Change, all changes, Cambio, Todo Cambio

I apologize for the fact that it has been a long time since I have updated the posting. Mostly I have been just scrambling to keep up, with treatments, changes in plans, decisions, just life. My energy has been less but I really don't feel too bad. The radiation has been okay, and my skin is great. I do feel pretty stressed though.

I have been doing a lot of research on my particular type of breast cancer in the last three weeks, and have become increasingly unsure of the treatment course decided upon. I am comfortable with the decision to do lumpectomy and whole breast irradiation as being sufficient to treat the local disease, but the information that there are questions about whether even tiny Triple negative breast cancers need systemic chemotherapy treatment, which is being questioned with very preliminary research, has been really bothering me. The standard of care suggests below 1 cm with no node spread "May" not need chemotherapy, if over that in size, yes. If below .5 not needed. My tumor was .8, a gray zone, and accorded to Doctor discretion, based on statistics, ....chemo not necessary. The numbers quoted did not seem to suggest that Chemotherapy changed things very much. My chance of no recurrance is very, very good. It seemed a reasonable thing to follow the standard of care, and no chemo.

However, the cancer I have is aggressive, may spread by other means than lymph system, and tends to metastise early if it is going to. If this one hasn't shown up again in 18 months to two years, it likely won't and the numbers get better later, unlike my previous ER+ tumor where the risk of recurrance stays the same over ten years. The thing is, if it does metastasize, it is sneaky about it and goes places that only symptoms will find it like brain, bone, liver, etc. Other breast cancers are like this also and at that point they can only slow it down not cure it.

I have discovered that if treated early enough, this cancer is acutely sensitive to chemotherapy. Since I have some concern that it could already be somewhere else, I feel that now is my chance to stop it everywhere it could be, and that is why I have chosen to have the chemotherapy after all. The other element of this, is that there is some doubt in the research community about the best way to treat these very aggressive, very tiny cancers, as there is not much data on this and if perhaps it should be treated more aggressively, even though small. The reason there is not much data on the early cancers, is that they are usually found in a later stage. So , In my mind, the numbers may not really reflect the true risks. The numbers they are quoting me on recurrance risk might be re-evaluated some day. Lets say I just trust my "gut instinct" more than their statistics. My "gut" is telling me to be more aggressive. Being an engineer, Ron loves those numbers, and I do wish everyone diagnosed with cancer could have the "good numbers" that I have and I know I am not being very scientific in not trusting them more. The thing is I don't want to regret not fighting harder, when I had a chance to perhaps beat this thing for good. After chemo, I hope to be able to rest easy, that I have done everything, and if it comes back anyway, which it can, that I tried and I can fight it again if necessary. I will begin chemotherapy on May 19, and will be doing 4 cycles three weeks apart. I have spoken with several other survivors and I am confident that this is the right course of action for me. We will not know if having the chemotherapy has changed the course at all, only if it doesn't, but I can't change that. I am reminded of my favorite, "Serenity Prayer"

God, grant me the serenity to accept the things I cannot change,
The courage, to change the things I can,
And the Wisdom to know the difference.

I am praying for this to be a "wise" decision.


Dee