Choices, part 1.

Image from my friend Randy. Thanks, Randy!

So I mentioned that I have choices to make. A caveat that I am not an expert here and so I am repeating what I believe my surgeon told me. Any mistakes in this retelling are my own.

The surgeon has patiently walked through this with me here's my takeaway. Reminder that we won't know anything about chemo until the tumor is removed and we get the oncopanel done to learn more about the little turd. I am also still waiting on biopsy number two to make sure there is nothing wacky happening in Parus minor, though the likelihood there is low. On the very small chance there is something bad in that biopsy, it could change my options, but as they stand right now, I have two options.

Behind door number 1: I can get a lumpectomy followed by radiation. Radiation would be 5 days a week for several weeks. It's a comparatively minor surgery, and so recovery is not so bad. If cancer comes back, though, a second lumpectomy is out of the question, because radiation can only be done once. They don't offer lumpectomy without radiation: those outcomes are not good. The tumor is small (about a half a centimeter) but they'll take out a melonball around it (that's how I envision it anyway: surgeon slices me open and melonballs out a blob with Ernie the Problem in the middle and then sews me up). Parus major would be smaller but not tremendously so.

Behind door number 2: Mastectomy. No radiation (generally) required. Bigger surgery, recovery time longer, but add in radiation on lumpectomy and it's about even. I can do one or both breasts, up to me, but one breast seems quite odd if you know me in real life...

Reconstruction is an option for either, and there are a lot of options there. The surgeon who would do this surgery is awesome and I loved him. Not having recon is also an option. I'll do a separate post about Things I Learned about Recon. 

A lot of studies look at survival rates at fixed intervals. Five-to-eight-year survival for these two options are the same...but note that this is about survival, not living cancer-free. With a lumpectomy, recurrence is more likely to happen but it gets caught faster, and then survival evens out. Apparently my life from here will be a never-ending series of screenings. I suppose that is better than the alternative of not finding it if it comes back.

Since I'm reasonably young (hush you), this is something to consider. A lumpectomy with radiation has set recurrence rate that they cite for older folks, but my surgeon said essentially that I can think about the risk as about 0.5-1.0% per year. Mastectomy decreases to about 2-3% lifetime...

...But these rates are done on pools of women, which is what we want for a good study. Since most women who get breast cancer are older, these studies are done primarily on post-menopausal women (which I am not). Which is to say that they may be a bit skewed one way or another. Since there's only one me, there's no study on 100s of Krises to tell me what my exact chances are of recurrence. If only I could know the future...and indeed, my surgeon is happy to answer my questions about these statistics, but has reminded me to take them with the grain of salt they deserve: we can't really know how exactly they apply to me.

I'm also trying to think about recovery from each of these now, and in the event of recurrence. A mastectomy now vs a mastectomy in 15 years in the event of a recurrence...those odds vs thinking about a recovery at that point in time? 

So there are tradeoffs here and choices to be made. I've spoken to others who have had preventative surgery, who have wanted it but weren't able to get it, and who have opted not to. Each person is different, their reasons, situations, and choices are different. I haven't made any choices yet but will share more as I wade through this.