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At the age of 51, business professional, wife and mother of a 21-year-old daughter, Annika Närling, of Stockholm Sweden, was diagnosed with breast cancer.

It was only in 2022 that Annika would discover that her friend Cecilia de Leeuw, who met Annika at Ruter Dam a Swedish Executive Development and Mentoring Program for women in leading positions at large Swedish corporations, was to become the CEO of C-RAD. This was a wonderful coincidence, as C-RAD’s breath-hold solution had given her much needed reassurance during therapy. Annika shares her story.

This was news she did not expect, not only for her and her family, but also for her close friends. During Annika’s cancer treatment journey, she would undergo surgery, chemotherapy, radiotherapy, then five years of antihormone tablet treatment – the radiotherapy facilitated by the addition of C-RAD’s surface guidance technology.

Routine breast cancer screen delivers unwelcome news

In Sweden, when a woman turns 40, you get an automated appointment to a mammogram every two years. In December 2020, I went to my routine mammogram, which I’d done several times. I didn’t give it much thought as I hadn’t had any breast-related issues or concerns.

I received a letter with a new appointment to return to the clinic for a checkup and ultrasound scan. Again, I wasn’t too worried about it because I have three sisters and two of them had this same experience and they were false alarms. However, when I went to my appointment, December 17, 2020, the clinician wanted to take a biopsy as well.

Annika Närling, Stockholm, Sweden

I was told that the results would take a while as we were getting close to Christmas and that the laboratory had reduced operating hours, meaning that I should expect to get the results after Christmas. Even at that point I managed not to be too anxious or spend too much time thinking about the results.

On December 30, I met with the breast surgeon who informed me they had found two one-centimeter tumors in my left breast. It was tough sitting there on my own, I remember feeling very vulnerable. While walking through the corridor with the nurse, I noticed a large box with different size breast implants. I was thinking: Is this something that I need to understand and deal with? I was also thinking and worrying about my husband who was standing outside the hospital entrance in a snowstorm, because it was during the Covid pandemic, and he couldn’t enter the hospital to be with me.

My cancer treatment journey begins

I didn’t have to wait very long to begin treatment, which started with surgery, scheduled for January 20, 2021. During the procedure, surgeons found a third lesion measuring six millimeters. Interestingly, all three of the lesions were different types. One was triple-negative, and the other two were HR+  (hormone receptor-positive). The bad news was that I needed to do a second surgery on February 24 to ensure the removal of tissues in the space around the third lesion. But the good news was that nothing was found in my lymph nodes; there was no indication that the cancer had spread and it was at an early stage at diagnosis.

Following surgery, I began chemotherapy in March 2021 and had a PICC (peripherally inserted central catheter) line put into a vein in my arm until the last treatment in July. Unfortunately, my chemotherapy had to be halted, because during the second surgery, the skin was grafted from under my arm to my left breast and the scar under my arm became infected. The infection would have to heal before resuming chemotherapy.

All in all, I got six treatments every third week, with the last by the end of July 2021. The more treatments I got, the tougher it was for my body to recover. Even though it was a tough period, there were many small things to be grateful for: getting medicines to reduce nausea during treatment, meeting with many empathetic nurses, living within walking distance to the hospital and being able to walk to receive my treatments. I spoke with several patients who had to travel very far each day for their chemo sessions.

Chemo treatments required a PICC. I had a very nice view during treatment at Stockholm SÖS, Sodermalms Hospital.

A focus on breathing during radiotherapy

After my round of chemotherapy, it was time for radiation therapy, 15 treatments over three weeks beginning in early September 2021. Each therapy session was an average of 15 minutes, and the doctors said it would include a “breathing adjustment treatment.”

I didn’t know what that was at the time, but this is what it involved: before the treatments began, they took radiation pictures of me – almost like a template. The radiation therapists told me to look at a screen and breathe according to simple instructions. I was lying down on a blue plastic bed with my knees up high and had to hold my breath at a specific range and lie perfectly still. The screen shows marks to maintain the proper range, a red/orange bar. If I kept my breathing cadence between these bars everything was fine. However, if I took a deeper breath or changed my breathing rate, then it would cross the bar and an alert would sound and the radiation beam would stop. This only happened during a test of the system, not during my actual radiotherapy.

With this solution – C-RAD’s Catalyst+ HD system on an Elekta Versa HD™ radiation treatment machine -– I could see that if I wasn’t moving, the treatment was more accurate. By being focused on the breathing exercise, it kept my mind off other things. I also felt reassured by this technique because I understood that without it, the treatment might not be as precise and could cause more side effects. This was very important, as I had left-sided breast cancer, meaning that the treatment area was very close to my heart. To me the technology was analogous to a safety belt during my treatment.

The picture was taken by a nurse after my final radiation treatment. 

Networking reveals ‘it’s a small world’

One of my goals in the beginning of 2021 was to promise myself that I would strive to be in the best shape possible to participate in a group hike that had been planned a while ago. I’ve been very open with my journey and as mentioned in the second paragraph of this story, Cecilia and I had met through the women’s network and just before my radiotherapy, we were meeting up for a hike and everyone that participated in this event knew I had gone through chemo. I had lost my hair, eyebrows and eyelashes and everyone was asking me how I was doing.

Before the hike, I sent an email to everyone in our group about my journey so they would feel comfortable and not sensitive around me. Everyone knew, and Cecilia as well, as she was a part of the group that participated in the hike.

The RD19 (Ruter Dam) group on a hike at Omberg in September 2021.

 

On our second-year hike in 2022, Cecilia asked me how things were going. She then shared with me that she was starting as the CEO of C-RAD, a company that develops solutions for advancing how radiation therapy is delivered. She began to ask for detailed information about my radiation treatments and I actually had some pictures that the nurse took of me in front of the radiation equipment. And there Cecilia saw it – C-RAD’s technology for regulating the breath-hold during radiotherapy! It struck both her and I as a wonderful coincidence – my friend is going to lead a company whose solution had given me reassurance during my cancer journey.

Health, healing and enjoying life

Going through cancer and the energy-draining treatments the disease requires is a very special experience and it’s difficult to explain as well, with all peculiarities that chemo and other treatments do to your body. To reduce my anxiety, my mantra during this time was one step at a time and one day at a time.

The best advice I can give is never skip a mammography appointment if you have that opportunity. And to try to stay mentally and physically healthy and be open with family, friends and your work. I had precious support from my family and friends, and I was in close dialogue with my employer and felt fully supported when I decided to work fifty percent during 2021. I am on an antihormone pill (Tamoxifen) for five years and after that, hopefully declared healthy. At my yearly checkup in February 2023, I can report that I have a clean bill of health.

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