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Column: Cancer is another reason not to ask a woman if she's pregnant

Tina Akouris is a digital content producer for the Chicago Tribune suburban team. (Jose M. Osorio/Chicago Tribune)

I've been borderline obsessive with how I look lately — analyzing what I wear several times before leaving my house, all in an effort to avoid being body shamed for my recent weight gain.

"Look at you — you're pregnant!" a woman who works at my neighborhood community center recently shouted at me in front of my sons. I was embarrassed and wanted to get out of there as fast as I could.

This happens all the time. I've gotten comments from strangers, radiology techs, my dentist, a neighbor, the dry cleaner across the street, the ladies who own the neighborhood coffeehouse, and it's all the same: They point at my stomach and make the "you look pregnant" comment.

"How can you not be pregnant?" the coffee shop owner asked, "when your arms and legs are so thin and your stomach is so big?"

The dry cleaner: "Are you pregnant again? No? After you had the boys, you were so slim. What happened?"

Cancer happened.

Three years ago this month, I was diagnosed with stage 2 breast cancer. On Dec. 7, 2015, I had a lumpectomy at Loyola University Medical Center. After 33 days of radiation therapy, I was put on tamoxifen, which I'll have to take for 10 years.

Three of my doctors warned me that one of its side effects is weight gain. The number 20 was thrown around for how many pounds I'd pack on, but I changed my diet and started working out a lot more — and a lot harder.

But even with all the exercise and support from my surgeon at Loyola, Dr. Constantine Godellas, people still point at my stomach and tell me I must be pregnant since my gut is so big.

Dr. Timothy Pearman, director of the Supportive Oncology program at Northwestern Memorial Hospital, said studies have not shown a direct correlation between tamoxifen use and weight gain, but it's what oncologists believe and what patients have experienced. The Cleveland Clinic and the Mayo Clinic also contradict those studies on their websites, listing weight gain as a side effect of the drug.

"Many women gain weight during treatment, and most of them will not return to their original weight," Pearman said.

The University of North Carolina at Chapel Hill School of Medicine published a study in 2016 that looked at evidence of weight gain in early-stage breast cancer patients undergoing endocrine treatment, such as taking tamoxifen.

The study states: "Patient-reported weight gain ranged widely from 18 to 52 percent of patients in year one and from 7 to 55 percent in year five. Some studies reported categories of weight change: lost weight (9-17 percent), stable weight (47-64 percent) and gained weight (27-36 percent).

"Wide-ranging and inconsistent results point to the need for further research to clarify annual weight change (loss, gain, stability) from (breast cancer) diagnosis through five years of (endocrine treatment) and beyond," according to the study.

While the results are mixed for breast cancer patients, my protruding gut doesn't lie.

In April, after I had my yearly MRI and had just finished a fitness challenge at work, I felt as though I'd gotten my life back. But the rude comments and the finger-pointing at my midsection continued.

Then I saw Dr. Godellas. I poured out everything that frustrated me about the weight gain, the medication, the rude comments.

"I'm so sorry this is happening to you, but I think you look great. And as long as your clothes fit, that's all that matters," he told me.

So why are people emboldened to ask such personal questions?

Going through breast cancer treatment is difficult enough, and it's a long road. But the emotional and psychological aspects are as difficult as the physical side effects of surgery, chemotherapy and radiation.

As for those rude comments, Dr. Benjamin Jacobson, director of general psychiatry at Lake Forest Hospital said: "Either ignore it and recognize that they don't know what (you've) been through, or educate people."

I've heard from friends who tell me not to worry so much about how I look. Or they'll tell me to rehearse a comeback or two, so I can fire back at these people when it happens.

But I can't.

What has helped is the experience of going through cancer. Cancer changes you. Going through something like this, where your mortality is tested, gives you an I've-been-through-way-worse attitude when it comes to just about anything else you face in life.

Even though I am very sensitive to comments about my body, I am standing up for myself more often in all facets of life, and I feel mentally stronger because of it. I refuse to tolerate people who make harsh or ignorant comments when they have absolutely no idea what is going on in my life.

Tina Akouris is a digital content producer for the Chicago Tribune suburban team. She wrote this about her personal experience.