Sunday, July 28, 2013

No Chemo. Is this Over?

Two months ago I didn't have cancer in my left breast. 

Actually I *did* have cancer in my left breast but I didn't know it so I lived my life like I didn't have cancer at all.

Now I don't have cancer in my left breast because my left breast, the DCIS, two lymph nodes and the two "surprise" invasive tumors were removed on June 17th.

So I really don't have cancer in my left breast. And an MRI says I don't have cancer in my right breast either.

And I have just been told that chemotherapy will not improve my chances of being cancer free in five years. So there would be no benefit to taking my system down with a bunch of poison.

Does this make the battle over? I get to keep my hair. I feel good. I've been to a cancer survivor event. Am I done?

For some reason, it just doesn't feel that way.

I started Tamoxifen on July 17th, a month after my surgery.
Tamoxifen is a drug known as a selective estrogen receptor modulator or SERM. Tamoxifen looks and acts like estrogen to the cancer cells but doesn't feed it and therefore keeps the cancer from growing and/or spreading to surrounding tissue. Since both of my cancers (DCIS and invasive tumors) feed off of estrogen, I’ll be taking Tamoxifen to reduce the chances of recurrence. Sounds dramatic but at this point, this feels like a daily reminder of the cancer that was hiding in my breast.

But the biggest reminder comes any time I shed my clothing and see a beautifully healed eight-inch scar where my left breast should be. 

Mastectomy recovery wise, things are incredible. I'm back to walking, running, cycling - even rock climbing and bowling. I dodged the chemo bullet and I feel physically strong but, in the quiet moments, I sometimes feel worry. And dread. Worry about what's hiding behind or inside Pancho (breast number two) and dread that I will again one day hear the words "You have breast cancer." 

Intellectually, I read and digest the information that ranks my 'risk of recurrence' in the next five years as 8% as long as I'm taking the Tamoxifen. I also understand that Tamoxifen comes with an "FDA black box" warning and cancer risks of its own. I also understand Tamoxifen, for some people, is considered somewhat of a cancer dragon slayer. I also understand that some men and women choose not to take it based on side effects that negatively affect their quality of life.

But probably the most significant and relevant piece of information that I know for sure is that my breast cancer risk factors were super low in the first place. I eat well. I exercise. I avoid toxins in my home and garden. And, until January 2013 when my mom was diagnosed with Stage 2b invasive ductal carcinoma at the age of 63, I didn't have a family history of breast cancer.

 Yet the last two months have been very real. 

On July 25th, I had my first appointment with the reconstructive plastic surgeon. In the days leading up to the appointment, I hedged on whether or not I was ready for such a conversation. In the beginning, I'd been adamant about wanting simultaneous mastectomy/reconstruction. Since there were so many unknowns including node involvement, I was told a simultaneous reconstruction was not advisable. In retrospect, I'm pleased with the path of an independent mastectomy. I'd been ignorant of my options and really was trying to get on and get past something quickly. 

A month ago, as I submitted blood for my BRCA testing, I felt confident that if the BRCA results were negative, I would happily keep Pancho and begin the reconstruction process with Lefty. What I thought I had decided a month ago and how I feel now, are different. Today I’m not interested in a cosmetic surgery, only required surgeries that prolong my living a healthy life. Today I'm not confident, as I mentioned, that there isn't some cancer evil hiding in Pancho waiting for me to get to the whew-I'm-so-glad-I’m-done-with-that-shitty-experience point and then rear its ugly cancerous head. 

I know this isn't likely. 

I also know I'm not alone in the anxiety.

I’ve had some nightmares. I think every cancer warrior must.

Some revolve around a new diagnosis. Some revolve around the word metastatic.

But every single one of them revolves around me leaving my children motherless way too early.

Anxiety and a person's ability or inability to deal with it can lead to a prophylactic mastectomy.

 And, on this day, I'm mulling over my options.