I met my medical oncologist, Dr. Song, for the first time this morning. It’s kind of like going to the dentist, where you spend 45 minutes with the hygienist and five minutes with the dentist. In this case I spent 45 minutes with a resident and five minutes with the oncologist.
I had trouble understanding the resident because of his accent, but he was competent and thorough and didn’t seem to mind repeating himself when asked.
There wasn’t a lot of new information today; it was more a matter of them pulling together all the bits and pieces from the last six months, and making recommendations.
- My cancer is considered gone.
- Further treatment is directed towards the goal of preventing a recurrence.
- With radiation but no further treatment, there is a 17% chance the cancer will recur (I didn’t think to ask at the time whether this was a timed prediction – ie within five years)
- Chemo would provide me with a slight reduction in risk, but the benefits do not justify the risk. So NO CHEMO!
- Hormone treatment – Tamoxifen – will further reduce the risk of recurrence from 17% to 11%.
- All women face a 10% risk of contracting breast cancer, so my risk – with radiation and Tamoxifen – would be only slightly higher than anybody else’s.
- Hormone treatment consists of taking a pill a day for five years.
- The serious side effects of Tamoxifen include a 3% risk of potentially fatal blood clots in the legs or lungs, and a 1% risk of uterine cancer. There are other more common but less spectacular side effects, such as hot flashes, vaginal dryness and weight gain.
The oncologist recommended that I start taking Tamoxifen as soon as my radiation therapy is over. However, the choice is entirely mine and I’m not entirely sure I want to do it.
A 3% risk of blood clots is not insignificant. The risk is greater for sedentary people and hopefully I’ll be active by then, as my spine surgery is a week from today. But Ottawa’s favourite bicycle courier, Frank Plummer, died of a blood clot at the age of 40, and he was a marathon runner.
If Tamoxifen gives me a six percentage point advantage with respect to breast cancer, but a 4% disadvantage with respect to blood clots and uterine cancer…well, doesn’t one practically cancel out the other?
These are things I need to consider when making my decision.
Still. Tamoxifen or no Tamoxifen is a good problem to have. I remember when I first got diagnosed, Lori was saying reassuring things about treatment, and I turned to her and said “Honestly, I don’t care about the treatment. I just want to live. I will happily do whatever it takes to survive.”
And I meant it, absolutely. Mastectomy, chemotherapy, radiation, side effects, whatever it takes. I’ve been incredibly lucky that it has taken so little.
I am so pleased for you! And now you can concentrate on your back and then you’ll be DONE! I have to write an update but I saw my medical oncologist on Monday and I am considering myself DONE with this whole business also.
SQUEALING WITH JOY!!!
Oh I am SO incredibly relieved and happy and overwelmed for you right now!
Now onto your back!
Sounds very encouraging, zoom! YAY!!!
Every case is unique of course, but in my case (which was very similar to yours) I didn’t take tamoxifen: my entire treatment was surgery + 6 weeks of radiation, that’s it. 10 years, no recurrance.
Whatever you decide, congratulations. You’re out of the woods.
BTW, I should clarify, the surgery was a lumpectomy, not a mastectomy.
Truly happy to hear your in the beginning of your remission. Wonderful news, Zoom.
There’s a more recent drug that is supposed to be better than Tamoxifen–it’s called letrozole. You might want to look into this.
http://www.medicalnewstoday.com/articles/161563.php
Congratulations to you too Julia – I’m very happy for you!
Mudmama, thanks. Yup, the back surgery is next Friday. Then a few weeks to recover, followed by a few weeks of radiation, and I should be as good as new again. Give or take a percentage point.
JJ – thank you, and congratulations to you on reaching the 10-year mark. That’s very encouraging. (Mine was a lumpectomy too. They did talk about mastectomy for a bit there, but it turned out the scary things the MRI was seeing were imaginary, so they went back to Plan A.)
