“This is Terry, from Genomics Health. I just wanted to tell you about the test that Dr. Hwang ordered.”
“Is this the oncotype test on the tumor they found in surgery?”
(This test is ordered for patients with stage 1 or 2 cancer, with estrogen-fueled cance and clear lymph nodes. That’s me. Apparently cancer has its own DNA. Who knew? At some intuitive level, this makes sense. In the endless, self? not self? judgments that white blood cells and other bio-police are always making, cancer cells are definitely “not self.” At the most basic level, the cancer wants to turn “my-self” into “its-self.” Yet even though I’ve lived with this cancer DNA idea for a couple weeks, it still surprises me a little. Some genius geneticists have identified 21 DNA markers that can help determine each cancer’s “not self” personality. Of these, 16 are cancer-related and 5 are “for reference,” whatever that means. How fast will it grow? How aggressively will it invade other tissue? What is the likelihood it will come back? Depending on which markers the cancer has, it will be assigned a “type” designation, thus “onco-type.” Of course, this costs a fabulous amount, about $3,500, in the range of the test for the BRCA genes that can pass breast cancer from mother to daughter.)
“Yes, that’s right, the oncotype test,” the Terry voice answers. “I just wanted to let you know that we’ve gotten the approval from your insurance company.”
“We’re blessed with really good insurance,” I say. “They’ve been covering these things at 100 percent, thank God.”
“That’s right, they are covering this test. It will take about 10-14 days for the results to come back,” the Terry voice says. “I’m just calling to say that if you have any questions, you can just call me here at Genomics Laboratories. Here’s the number.”
For once, I’m not sure what to say. Why are they calling just to say that they’re doing the test that I knew they were doing? And questions? I have a million. Why did some of the cells in my left breast decide to go haywire? Exactly what has to happen before a cancer becomes invasive? What sort of cellular cascade of reactions has to happen before the cancer busts out of the milk duct? Then, once the cancer begins its long march into other tissue, what determines how fast it grows? Are fast-growing cancers the same thing as aggressive cancers? For instance, do some cancers grow fast and stay in one place while others grow more slowly in size but move more quickly from place to place? Is it really true, as I recently read on some breastcancer.org discussion board, that there are 27 types of breast cancer? If there are 21 genetic markers, wouldn’t that mean that there are many more than 20-odd different combinations of markers, cancer locations and cell types?
But the Terry voice can’t answer any of these questions, so I just thank her and we hang up.
But I am grateful to the Terry voice. She is giving me a two-week reprieve. While I’m still sore and still wearing a jog bra most of the time, and still putting a panty-liner in my bra (sticky-side out, thank you breastcancer.org women) to mop up the slight “seeping” of blood and whatnot, the swelling in my incredible expanda-boob has abated. I’m cleared to exercise, (brisk walking for at least an hour, stretches, bridges) starting tomorrow. I’ll wear my Yentl-Ace bandage get up for the walk, but even so, life is normalizing a bit. I’m actually going to work this week. I won’t have even partial answers to all my questions until I find out the color of my cancer’s parachute. Waiting was terrible when I first got diagnosed. Now, it is an opportunity to just live.