Confirmation that I made the right decision

Much of my treatment since diagnosis has been done on gut instinct. Breast cancer comes in so many varieties, and there are so many varieties of treatment, and nobody is certain which treatments work best together, and which combination of treatments is the most effective. There is a standard of care, of course, but my feeling is that it goes out of date almost as soon as it is announced; there is always something new in the pipeline. New is not always better, of course, but it offers promise....and on that promise, I've made a lot of my treatment decisions.

What do I mean? Well, I've chosen a lot of "optional" treatments. My initial mastectomy was absolutely dictated by my surgeon, who made it clear that my life would be shortened if I did not take that option; my second mastectomy was prophylactic (there was no cancer found in that breast) but I took the option to reduce my risk. Chemo was a necessity; what type of chemo was an option. My optional treatments have included:

- Prophylactic mastectomy (I figure I can't get breast cancer in tissue that they removed!)
- Ovarian suppression to make me post-menopausal; going one step further to remove my ovaries (because my cancer feeds on estrogen, and because of links to ovarian cancer)
- Taking an AI (Femara) instead of Tamoxifen (Femara is proven more effective than tamoxifen in post menopausal women...but since my menopause was artificially induced we can't promise this is true for me, because there are no studies yet on the subject)
- Taking Herceptin for two years instead of one year (this is undergoing study in the HERA trial, but the results won't be out until 2008, which is too late for me....my two years ends in late September of this year)
- Radiation after mastectomy (I had one positive node. If there are four or more positive nodes, radiation is prescribed; for no nodes, no radiation. Since I fell into the gray zone and it made sense to me, I went for radiation.)

I may never know if I would have been cancer free without those treatments, or if my cancer will return despite the treatments....it's a major, major gamble, because none of these treatments is "fun" and they all have side effects that I live with to this day.

However, today I read this:
http://www.lbbc.org/news-detail.asp?section_tag=G&news_id=1288&tr=y&auid=2738600

Here's an excerpt:
The researchers concluded that people who had one to three positive nodes and either a low number of negative nodes, invasion in the lymph vessels or are under 40 had an increased risk of LRR. They suggest that this group may benefit from undergoing the same treatment as people who have had cancer detected in at least four lymph nodes.
What Does This Study Mean For Me?
If you have been diagnosed with breast cancer, have had a mastectomy and have found out that you have one to three positive lymph nodes, you may want to ask your doctor how many negative nodes were found in your axillary lymph node dissection. If you find out that you have a low number of uninvolved nodes, you may want to discuss the option of postmastectomy radiation.
Radiation may kill cancer cells remaining in your lymph nodes or breast that are undetected or dormant now but could cause a recurrence years after. You also may consider this treatment if you have one to three positive nodes and are under 40 or your cancer has traveled into the lymph vessels in your breast. Side effects of radiation include soreness of the skin and fatigue.

I still pay the price of radiation: my skin still hasn't recovered, I still don't have full range of motion, I still get pain in that area. I only had one in twenty-five nodes that was positive, but since I have the additional risk factor of being under 40, this study says that I did the right thing.

I may find out that I've done the wrong treatment at some point. I may find out that the side effects will cause lifetime problems as bad as what they were meant to resolve; I may find out that I will recur anyway despite the treatments. But today, I'm grateful to read that my gut lead me in the right direction, that radiation was probably helpful, and that I can be glad that I made that decision. I am also glad that it's behind me, and I don't have to face making that decision again....what's done is done.

Cancer is not behind me. It is a part of who I am now; my survivorship helps to define me. I am a mother, wife, friend, activist, reader, hiker, member of PEPS, fundraiser, walker, runner, writer, dreamer, optimist....and survivor. Having had cancer influences my thoughts every single day, and perhaps every single minute. It is more of a relief than I can adequately express that sometimes I run into some data or an article that presents a viewpoint that because of my decisions, I will likely survive.

Phew. Let's hope that the next articles reach the same conclusion!