Over-Screening for Breast Cancer?

Earlier this month, both the American Cancer Society (ACS) and the Journal of the American Medical Association (JAMA) published communications alerting the medical community about over-screening for breast cancer. The estimate now is that 30% of the breast cancers which are found are so slow-growing that they are not life-threatening; and, some of these will disappear completely without any medical intervention at all.

Breast cancer screening has greatly improved the ability to find very small tumors; mine was only 2mm in size, and showed up on my yearly screening mammogram as a concentration of white dots, called microcalcifications, indicating an area of rapid cell turnover. The tumor wasn't found at my OBGYN exam a few weeks before; it would have taken months before it had grown large enough to be felt.

My tumor had already reached the invasive stage; it had broken through the breast duct, and was invading the surrounding tissue. At this point, the cancer cells have had a chance to reach other areas of the body, possibly creating secondary tumors. If the patient is fortunate, there has been no metastases, or tumor formation at other sites, and the cancer cells which did migrate elsewhere have been killed by the patient's immune system.

People have asked me how I feel about undergoing biopsies, 2 lumpectomies, 6 weeks of radiation, several screening scans and MRIs, and taking anti-cancer meds for a 5-year course when there is a 30% chance that my cancer wasn't deadly to begin with.

My response is that there is a 70% chance that my invasive cancer would have killed me, so I am very happy that it was found so early. If I had not gotten my yearly mammograms as recommended, my cancer might have spread to my lymph nodes, greatly decreasing the odds of my survival. Another advantage is that my node-negative status meant that I avoided needing chemotherapy, and I am very grateful for that.

I don't feel that I should have delayed treatment, hoping that my cancer would resolve itself. Once you find out that you have cancer, you just want it out of your body. It would be difficult, if not impossible, to just "do nothing" when you're diagnosed, unless there is an additional means of confirming that the cancer you have is indeed the non-fatal type.

My cancer was Stage 1, but even cancers this small, and some at Stage 0 (non-invasive) have proven deadly. There is so much that we still don't know about what causes some cancers to grow, and others to become dormant, or even totally disappear.

So, until researchers can determine which breast cancers are non-fatal, women shouldn't forego being screened. The ACS is standing by its recommendation of yearly mammograms for women over 40. That is vital for us to remember amid all of the current controversy.

Your "new normal"

As a cancer patient, your goal is to reach the end of your active course of treatment, and to get your life back to where it was before you were diagnosed. But, like so many other things, this is not as easy as it sounds, physically, mentally, or emotionally. And, the truth is: your life will never be the same. You have gone through a life-altering experience. There's a term for what you're attempting to establish: your "new normal"; meaning living as normally as possible, knowing that you cannot restore your pre-cancer life.

Your transition from a "cancer patient" to a "person with cancer" isn't easy. You eagerly hoped for the end of your active treatment period, when it seems as if all of your waking moments are spent going to medical appointments, imaging studies, chemo and/or radiation, lab testing, etc. You know that it's necessary, but you can't wait for it to be over, and you feel more like a patient than a person.

When you're placed on "follow-up", you're going to really miss the personal contact with, and support from, the majority of the wonderful people who got you through a hellish period of your life. You will feel very alone as you face the future. You need to prepare for how you will handle this transition, and what resources you'll need to establish your "new normal".

You may find that emotions which you suppressed during treatment are now coming to the surface, such as anger and sadness. This is similar to post-traumatic stress, or delayed grief. It's vital that you face your feelings and work through them; otherwise, they will prevent you from moving on with your life. Talking to family, close friends, or even joining a support group will help you realize that you are not as alone as you might feel at this time.

Chances are, you'll deal each day with physical reminders of what you've been through as well: I see my scars, and as they are healing, I'm also healing inside. I don't think about my cancer returning, but if it does, I know that I'm strong enough to face it. I won't allow cancer to "co-opt" my present, or my future. I wake up each day seeing the person in the mirror as someone who has "had" cancer, even though I still visit my doctors, take daily meds, and will be doing so for a few more years.

Many people, as part of their "new normal", choose to do something which gives meaning and purpose to their cancer experience. For me, it was deciding to begin this website, writing about my journey. Previously, I wouldn't have had the courage to do something like this, but this is one of the "gifts" of my cancer. I wanted to take something negative and turn it into a positive; I also hoped that sharing my feelings might be of some help to other cancer patients.

People also decide at this time to follow their dreams, do things they never had the chance to do before, or take their future life in an entirely different direction, such as: going on that trip they've only imagined, climbing a mountain, or starting their own business. The rest of your life from this point forward should be defined by you, not by your disease.

For me, the dream is to retire and to move to Maui. After all that I've been through, I'm even more determined to make this my reality. I want to die there, and have my ashes scattered at Keawakapu. When Lindbergh was receiving medical treatment in New York, and it was confirmed that he only had a few days to live, he asked to be flown back to Maui so that he could die at his beloved Kipahulu. I feel the same way.

Focus on your future, and do something meaningful with the life which has been "given back" to you.

Life is precious. Don't waste it!

Do You See Miracles?

"There are two ways to live: you can live as if nothing is a miracle; you can live as if everything is a miracle." Albert Einstein

I read this quote on another website about a cancer patient, and it really hit home. I have always been someone who lives as if everything is miraculous, and this has been greatly magnified by having cancer.

Is life really worth living if you never take delight in what you see around you, who you have around you, and what gifts you have been given? To me, that's not living; it's just existing, and there is a huge difference.

