Back Again

Well, it's been a long time, hasn't it? I haven't thought about this question of the mastectomy very much since my last post in May, actually...and when friends have asked what I decided, I find myself saying "I THINK I will have the mastectomy, but not till January."'

Why January? Because I want to finish the book I'm writing, and I want to teach my classes this fall. Then, if I do the surgery, I can take the spring to recover, devoting myself to it like a full-time job.

This month I saw the two important doctors: the oncologist, Dr. L., and the breast surgeon, Dr. C, who I have the tiniest crush on (there's something about the combination of tall and calm that I'm drawn to). And here's where I'm left: The oncologist still thinks I should get the mastectomy, and the surgeon, whom I saw today, still argues just the opposite.

Her reasons:

1. The Padgett's was a recurrence in the same breast.
2. I can't be radiated, because I have already been radiated there.
3. There was a close margin, .5 mm.

Here are Dr. C's reasons:

1. Yes, it was a recurrence, but the amount of DCIS was tiny, "microscopic." Dr. L. had mentioned this in passing, but didn't give it much importance.
2. Good and bad margins are not all that reliable; 1 out of 3 times, there is cancer where there's a clean margin, and no cancer where there's a close one. He seems confident that I'm "low-risk".
3. For cases that are low-risk, there is no evidence that mastectomy will be life-saving. The DCIS grows slowly and can be caught on yearly mammograms.
4. He intimated that the surgical result will not be pretty, because the tissue has been radiated, so the reconstruction will likely not look very good. Sigh.

Of course looks is not my first priority -- living is. But I could feel that Reason #4 was not something I could easily discount either.

We agreed that I would get a mammo and MRI (ugh) in January, and see him again. By then I should know what I want to do. Except I don't know how I'm going to make this decision any better than I can make it now, and I don't feel equipped to make it now, unless a little scroll descends from heaven and tells me EXACTLY HOW MUCH (or even approximately how much) I'm risking my damn life by not getting the surgery.