Pancreatic cancer tests pastor’s faith, affirms her trust in preventive care

It’s hard to say who was more taken aback by Chicago pastor Brenda Bravatty’s pancreatic cancer diagnosis: Brenda or Rajesh Keswani, MD, MS, an interventional gastroenterologist at Northwestern Memorial Hospital. Brenda felt perfectly healthy when she met Dr. Keswani as a precautionary measure after genetic tests revealed she was at high risk for pancreatic cancer. An MRI screening was normal, but Dr. Keswani knew that early-stage pancreatic cancer does not cause symptoms and is hard to detect with medical imaging. He recommended an endoscopic ultrasound to look for even the smallest sign of the disease.

After the procedure, Dr. Keswani sat with Brenda and her husband and shared shocking news.

“He said, I found something, and it’s so small, I can’t believe it,” Brenda said. “He called the next day and said the biopsy showed I had pancreatic cancer. I’d never had any health problems, and he was saying I had a serious disease. I could hardly believe what I was hearing.”

Although Dr. Keswani regularly performs advanced procedures to screen for pancreatic cancer, he said it is rare that it is caught as early as Brenda’s.

“I was really dismayed during her endoscopy,” Dr. Keswani, director of endoscopy for Northwestern Memorial Hospital and director of quality for the Northwestern Medicine Digestive Health Center. “She’d had a recent scan that didn't show anything, and it hits you that you’re about to diagnose someone with something that is life-altering. That is very humbling.”

Brenda’s diagnosis started a year of treatment that would keep her away from the church and ministry that were central to her life. The experience reinforced her trust in preventive care, but at the beginning, it tested her faith in God. She struggled to find hope in her diagnosis. After watching two of her brothers undergo pancreatic cancer treatment, Brenda knew the path would be difficult.

“I felt that I was sinking,” she said. “When I heard I needed chemo, I was shaking, I was so fearful. The chemo for pancreatic cancer is so strong, and I relied on my family and my friends to get through it. My faith in God was my daily companion, but there were moments when I really struggled to understand or make sense of this difficult situation that was happening to me.”

A couple of months after finishing chemotherapy, Brenda asked Dr. Keswani a question that would change her perspective.

 “I asked him, how often do you find pancreatic cancer so early, and he said, ‘Never,’" she said. "I knew my life is a miracle, and I started looking at my process as an opportunity.”

Devalingam Mahalingam, MD, PhD, hematology and medical oncology at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, led the multidisciplinary team that developed Brenda’s care plan. He said the early detection of Brenda’s cancer gave her an advantage as she began treatment.

“It’s hard to detect pancreatic cancers early, and 80 percent of patients present with advanced disease that is not able to be curatively treated,” Dr. Mahalingam said. “Pancreatic cancer’s symptoms are quite insidious – vague abdominal pain, and new-onset diabetes. Often, those don’t immediately indicate the need for a pancreatic cancer evaluation.”

Brenda had surgery called a Whipple procedure and then took several weeks to recover. When she felt stronger, she began a rigorous course of chemotherapy that included a cocktail of three intravenous drugs given every two weeks.

“Brenda completed six months of chemotherapy and she tolerated the treatment really well because she had a positive attitude and she stayed physically active,” Dr. Mahalingam said. “We recommended physical therapy so she could maintain her energy throughout her treatment. It worked so well that she was able to share some of that energy with our staff and with other patients who were also at our cancer center for care.”

Those conversations with other patients reinvigorated Brenda’s faith, and she used each infusion appointment as an opportunity to help others.

“When I was in the waiting area, I saw people who were crying. I talked to them and said, ‘I’m going through this too,’” Brenda said. “Every time a nurse performed a procedure on me, I said, ‘you are doing something that has great value.’”

Throughout the treatment process, Brenda realized she wanted to help others become more intentional about their health. She returned to her ministry, where she helps women overcome domestic violence, single parenthood, emotional issues and other challenges that often make personal health a lower priority.

“Preventive care is so important, and so many people in the Latino community need to hear that,” she said. “I’d always been so healthy that I really am fortunate that I followed up with Dr. Keswani after my genetic screening. That really wasn’t in my nature.”

Dr. Keswani said many pancreatic cancers do not have genetic causes, but for Brenda, there was little that could be done to prevent the disease because of her genetic mutation. Since her cancer was detected early, she wasn’t yet experiencing symptoms that would have made her recovery even more difficult.

“It’s hard to say someone is lucky when they have pancreatic cancer, but with Brenda you have to recognize the blessing of early detection,” Dr. Keswani said. “It’s a story of hope because medicine is advancing. More blood tests are being developed, and artificial intelligence will help us detect pancreatic cancer earlier. If we’re going to make a dent with this disease, it’s going to be with early detection. Brenda was proactive, and it has changed her life.”