Yesterday was my one month check-up with the dashing Dr. C., my surgeon. I was looking forward to this, as I was determined to pin him down on the question that seems to get talked around every time, including with my oncologist: if I don't have a mastectomy, how much more likely am I to die of breast cancer?
Thinking about it since I saw Dr. L, the oncologist, I realized that we had discussed odds of recurrence. Of course, this is salient too: no one wants to go through the wicked uncertainty and discomforts of the experience I just had, even if the results are, happily, a good prognosis. But the more important, the crucial question is simpler and razor-sharp: am I risking death by not having a mastectomy, and if so, by what odds?
Funny how difficult it was to put this question into the clearest and most direct phrasing. While I waited two and a half hours to get into the examining room (he was "backed up", as the receptionists say, which conjures constipation more than crowding), I tried out different versions till I settled on the one above. Meanwhile, patients all around me were tapping their feet, buttonholing staff, and generally in a bad mood about the interminable wait, especially one elderly Russian lady who had originally had a later appointment and had been shifted to a much earlier one, only to be taken an hour after the original time. As for me, I'm an old hand at this, so I know you have to come armed with very long books -- fortunately, I never run out of those I'm supposed to be reading for my job as college professor.
Dr. C. looked worn, and I felt for him: it was dark by the time I saw him, most of the staff had gone home, and there I was with my questions. First he looked at the breast in question, and he was pleased with himself: "It looks as good as any reconstructed breast would," he remarked with innocent pride; I felt like Galatea. "I have a question for you, and I'm going to be blunt," I said when he was done. "Go right ahead," he said generously. After all that mulling over phrasing, you'd think I would have gotten it right. But I only got half the question out when he interrupted me to say that yes, mastectomy is the standard procedure, and the radiologist I'm going to see will probably tell me the same thing as Dr. L, but he thinks it's okay to save the breast. I mentioned statistics for survival versus reccurence, but his answer was confusing, and he was in such a rush (poor man, I don't blame him) that there was no time to parse it out.
Basically what he seemed to say was that my chance of getting a life-threatening cancer (i.e. one that has advanced too far to "cure") is less after this surgery than it was eleven years ago, because this was DCIS. If I do get one, and the chances are low (I could not seem to get him to say how low, and I tried), it would be from the original cancer, not this one. On the other hand, the rate of recurrence from this one could be as high as 10-20% (!), though not life-threatening recurrence. If that happened, mastectomy would be necessary. In sum, he seemed to claim that studies did NOT show a survival advantage from mastectomy in my case, though it would have a recurrence advantage. And meanwhile, I get to keep my breast, such as it is.
And just to complicate matters, even mastectomy would not reduce the risk of either recurrence or survival to zero. Welcome to the wonderful world of cancer.
Which brings me to the question in the title: at what price do I get to have two more-or-less matching breasts? On what scales am I supposed to weigh all this? It's like playing poker for your house, your job, your life, while unable to see all your cards.
On the one hand, there are the odds, which is to say the studies and the statistics they proffer from which the odds are derived, that imply the risk is worth taking. Get into the car, book that trip, cross that street...it will probably be okay, so why not? On the other, there is the worth of that breast...a globule of soft fat (with some scar tissue thrown in and no nipple, in my case) that evens out the bra, the shirt, the bathing suit, the nightie. Why risk anything at all for this hunk of stuff? What's it worth?
I don't know, right now. That's the truth. I'm waiting for March 18th, when I finally get to see the radiologist. Maybe that will shed some clearer light on all this. I hope so. Because I'm flying blind.
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