The base information that they were dealing with was very
good. The lump was 1.6 centimeters long,
1.5 wide, and 1 thick. So it was smaller
than an inch in its longest dimension, which means it was caught quite
early. It tests positive for hormone
receptors (ER+ and PR+), so it will respond well to aromatase drugs that
suppress estrogen production. It tests
negative for HER2, which is a good thing in that HER2 positive tumors are more
aggressive. The result of an oncotype
test was 7. Anything less than 18 is
considered low. So low, in fact, that
chemotherapy is not recommended. Anything over 30 (the test can go as high as
100) has a high risk that the cancer will reoccur, and chemotherapy is
recommended. 18-30 is intermediate, and
chemotherapy may or may not be worth the risk of the side effects, depending on
other characteristics of the individual tumor.
The risk of recurrence with an oncotype test of 7 is 8% per decade. The only disappointment was that the tumor
was described as a grade 2 tumor. That
is on a scale of 1 to 3, where 1 is slow-growing, 2 is intermediate, and 3 is
fast growing. But everything else was a
good as possible, given one has a cancer.
The first doctor we saw was Dr Alphonse Taghian, the
radiation oncologist. The purpose of
radiation is to reduce the likelihood of recurrence. With no radiation the recurrence rate is 15 –
40%. Radiation reduces that to 2%. He outlined 4 possible courses of
treatment. The traditional treatment is
6 weeks of radiation, 5 days per week.
The first 5 weeks target the entire breast, and the last week targets
the location of the tumor. The second
treatment is a Canadian variation on the first, which consists of 4 weeks of
radiation, 3 treating the entire breast, and the last week targeting the tumor
location. The third course is called
Partial Breast Irradiation (PBI) which consists of intense radiation of just
the area where the tumor was removed.
This is done in two treatments per day for one week. The fourth course is very similar to #3:
radiation targeted toward the location of the tumor, but just once per day for 2 weeks. All treatments appear to have the same
results. They don’t do treatments 3
& 4 for many types of breast cancer, and the amount of data documenting the
results varies. They have 25 years of
data for treatment 1; 12-15 years for treatment 2; 9-10 years for treatment 3;
and treatment 4 has been in a clinical trial for just 1 year. Treatments 1 + 2 are available in many
locations, including Emerson Hospital, which is much more convenient to Stow
than MGH. Treatments 3 + 4 are only
given at MGH. Dr Taghian did not
recommend any one treatment, saying Barbie should sleep on the decision.
The second doctor we saw was Dr. Gadd, the surgeon who
performed the surgery. She gave Barbie a
copy of the pathology report that she had discussed over the phone. She inspected the incisions, and was impressed
that Barbie has healed well. Maybe
conducting is therapeutic. Dr Gadd will see
Barbie again in a year. She emphasized
that the results were all good, and Barbie has a very treatable form of breast
cancer.
The third doctor we saw was Dr. Jennifer Shin, the medical
oncologist. She was very concerned about
Barbie’s emotional reaction to what has happened to her and the news she was
getting. While the surgeon and the
radiation oncologist worry about cancer in the breast, her concern is about the
overall outcome and the possibility that this cancer can spread to other parts
of the body. Because of the low oncotype
result, chemotherapy is not recommended.
But hormone therapy is recommended, and Dr Shin prescribed an aromatase
drug that she should start taking after the radiation treatment is
complete. Barbie will take this drug for
5 years, and the anticipated effect is to halve the rate of recurrence. So instead of an anticipated recurrence rate
of 8% per decade, it becomes 4%, which is not significantly different from the
rate of new cancers for post-menopausal women.
The effect of the hormone therapy is to eliminate estrogen, which causes
tumor cells to grow faster.
Unfortunately, it also results in a reduction in bone density, so Barbie
will get a bone density scan as a baseline before she begins the treatment, and
she may have to take something like Fosamax to counteract that effect. Another piece of good news: the copay for the
drug prescribed is $19.33 per month. A
far cry from the cost of Multiple Myeloma drugs!
While waiting for between doctor sessions, Barbie and her
team came to a decision regarding which radiation treatment to choose. Barbie opted for choice 3, the one-week PBI
treatment in at MGH. It will get the
treatments over quickly, and let her start the hormone therapy sooner. Scheduling is underway; Dr Taghian said the
first available time would be the second week in May.
Net: This was a small, relatively benign tumor that was
caught early. The lumpectomy was
successful, and the lymph nodes show no sign of it spreading. It is PR+ and ER+, so it will respond well to
hormone therapy. It is HER negative,
which means it is less aggressive. The
oncotype of 7 means chemotherapy is not recommended. The course of treatment will be 1 week of
targeted radiation in May and 5 years of estrogen suppression.
Emotionally, it was a great relief to get all this
information and have a definite treatment plan.
The doctors are all top notch, and the treatments should not be overly
intrusive. Naturally it would have been
nicer if Barbie did not have had any cancer, but if one is forced to become
acquainted with this disease, this was a good type to have.
On the Multiple Myeloma front, the race to benefit the MMRF
(Multiple Myeloma Research Foundation) is coming up soon on April 27th. We now have a team of 6 (assuming Barbie can
now sign up), and the fund raising is going well. You can still join the team if you would like
to run or walk a 5K course at Carson Beach in South Boston. If you are unable to do that, you can
participate financially by donating at http://www.themmrf.org/teamraiser/races/1590.html. MMRF earns awards for having a high (>90%)
portion of the funds raised go to actual research. The efforts they fund will make it so that
when my MM comes back, I have a greater chance of surviving. Recently I read a blog by Lon Nessler, a Yale graduate who died last
November of Multiple Myeloma. See http://nesseler-medical.blogspot.com/. He describes MM as a rare, incurable, universally-fatal blood cancer. The goal of the MMRF is to remove the words
incurable and universally-fatal.
Obviously their efforts were not in time for Lon Nessler, but who knows,
they may be in time for me. That’s why
I’m running the race. Please join my
team in whatever way you can.
Meanwhile, we continue to get
great joy from our sons and their growing families, and hope to be able to
spend more time with these ever-so-cute little ones. Here are Brian + Brendan, Andrew + Emma. Both little ones clearly taking nourishment.
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