Radiation Rumination

Wide awake at 4am.   And what better way to spend the time than to muse over whether or not to radiate my chest.  Which is still an open question between me and my doctors.  It is also a decision that ultimately rests with me.  I hate being a grown-up.

Radiation is another tool in an arsenal of treatments to reduce the chances of this cancer returning, otherwise referred to as 'risk of recurrence'.  Yet another tool to cure cancer that also causes cancer, but whatever, I'm not complaining, I'm just pointing out bitter ironies.  Nothing can reduce your chances completely, but the goal is to take your number down into the single digits.  So, depending on who is looking at the numbers and how, my chances of recurrence today, following chemo but before radiation, is somewhere in the 10 percent range.  At one point I heard a 9, and since that is a single digit I have become very fond of the number nine.

By the way, the statistics the doctors use to determine ones chances of recurrence are based on all the cases of women with breast cancer who came before me.  They record how these women fared after their treatment, how long they lived, how many years passed before their cancer recurred, etc.  They put these women into studies to see how they did with certain chemo drugs and how long they lived after radiation compared to how long they lived without radiation.  I think about these gals everyday and I thank them.

Apparently, radiation would cut my chance of recurrence by about 1/3.  Wow, right?!  Except my chance of recurrence today, without having ungone radiation, is already very low.  Should we just call it 9?  If we do, then radiation would drop my number to a 6.  Not as impressive anymore, going from a nine to six.  Especially given all of the risks that come with radiation.  Radiation can cause cancer.  Radiation will damage the skin. Radiating the lymph nodes under my arm could cause lymphedema (permanent swelling of the arm).  There is a 10% chance that radiation could permanantly damage the implant which would then have to be removed but could not be replaced.  Most importantly, radiation beams could hit my heart, located under my new left breast, and will almost certainly hit parts of my lungs.  I am not in my late 70's.  I am in my late 30's and, should I be around for another 40 or 50 years, it would be nice to have my heart and lungs functioning well.  

The first radiation oncologist we visited (let's call her M, just for fun) says she is on the fence as to whether or not she would recommend radiation for me.  My surgeon told me she's known her for 20 years and she is a very opinionated doctor and is rarely on the fence about anything.  So all I can really glean from that is that she is trying to torture me.  We sought out a second opinion at Memorial Sloan and, lo and behold, a doctor from the radiation department recommends radiation.  Yes, obviously I don't really know what to do with that recommendation either - these are doctors who have just met me and perhaps they looked at my case file for 10 minutes?  20 if I wanted to be super generous.  So we're going back to see M tomorrow. And maybe we'll get closer to an answer.  And after we see her we'll stop by Dr. Ruth's office, my oncologist, so we can discuss hormone therapy and shutting down my ovaries for a year.  It's going to be a fun day.

But we did have a great weekend...