Dr. Dawg, thank you. I’ll take a look at the link. Do you know what the protocol is, if it turns out I’m interested in Letrozole instead of Tamoxifen? Can I just request it of my oncologist?
Dr. Dawg, I just checked it out and saw that it’s an aromatase inhibitor. The oncologist did tell me about this today but said I won’t be a candidate for a few more years, after I’ve gone through menopause. However, there is a good chance they’d switch me from Tamoxifen to an aromatase inhibitor part-way thorugh the five-year treatment plan. Thanks for the link.
I am glad you are opting for caution … there is a family history of heart disease and stroke that might mitigate against anything that could cause blood clots.
It’s bee a long haul but you’ve made it almost to the end of the tunnel now.
My cancer is considered gone.
This is excellent to hear.
If Tamoxifen gives me a six percentage point advantage with respect to breast cancer, but a 4% disadvantage with respect to blood clots and uterine cancer…well, doesn’t one practically cancel out the other?
Statistically, this depends on how common blood clots, uterine cancer, and breast cancer are. Imagine the chance to reduce your risk of heart disease by 10%, while increasing your risk of tiger attack by 10%. Overall, it’s a great option, since heart disease is a far more likely problem.
I don’t know about the relative frequency of the three medical conditions you mentioned, but it wouldn’t be too hard to find out.
Yay Zoom! So happy to hear that the cancer is gone. All the best to you.
Oma – the family history of heart disease and stroke – was it just one of my grandmothers and my half-uncle? Or were there others?
Milan – Your tiger analogy is excellent. Maybe I phrased it wrong. Of 100 women taking Tamoxifen, three will get blood clots and one will get uterine cancer. (I’m not sure what the equivalent rates would be among women not taking Tamoxifen.) Of 100 women just like me, 17 out of 100 will get breast cancer if they do nothing. If they take Tamoxifen, 11 will get breast cancer (compared to 10 out of 100 in the general population). I’m not sure I’ve explained it in a way that changes your answer though…I suspect not.
Dr. Prole, thank you! It’s a weird thing hearing it’s gone, actually. It feels like there’s a hazy, ambiguous line between cancer and not cancer. Like…it’s theoretically gone. You know?
I am so pleased to hear that the worst seems to be over, with regards to your breast cancer. I hope your back issues get resolved as smoothly…
The statistics are pretty tricky.
First, you need to think about how much your risk of each illness differs with and without Tamoxifen. Then, you need to compare the severity of the illnesses.
Great news, Zoomie.
And with everything you’re learning about statistics maybe you can find a new career handicapping the ponies at the racetrack.
Good news all round. And it’s interesting seeing people lay out the stats in ordinary terms. Very useful.
We are so relieved…onwards and upwards. Love you lots,
Deb and Rob
Your great grandmother died of a stroke as well … we have very little family history to go on. Three of the five people died of stroke or heart attack, one died of some misadventure very young, and one is still alive at 69. Not good odds there.
So glad to hear you are “cancer gone.” Wishing you ever-progressing healing on your journey.
Cheryl
That’s brilliant! I’m so pleased to hear it. Go you!
Well, that is danged good news! It seems that from now on, you’re about on the same playing field as the rest of us and that ain’t bad. Hooray, Zoom, hooray! You fought well.
yay dragonslayer – nice geo-catch! ‘serendipitous – copacetic meets kismet – with karmic relief!’ (haiku – gesheunteit!)
Yahoooooooo Zooom
That’s great news! Congratulations. And I agree with Milan’s comments about the relative risks of the various illnesses; I was about to make a similar comment (I’m a math prof, though not a statistician!)
You’re gonna live forever most like. Well, till the dinosaurs come back anyway. My partner does Tamoxifen or the like for rhuematoid-arthritis. Scheduled carefully a gin and tonic or glass or two of red wine doesn’t interfere. Looking forward to seeing you frolicing sans wheelchair in a wee while…