Breast Cancer Treatment... the decisions are YOURS

Dr. Dick pulled out the yellow tablet as soon as we were seated in the examining room. He said, repeating from the first visit, that he would write this all out so that I could have it upon returning home.  He started with my diagnosis and proceeded to outline the size, the lymph node status, and the estrogen receptor as positive.

“There is extensive ductal carcinoma in situ and the margins are close but negative.   Clean margins are necessary to insure that all the cancer has been removed.”

I had no idea what close but negative really meant.

“Your prognosis is 85% cured.  Now I’ll write out your treatment.”

“ I want to ask about the ductal carcinoma and the margins.”

“Please not interrupt me until I am done”.  I felt as though I had been slapped in the face.  He then proceeded with his treatment plan.

“Systemic treatment needs to consist of immediately stopping hormone replacement therapy (HRT).” He underlined the word definitely.

“You’ll go on Tamoxifen (a drug that hopefully prevents breast cancer) twice a day for five years. Side effects are hot flashes (15%) and uterine cancer (1%) and blood clots (1%).  Taking the Tamoxifen and stopping the HRT would improve my prognosis from 85 percent to 90-92 percent.”.  I attempted again to interrupt and bring up the O’Mara study that showed that cancer survivors who continued on HRT did no worse than those who stopped. 

He snapped, “That was not a randomized study. Please do not interrupt me.” 

Now I was getting mad.  I couldn’t ask questions, I couldn’t talk and he was increasingly speaking to my husband and not to me.  He then offered me chemotherapy if I wanted a 2 percent greater survival- - i.e. to 92 percent.  Of course, the side effects would be hair loss, fatigue,  and low blood count among other things.  I replied with great certainty.  “For 2 percent I could get hit by a truck.”

But the real shocker was yet to come.  Methodically putting all this down on the yellow lined paper, Dr. Dick said, “Now we will discuss local treatment. 

“ You need further surgery to get better margins due to the extensive DCIS (ductal carcinoma in situ) and that could be another lumpectomy or a mastectomy.”

I was floored.  All my ability to discuss my future rationally went out the window.

“More surgery?” I asked.

“Yes,” he replied, “ and followed by 6 1/2 weeks of radiation.” 

I was numb, but I went on to my next question and asked about doing a hormone level test.

“Couldn’t we find out what my hormone levels are now, and then with those results, add enough estrogen or progesterone or whatever I needed to get rid of the menopausal symptoms?”

I had been getting less and less sleep at night and I was pretty sure that it was due to lack of estrogen.  Dr. Dick said that Tamoxifen would act like a mild estrogen to all the body except the breast and that should help.  He asked me, “What would a blood test show except that you are post menopausal?”  Another slap in my face.