than 70 percent. Even with this therapy, majority of women progress over time. Clearly, Ms. Mack is not a statistic! Therapies are no longer ‘one-size-fits-all’ but targeted for each cancer subset. We still have a long way to go and we are still losing too many women… but there is a lot more hope for many years of good quality life for a patient diagnosed with a metastatic breast cancer now than there was even a decade ago.”
Giordano said the performance status of the patient at the time of diagnosis of brain metastases is an important prognostic factor. “Ms. Mack has remained a very active and fit individual, which I believe has helped her tremendously,” she said.
On Monday, July 10, Tamara Mack received another good checkup with her doctor. The cancer remains stable and she will continue her treatment as long as the cancer does not grow on it or toxicity does not develop, Giordano said.
With the good news, Tamara will continue to take six chemo pills a day for life. But, she has one more thing to be positive about. Finding humor in something many women would find devastating, Tamara said having no hair for the rest of her life is a blessing. She has a couple of very realistic wigs she can pop on each morning hassle free.
“I never liked to fix my hair so the fact my hair will never grow back is a blessing,” she said with a chuckle. Joking further, she added, “I’m seven years past my shelf life and expiration date but I haven’t gone bad yet. I’m just happy to be here and feeling good. It has been a journey but a very good journey.”
In her doctor’s words, Tamara Mack, “is a survivor; a survivor with metastatic breast cancer.”