Back in March, my routine mammogram had some suspicious spots. An ultrasound showed calcium deposits, and a needle biopsy showed cancer cells. The good news was that it was DCIS, ductal carcinoma in situ, and it was noninvasive. One lumpectomy and a re-incision later, and I had nice clear margins all around the area. All that went along like clockwork, each decision leading to the next without too much thought on my part. Yes, I could, of course, have chosen a wait-and-see approach, since the area was not overly large. For me, I knew just the knowledge of a cancer, no matter how confined, just happily coexisting in my milk duct would have driven me nuts. I also knew that in 20% of women diagnosed with DCIS through needle biopsy, invasive cancer was found only because they had a lumpectomy. Now that the surgery is over, the hard part for me, as far as decision making goes, is at hand.
Post-surgical treatment can be radiation therapy, endocrine therapy, or both. There's a magic formula, known as a nomogram, available for some cancer types, including breast cancer. When my specific information is plugged in, the physician came up with a 14% chance of the cancer reoccurring. Undergoing radiation therapy cuts that risk by one half to two thirds, so 5%-7%; endocrine therapy alone closer to one third, so 9% about. Combining the two therapies would only reduce the chance of recurrence by two percent better than radiation alone. So, I could just wait-and-see, having a mammogram every six months on the affected breast; go for the radiation alone; go for the endocrine therapy alone, or get the combo platter. Part of me thinks wait-and-see would be nice, since each therapy has the possibility of side effects and 86% chance of not having breast cancer again are pretty good odds. Part of me thinks radiation might be the way to go, since the first lumpectomy found some outlier cells in the area that should have been the safe margin, cells that didn't show up on the ultrasound, so there may be others floating about. There's a part of my that really does not want to do endocrine therapy because I'm not a big fan of medication and I get enough hot flashes as it is. As Dirty Harry says: "you've got to ask yourself one question: 'Do I feel lucky?' Well do ya, punk?" Luck and chance; I've never done well at the casino so in that sense, I'm not very lucky. Maybe the question, for me and for everyone, is what will give me peace of mind, what decision can I live with. "May the odds be ever in your favor."