It has been a busy couple of days with appointments.
Yesterday I met with a genetic counselor to discuss my family history and whether there was any need for additional genetic screening. Both of my parents have had cancer (and are living), they each have a sibling who has had cancer (passed away, but not at a young age), and that's about it. I'm the baby in my generation - youngest of all my siblings and cousins, and no one else has had cancer. Even though this makes it look unlikely that there is a genetic component to my cancer, they already have my blood sample and can easily analyze it further, so I decided to go for it. I'd rather know, even if there isn't anything I can do about it. So they will look for moderate breast cancer genes and other emerging genes, just to see if there's anything else there. It won't change my treatment, but it could change my future cancer screenings and will be good information for the rest of my family. I also agreed to join Geisinger's My Code program, so that my information can help us learn more about cancer for future generations.
Immediately after that appointment, I met with Dr. Patel, the Medical Oncologist. The genomic testing of my tumor was successful, and results showed that I have a Low Risk Prosigna Score of 28 (0-40 is considered low-risk). The probability of distant recurrence at 10 years is only 3%. This is incredible news! The purpose of chemotherapy is to reduce the chances of this cancer spreading to other areas of my body. So, since my tumor was very small, had clean margins, my sentinel lymph nodes were clear, and the genomic testing only shows a 3% chance it could spread, there is no point in doing any chemo! This is a great relief, because of all the treatments, chemo has the most impact on your life, both in the short-term and long-term.
Dr. Patel does still want me to take Tamoxifen, which is shown to reduce the risk of recurrence even locally for estrogen-positive cancers (like mine). However, he said if I don't tolerate it well, he wouldn't be too concerned about discontinuing it. Tamoxifen is a drug in the form of a pill - I'll take it for 5 years, starting after radiation has completed.
I asked whether it would be a good idea to get a full body scan to make sure I didn't have cancer elsewhere, and he said it wasn't needed. There is no indication that I have cancer anywhere else.
So, I just let him know when I'm ready for my prescription, and other than that, I don't need to see him for 6 months unless I have a problem.
Finally, this morning, I met with the other Dr. Patel, the Radiation Oncologist. I went in unsure whether radiation was really needed, but looking at stats, it is clear that this is the best way to go. In a study of over 1,000 women my age, 40% of those who only had a lumpectomy had recurrence of cancer in the same breast, compared to 20% of those who also had radiation. That's a pretty big difference. If I add in the Tamoxifen, he said I'm probably down to a 15% chance it could recur in the same breast. Considering about 12% of women will develop breast cancer at some point in their lifetime, I'd say that's a pretty good number.
I go in Friday for a CT scan to do mapping of my breast to determine the exact radiation plan. It will take about a week for that to be determined, and I'll start radiation shortly after. I'll have 36 treatments: 28 of the whole breast, 8 concentrated on the area of my lumpectomy. This will take about 15 minutes of my time every week-day for 6-7 weeks. Immediate side effects are sunburn-type issues of the skin, some fatigue, some tenderness and swelling. My heart and lungs will get some exposure to the radiation as well, but it will be minimal and hopefully won't cause any problems (but it could).
So, overall this continues to be the best case scenario for breast cancer. I am very fortunate!
