The road less traveled
Getting it off my chest
By LINDA ESPENSHADE
Updated Oct 03, 2008 11:06

Of all the advice I received during my experience with breast cancer, one sentence reigns supreme: "You have to walk your own path through this."

Another breast cancer survivor gave me this advice soon after I was diagnosed. I was asking her about the specifics of her situation, searching for clues about how to deal with mine.

Gently she deflected my questions and explained to me that each person's journey through cancer is unique.

I didn't understand completely what she meant until people started regaling me with stories about how "Lisa" did this when she had cancer and "Helga"'s doctor told her that.

"Stop!" I shouted at them telepathically. I know you're trying to be helpful, but stop!

I bet you don't know the size of "Lisa"'s tumor or whether or not she had many in situ cells. I bet you don't know how estrogen or progesterone positive the tumor is. You may not know if she's premenopausal.

Do you know exactly what kind of cancer she has or its stage? Do you know whether her cancer is HER-2 positive or not?

I'm guessing you probably aren't real clear on the results of her oncotype DX test either.

The possible combinations of factors that determine how a doctor treats breast cancer appear limitless to me during my brief foray into the world of oncology.

Don't get me wrong. It's nice to hear that you have outlived breast cancer by 20 years. That's positive. That's hopeful. That's encouraging.

But that really doesn't mean anything certain about my cancer.

That your 45-year old sister is doing well 10 years after her double mastectomy doesn't mean I will be doing fine 10 years from now, nor does it mean that I should have a double mastectomy.

It just means that she made a good decision for her. And I'm happy for her — truly. Now I need to make decisions for myself.

You see, part of the decision-making process for breast cancer patients isn't even medical. It's personal preference. It's emotional. It's unique to me.

When doctors gave me a choice between a lumpectomy and a double or single mastectomy, they told me that I would have to decide what level of stress and uncertainty I could tolerate.

The mastectomy would require a lot less follow-up. The lumpectomy would mean mammograms and MRIs every six months for the next couple years.

Choosing to keep my breasts means that I accept the possibility of more ultrasounds, biopsies and emotional upheaval whenever the ultrasensitive MRI finds something suspicious.

That's a choice only I can make. Knowing that "Carla" decided to have a double mastectomy doesn't help me decide what to do.

My surgeon tells me breast cancer treatment is much more patient-driven than any other kind of cancer.

If a person gets colon cancer, the doctor tells the patient how it will be treated. If a person gets breast cancer, the patient decides among the options.

It seems people aren't as possessive of two inches of colon as they are two breasts.

In some ways, breast cancer is a more difficult cancer for patients to deal with, my surgeon said, because the patient has to make so many decisions.

Like my 4 percent.

According to my oncotype DX test, which analyzes my cancer post surgery, I have a 14 percent chance of my cancer recurring within the next 10 years. Like all things about my cancer, this statistic throws me into a vast pool of uncertainty.

One oncologist tells me I could lower my chances of recurrence to 10 percent if I had four rounds of chemotherapy.

4 percent.

Another oncologist said he didn't think the relative percentage was worth the possibility of long-term and short-term side effects of chemo.

So I asked my surgeon and the radiation oncologist, who echoed the concluding sentiment of the first two oncologists — "You have to do what feels right for you."

So I chose not to have chemotherapy. Some friends agreed with my decision; others disagreed.

Ultimately, though, I have to be satisfied with walking my own path through this disease.

I just hope it truly is the best one for me.

Editor's note: This column is a thematic journal of Linda Espenshade's experience with breast cancer that started in mid November. She is now on the road to recovery. You can e-mail her at cancercolumn@lnpnews.com.

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