I liked Dr. Leong immediately. She has a calm efficiency, and a good bedside manner. One of the first questions I asked is “Do I have actual cancer?” and she said “Yes.” without hesitation. So that’s that then.
We talked at length and I took on a lot of information about statistics and pros and cons of treatments available. I found a lot of the terminology over my head and had a few Homer’s brain moments where I zoned out entirely.
There are still big gaps in my knowledge but fortunately no decision needs to be made right away. The next step for me is an MRI which will identify if there are any other cancers within the breasts -WTF?! You don’t know this already? Apparently not, ultrasound/mammos are only partially effective for ‘younger’ women with denser breast tissue (which makes me laugh given the state of my poor envelope flaps).
Unfortunately, mammograms miss 20-25% of all cancers. They also underestimate the size of DCIS in a third of all lumpectomy patients. When this happens, the surgeon misses some DCIS and another surgery is needed. MRIs, which use magnets rather than radiation, can find what mammograms miss. According to a 2010 JNCI article by Dr. Constance Lehman : “Over the last decade, research has confirmed that of all imaging tools, MRI has the highest sensitivity in detection of DCIS (compared with mammography and ultrasound).” Although MRIs are considerably more expensive than mammograms, avoiding a re-excision would not only be less costly but also less traumatic.
While I’m fortunate to have access to an MRI it’s a reminder that the medical community can do the best they can but no diagnostic tool or treatment is perfect and all decisions have inherent risks.
Treatment choice is either breast conserving surgery (lumpectomy) or a mastectomy followed by a reconstruction. Once hearing of the downsides of each I felt as if I’d been offered the choice between a kick in the teeth or a punch in the bollocks.
Lumpectomies are less invasive and require a shorter stay in hospital. But they also require five weeks of daily (daily!) radiotherapy. The surgeon can’t know for sure the size of the affected area, so what’s extracted is biopsied and if the clearance is insufficient, back in they go. There is a 10% recurrence rate.
Mastectomies are a more complex procedure with a bigger wound (no shit!) plus there can be complications associated with the reconstruction and a risk of lymphoedema (mum had that – not at all pretty). There is a 0.3% recurrence rate. I’d also be eligible to have the non-affected breast ‘done’.
I had been considering the prophylactic double mastectomy, a la Angelina Jolie, in any case so had been really open to the sledgehammer-to-a-walnut option. But I’ve since got scared off this a bit by the downsides.
Dr. Leong was happy to offer either treatment. However before going ahead with a mastectomy I need to be referred to a plastic surgeon (laughable given the contents of my make up bag are a decade old) and a psychiatrist (ironic because there’s absolutely nothing wrong with me noggin *twitch* *twitch*).
Mum’s treatment started off with a lumpectomy followed by radiotherapy. The next decade were a catalogue of procedures that were increasingly invasive and misery making.
What would you do?