mastectomies, not a thing of the past ...

The thing that bothers and surprises me is how quickly and definitively my own breast cancer was deemed a case that warranted mastectomy. I mean, this is 2007. I thought that advances had been made so that options were available for women with breast cancer that would preserve the breast, and that mastectomies were becoming a thing of the past.

I was talking today with my cousin’s husband, who is a doctor in Arizona and an expert on breast disease. It seems that with MRIs, more and more small, previously undetected, breast cancers are discovered. Twenty years ago, the site of my 2nd site of cancer cells would never have been found. I would have had a lumpectomy and then radiation. Would the radiation have killed the 2nd small site? Who knows? Maybe.

So it seems that now with the super-sensitive diagnostic testing, more 2nd cancer sites are discovered. And the protocol, at this point, is that if 2 primary cancers are detected in the same breast, mastectomy is the answer – no matter how small the cancers are.

Because more 2nd cancers are detected, more mastectomies are being done than before. Is this "progress" saving lives, or just generating more surgical business?

It seems like overkill to me. There must be a way to remove small cancers on the same breast without having to remove the whole breast. If we are going to detect earlier and smaller stage cancers, there must be a way to treat them without surgery. However my cousin's husband said that, in this day, I would have a hard time finding a doctor who would risk it.

And then there are the women in my breast cancer support group who elected to remove their healthy breast, and who had mastectomies when only a lumpectomy was required. Perhaps I don't know enough about cancer.

beginning thoughts on cancer

It is not easy for me to grasp “cancer” – the concept or the disease. I don’t feel sick, and yet I have cancer. It is only when I read the pathology reports that I begin to get some sense that there is something going on in my body that is alarming.

The cells don’t look right, with nuclei that are high grade, and micropapillary architecture showing frequent central necrosis. At the building block level, something is out of whack. Cancer is like an invader, and yet these are my cells that have begun acting differently and turned into something else.

When I first heard that cancer cells had been detected in my body, I thought that I was sort of like a tree with something else growing up the side of it, and eventually it would kill the tree if it were not cut off. Now I feel a little differently. The cancer feels more like it came from within me. Not that my environment – and all the hormone and pesticide laced food – does not play a part. It’s just that I don’t feel myself separate from my environment.

My environment and I are both the same life (if that makes any sense). I cannot hold myself apart from the world I live in, or protect myself from it. We are one.

my breast cancer

My Breast Cancer.

OK, I’ve said it. I’ve owned it.

It has not even been a month (Oct. 23) since Dr. Mondro (the radiologist) came into the room and said, rather off-handedly, “unfortunately the biopsy came back positive, but the good news is that the cells are still in situ.”

I was a little dazed, but that didn’t seem so bad. This was 2007, and this could probably be taken care of with a simple out-patient surgery. I had had skin cancers like this.

What threw me a little was when she handed me a big Breast Cancer book – somehow it didn’t seem to apply to me.

Then there were the MRIs, and the consultation with the oncologist (Dr. Bertrand) and the surgeon (Dr. Rimmer), and the talk about radiation therapy and hormone therapy. It all seemed so “aggressive”. Wasn’t this supposed to be “beginning stage” breast cancer?

I like my breasts. When I look at them, they look perfect to me. Balanced. And though they are a bit droopy now, they are not too big and not too small. They feel soft to me, comforting. And they are sensitive and like little antennae for me. Sexually, just knowing that they are there makes me feel just a bit turned on. All of this seems connected together to who I am, how I feel, my very passions for life.

I certainly was not ready to give one up, and didn’t even want to go there. I skipped all the chapters of The Breast Book about mastectomy. Just the mention of “drains” and the like scared me.

And then the results of the MRI came back with some “questionable” area in the same breast as the original cancer cells, but in an “opposite quadrant”. Damn MRIs are too sensitive. They pick up anything.

The surgeon, Dr. Rimmer, recommended a sonogram to detect and biopsy this “questionable” area. I wasn’t thrilled with the idea of another needle in my breast, especially when I was still black and blue from the first biopsy. When Dr. Mondro (the radiologist) was not able to see the area with ultrasound, I was relieved. Not only was the needle not going in, but I presumed that this meant nothing was there.

Wrong.

It only meant that now I had to have an MRI- guided biopsy. The day before the MRI-guided biopsy, the MRI doctor - Dr. Mullins - showed me the "questionable" area on a computer screen. It looked like a little silver diamond on the screen, shiny. It certainly didn’t look vague.

I asked what this could be besides cancer. Oh, maybe a fibroid cyst, Dr. Mullins said, a little node of denseness. That felt right. I had little bumps of things all over my body that were not cancer. Maybe this was just one of those.

The day that Dr. Mullins called with the results of the MRI-guided biopsy I was nervous. It seemed like every test I had had lately had come back with something “positive”. I paced the floor, put away the clothes.

I liked Dr. Mullins. I had made sure he knew that I didn’t like the idea of needles going into my breast and wanted to make sure he gave me enough sedative that I wouldn’t feel it. On the morning of the biopsy he came in and said “Oh yes, you’re the woman who doesn’t want any drugs, so I’ve brought a bullet for you to bite “, and we had laughed. He’d done a good job with the biopsy. Clean, he said. We just went in, got the cells, and got out.

Dr. Mullins was sweet the way he told me that the cells were cancerous. Invasive. But the area was small.

Maybe you got it all with the biopsy, I said. Maybe, he said.

I already knew that Dr. Rimmer was going to recommend a mastectomy when he called the next day. Still, I tried to talk him out of it. Why not 2 lumpectomies? I asked. I mean, they are really small.

Dr. Rimmer says that 2 lumpectomies will leave me with a very deformed breast, that I would never be happy with it. He says that they can reconstruct the breast during the same surgery that they remove it.

So this past week I’ve been trying to get my mind around losing my right breast – and having a fake breast. I haven’t even gotten to the part of having cancer cells yet.

Last night I went to a Breast Cancer Support group. One woman suggested keeping a journal, writing about it all. So that is what this blog is all about. Writing down my feelings. Every day as I make my way through breast cancer.

So far it seems like every day has been different. Sometimes I seem ok; sometimes I seem totally whacked out.