Thursday, March 24, 2011

Is hope a plan?

There is a series of blogs now in the NYT written by an oncologist whose wife is going through treatment for breast cancer. He is not a breast cancer oncologist and appears to be learning new facts about BC as his wife's treatments continue. The chief advantage of having an oncologist husband seems to be no waiting for tests or appointments. He also seems to be the liaison between his wife and her doctors.

Recently he asked his wife's oncologists about the chances of her having a recurrence? I am not sure if she was present for this conversation. Her BC had spread to her nodes.

Either it will happen or it won't.

Surprisingly he was OK with this answer. I would have been very annoyed. Given that he is an oncologist himself, he has access to the commercial site that will spit out a number after one inputs the facts. Now the database is filled with old data. Treatments are always changing. For instance, BC is divided into just two categories: estrogen positive and negative.  The data is skewed by her2 positives that in the past showed a disproportionate amount of the deaths for both categories. Now that early her2 positives are treated with Herceptin, this is no longer so but the data is based on the past. Then there is the issue of the size of the tumor. I had two separate doctors in my team run through this with me and received 2 different results. In the input section, you could select 2-3 cm or 3-5 cm.  (after the surgery, the official size was 3 cm with another 1 cm satellite) My breast surgeon selected the first. She was intent on proving to me that I was NOT going to die and that the numbers seemed to be in my favor. The oncologist on the other hand selected the second category which resulted in much more pessimistic numbers. Her point was to look at results with chemo vs no chemo and notice the huge difference.  Basically chemo would double my chances of surviving. Still I would think that there is a big difference between 3 and 5 cm and their fancy program did not distinguish between this.

And just because 30% of women with your same situation die, doesn't mean you will too.

It is what it is.

Or the chances of the woman whose funeral I attended this fall. She had Stage 0 BC diagnosed at the same time as mine was. She was told that after they removed the DCIS, she only had a 2% of ever dealing with it again. And she is dead now, despite her really good odds.

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