When I was first diagnosed, my response—other than to turn the whole cancer nightmare into a research project—was to cry, “Nuke it! Nuke it! Nuke It!”
I had the Valkyrie response: “Kill the wabbit! Destroy that cancer! Do everything!”
I wanted, want, to survive for my kid, my husband, my pets, my family, my friends, and yes, myself.
And yet, on the other side of what I hope is my first and last go-round with cancer treatment, I have a more mature appreciation for all the side effects that cancer treatment inflicts. The mouthsores and chemobrain are gone, but I still have less energy than I used to have. I need more sleep, 9 or 10 hours a night, to function effectively. I’m done by 9 p.m. I know that both the Herceptin and the radiation that I received may lead to heart damage down the line (though my echocardiograms have been good so far). Every day, I have cramps caused by the Tamoxifen that blocks my body’s ability to use the estrogen that was candy for my tumor.
One of the things that I think patients find the most frustrating is that, while we’ve come a long way, much of our treatment decision process comes down to the culture of our hospital and our doctors, and our personality, our tolerance of risk. It’s all an educated guess. There’s data, sure, but not nearly enough.
So it was interesting to note a “Science Daily” story today that suggests that, in some cases, less may be more when it comes to breast cancer.
Here is a summary of the main points, from research at the Seattle Cancer Care Alliance:
• Spare the chemo but not the cancer.
Thanks to the Oncotype DX test, which analyzes a panel of genes linked to tumor recurrence, nearly 50 percent of women with early stage, estrogen-reactive cancer can skip the chemo and go straight to hormone therapy. Alas, my Oncotype score was too high to get a pass, but I’m happy for the half of my fellow pink sisters who avoided chemo.
• Use PARP Inhibitors for triple negative cancer.
For the 15 to 18 percent of women who have “triple negative” disease—that is, it doesn’t react to estrogen or progesterone and it doesn’t express the Her-2 protein—there may be hope for treatment with PARP Inhibitors. These drugs prevent the tumor DNA from repairing itself, leading to cell death.
• Spare the radiation but not the cancer.
If the cancer recurs in my left breast, the standard treatment would be a mastectomy, because I’ve reached my lifetime limit of radiation in that breast. SCCA is experiment with another solution: a second lumpectomy followed by five days of radiation delivered only to the tumor bed.
• Spare the lymph nodes but not the cancer.
Today, if they find cancer cells in the lymph nodes under your arm, they usually remove a lot of them. This can lead to painful lymphedema, or swelling of the arm. But SCCA did a study that showed that early-stage patients who had only only one or two positive lymph nodes removed did just as well five years out as those patients who had many nodes removed.
If I ever face a recurrence, it will probably be difficult for me to resist responding aggressively. And yet, what’s the point in using a sledgehammer that knocks me out? What do you think?