Today, I had my quarterly follow-up with the gynecologic oncology team at The Ottawa Hospital.

I'm always thrilled when the team members I meet are Nurse Jacinthe and Dr. Faught. I met Dr. Faught on August 14, 2020—the first oncologist I encountered at The Ottawa Hospital after my unexpected diagnosis with ovarian cancer at the Queensway Carleton Hospital on July 29, 2020. And I met Nurse Jacinthe on August 31, 2020, when she visited me in the hospital as I recuperated from surgery so she could give me information on chemotherapy. They have been welcome constants in my care ever since.

Today, 3½ years later, Jacinthe escorted me to the little exam room, asking how I was doing and whether I had had any recent scans. Soon after, Dr. Faught arrived, telling me that he and Jacinthe had been discussing my case. My 3½ years without a recurrence are rare in the ovarian cancer world. Dr. Faught told me that having a mutation in my BRCA gene (about 20% of ovarian cancer patients have a BRCA mutation) puts me in the best category for the treatment of this disease. That's because people with a BRCA mutation respond better to treatment and have an additional option of a maintenance drug (olaparib). And among people with the BRCA mutation, a small number don't have a recurrence and the drug doesn't become toxic to their system. I appear to be in that small group within a small group, what Dr. Faught called "the best category of the best category."

Dr. Faught also reviewed the report of my recent pelvic CT scan, which Dr. Zhang had ordered for my upcoming breast reconstruction surgery. That CT scan report states: "No gross bowel abnormality. No free fluid or intra-abdominal masses." Dr. Faught said the report indicates no evidence of enlarged lymph nodes or nodules, confirming what I had surmised in reading the report in MyChart a few weeks ago. A silver lining of my non-ovarian cancer health challenges—particularly perianal skin cancer and a prophylactic bilateral mastectomy—is that I have been sent for numerous scans over the past three years. These have provided reassurance that my ovarian cancer has not recurred and confirmed the reliability of my low CA125 results. Dr. Faught said that they wouldn't typically send someone with a stable CA125 for a scan, so I take the scans I have received as a bonus.

Because my CA125 is low and stable and scans continue to show nothing abnormal in my abdomen (suggesting no recurrence) and because my blood work is acceptable and consistent and I feel good (suggesting I'm tolerating olaparib well), Dr. Faught recommended I continue on the drug. "We don't want to rock the boat," he said. When I asked him how many ovarian cancer patients of the Cancer Centre are like me—still on olaparib three years after starting it—he said that he could probably count the number on one hand. More commonly, he said, BRCA-positive patients on olaparib experience either recurrence or toxicity, at which point they are taken off the drug. "We don't know why some people respond to treatment and don't experience a recurrence while others with the same type of tumours have a recurrence," he noted.

I asked Dr. Faught about milestones. He said that in most cases, ovarian cancer recurs in the first 18 months. If patients make it to five years without a recurrence, he said, they're typically viewed as being in the cured category.

Finally, I asked Dr. Faught about my risk for gynecologic cancers other than ovarian cancer. I knew that I was in the clear for uterine (endometrial) cancer and cervical cancer, given that I no longer have a uterus or a cervix. But I wondered about vaginal and vulvar cancer, particularly given that my perianal skin cancer was likely caused by the human papillomavirus (HPV) and this virus is implicated in vaginal and vulvar cancer. Dr. Faught noted that my BRCA mutation does not put me at greater risk of vaginal and vulvar cancer and that these two diseases present with more obvious symptoms than ovarian cancer (as I outlined in my World Gynecologic Oncology Day post). Dr. Faught didn't seem concerned, so I won't be either.

In concluding our appointment, Dr. Faught shook my hand then put his hand on my shoulder—one of those warm gestures of familiarity and optimism. I left the hospital feeling very lucky.