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Journey through the labyrinth -- My breast cancer treatment choices
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A breast cancer diagnosis touches off an intensely emotional, difficult period of a woman's life at the same time that it demands dozens of life-and-death decisions. Cynthia Brouse tells the story of her path and her choices.
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By Cynthia Brouse
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A second lump
Then came the punch that would complicate my future decisions: in addition to the 1.2-centimetre lump I had found while scratching myself in front of the TV one night, the surgeon had removed another lump of similar size that was hiding nearby, not visible on the mammogram or ultrasound.
What did this mean? It took a couple of weeks before the final pathology report was complete, and I took Dr. Love's advice to ask for a copy of it. There are many types of breast cancer, but they're all classified by stages from one to four; Stage 4 is where you really don't want to be. Breast cancer is considered to be at Stage 1 if the lump that has been removed is less than two centimetres across and no cancer cells appear to have spread to other parts of the body.
Chemotherapy and breast cancer stages
Either a larger tumour or spreading cells into the lymph nodes can vault you into Stage 2, which may mean a recommendation of chemotherapy (a concentrated course of powerful drugs that should kill any leftover cancer cells, though they also wreak havoc on other rapidly reproducing cells in your body, such as your hair and the mucosal lining of your gastrointestinal tract).
On my first visit to Dr. Lee, she doesn't mention chemotherapy until I bring it up. "Do you think you need chemo?" she asks. Unlike the male doctors I've had -- whose style is decisive and who would rather have their pubic hairs plucked out one by one than admit they're not sure about something -- this woman likes to think out loud. I find her approach both refreshing and scary.
Stage 1 or Stage 2, tumour grades and menopause
At first she tells me that radiation followed by five years of the hormone inhibitor tamoxifen should do the trick. My tumours were small-ish. I'm a Stage 1, then, I say. She concurs. But there were two tumours. Should we add them up? Some experts would, Dr. Lee replies. So, I press, that could make me a Stage 2. True, she admits. But my lymph nodes were clear. Ah, she says, but you only had a sentinel node taken out. Dismayed, I point out that the false-negative rate is very low. Yes, but that's not the gold standard yet. Maybe, she muses, chemo's not a bad idea.
OK, so I'm at either Stage 1 or Stage 2 -- does that about cover the numbers game? Not even close. My pathology report contains a gazillion other figures. For example, a tumour has a "grade" of either 1, 2 or 3, a measure of how aggressively it is growing. Mine was a 2. More confounding still is my age. I'm 46, and have already begun to experience minor hot flashes and irregular periods. I learn that there is a whole set of assumptions and post-surgery treatments (called "adjuvant therapy") for premenopausal women and another for those who've passed menopause.
Tamoxifen might help
After the numbers come the letters: ER, PR, Her2-neu, markers that express whether certain hormones and proteins can trigger your particular cancer to attempt to take over your universe. These triggers in turn determine which, if any, long-term drug treatments (such as tamoxifen, if you're premenopausal, or Arimidex if you're post) might help prevent a recurrence. I was happy to find I was Her2-neu-negative, but ER- and PR-positive: tamoxifen might help.
But would a course of chemotherapy help, too? On just about every score, I am betwixt and between treatment conventions. Dr. Lee tells me plainly that she doesn't know what to do with me. She takes my case to the annual breast cancer convention in San Antonio and asks several colleagues for their judgment.
Flaxseed to ward off breast cancer
Half recommend chemo, the other half don't. I seek another opinion myself from a breast cancer specialist who has recently been in the news because of his role in researching new hormonal therapies. Less well-known are his studies using ground flaxseed, mixed into muffins, to prevent recurrence. The muffin doctor is charming. "If you were my wife," he says, "I'd recommend chemo." Warning bells go off; I'm eight years old again.
Apparently chemo will give me an extra two per cent chance of survival. But there's chemo, and then there's chemo: an alphabet soup of different drug combinations, administered in a variety of different ways and over different time periods, are on the menu.
Chemotherapy treatment options
Dr. Lee prefers a combination called CMF that takes six months to complete, but with powerful additional drugs, nausea would be minimized, and hair loss is less likely. Dr. Muffin, however, favours a course called AC, which would last only 12 weeks but would make my hair fall out and my stomach wretched. It may also be hard on one's heart. How hard? "Well," says Dr. Muffin cheerily, "if you should have a heart attack when you're 73, you might not survive it."
I would prefer to survive a heart attack at 73, thank you very much. But I make a chart that compares all the side-effects of the two chemo types on offer and I listen to the tapes of my discussions with various doctors and nurses. (Sure enough, several things come up that I didn't hear at all the first time through, or have forgotten.) I meet with members of my family. Finally, I opt for chemo of the CMF variety.
But not before a cousin tells me about the latest innovation: for a few thousand dollars, a company in the U.S. will do "genomic" testing on the DNA inside tumours like mine, which, I was told, would allow them to predict whether I'm among the 20 per cent of women with my stage and type of cancer (I think) for whom it will probably recur, and therefore whether chemotherapy is indicated.
Aside from the effort and expense such a test would require, I'd rather the future remain behind a curtain of hope. I'll simply do everything I can up front.
Click to continue...
Page 2 of 3
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| 1. Breast cancer essay: Doctors, patients, a lumpectomy, lymphedema, research |
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| 2. Breast cancer essay: Chemotherapy, cancer stages, tamoxifen, flaxseed |
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| 3. Breast cancer essay: Radiation, side effects, menopause, medical studies |
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