I know that the fact that I'm alive is a miracle: when I was born 2 1/2 months premature, weighing 2 lbs. 7 oz., all that could be done was to baptize me and put me in an incubator. The amazing technology we now have to assist very tiny babies didn't even exist.

For a while, the doctors thought that I was born blind, that I would probably have severe problems ever walking or moving normally, and there was a good chance that my brain would be damaged by the inexact oxygen levels of my contained environment. My chance of survival was slim. All that I had going for me was my will to live, and the tender care of the nursing Sisters of Providence, who were completely devoted to me. I was released from the hospital 3 months later, weighing a whopping 5 pounds, still resembling a doll more than an actual baby. The doctor who delivered me used to call me "the little atom", because I was so small at birth.

I beat the odds, and survived, with no adverse affects. So, perhaps why someone like me sees life as miraculous - for me, it really is.

It's easy to get jaded and cynical about life, but it doesn't have to be that way; and, you don't have to experience life-threatening illness to make you appreciate being alive. There are miracles for you to find each and every day. It all depends on your outlook, as Einstein wisely observed.

So, I ask, "Do You See Miracles?" I hope so...

Back on my feet again - with caution!

I went to the orthopedist today, and I have been medically cleared to put weight on my foot and walk around again. I have to wear the Aircast brace for a couple of weeks or so, but this means that I can now leave the house, drive my car, and...go back to work!

My ankle is healing exceptionally well, even though my ankle and foot still look disgusting; an overall yellow, with a purple undertone, and bruises which will take some time to go away, I'm sure. I will be doing exercises at home to increase the mobility and strength of my ankle, and I'm getting used to walking around with the Aircast.

I'm sure that a lot of my progress is directly due to the terrific care and advice I received from my husband while I was unable to walk. As a former runner who has even done a marathon, he is a veteran of many ankle injuries, and his experience was invaluable to me during this time. We're planning to go out walking again this coming weekend; this is permitted, as long as I'm wearing the Aircast brace. It might not be a 4-mile walk, but I will be out there on the trail again! (Watching out for lurking holes in the grass...)

Just being out of commission for a couple of weeks made me feel truly sorry for anyone who is permanently confined to bed, or housebound. My Irish Nana who raised me used to say, "Every day that you wake up and you put two feet on the floor is a good day", so now I have a greater realization of just what she meant by that.

So, even though I didn't break anything in 1995 when I was run over by a van in Manhattan, but managed to break something just walking near my home, I feel very happy about the way this entire experience worked out. I will be wearing my Aircast, working out with weights soon, and getting back to my usual activities.

I would have been totally lost without my iPod Touch, its fantastic apps, and its wireless Internet, as I couldn't get to the Mac during my non-weightbearing stint. It was a lifesaver!

A Minor Setback

One week ago, I was out for my usual 4-mile walk with my husband, on the nature trail near my home. We were only a few blocks from home, and had just exited the trail, walking at the side of the road on some grass, when I suddenly stepped into a hole several inches deep, slammed into the ground on my forearms and hands, and injured my ankle. The hole was completely covered over by the grass surrounding it, so I didn't see it as I looked ahead.

As I struggled to stand up, I was acutely aware that I had done something terrible to my right ankle. Placing weight on my foot was difficult, coupled with a sharp, scream-inducing pain, which traveled up the outside of my ankle and calf if I moved my leg in the wrong direction. I insisted on "toughing it out" and carefully walking home, with my husband helping me. It was obvious that I needed to be taken to the hospital, as my ankle was swelling up considerably.

At the ER, I was placed in a wheelchair, and wheeled in to be evaluated. I noticed that the NP was wearing a breast cancer pink ribbon pin. When I commented on this, she said that she had been diagnosed with breast cancer at age 36, and had undergone a double mastectomy, and chemo, which "kicked her ass". I told her that I was also a breast cancer patient, and that I was glad that her ass had been kicked, because that meant that she was still here! As I have written before, you really do bond with other cancer patients, which is one "gift" of having had this experience.

I was placed on a gurney, and after a while, was wheeled into the radiology area for several foot/ankle x-rays. At this moment, it occurred to me that this was the first time since being diagnosed that I was NOT here at my "usual" hospital for anything related to my cancer treatment; and it was a positive realization. Today, I was just "the woman with an ankle injury"; how different for someone who had spent many days there seeing doctors, undergoing surgeries, scans and tests, having my radiation treatments, etc.

I was sent home wearing an Aircast, but told to see an orthopedist ASAP, preferably the following day. I managed to get an appointment with a MD at my husband's ortho MD group, and they confirmed that I had a hairline fracture (described as a "good" fracture) where the sprained ligament attaches to the ankle bone. I left the orthopedist's office wearing a knee-length, black "boot" that looks as if it was designed for Darth Vader.

Mine is black, not navy blue (the above photo was the best one I could find on the web), and the ortho nurse told me "Black goes with everything" - hmmm - what would anyone wear with the likes of this futuristic, velcro-laden footwear? The boot makes the ankle feel a lot more protected and better isolates the joint; although, it also evokes images of Frankenstein lumbering around as well...!

I have been home now for a week (one more week to go!), forbidden to walk anywhere except for short trips to the bathroom or other areas on the same level. The pain has gone from a "9" to about a "2", but if I move in the "wrong" direction, or something presses on the outside of my ankle - yeoucchh! My foot is bruised on both sides of my ankle; I have purple bruises at the bottom of my toes (!), and the top surface of my foot is now turning a lovely yellow color, which complements the purple.

I'm seeing the orthopedist one week from today, and hopefully, then I can go back to the Aircast, which means that I can drive a car, and thus, return to work.

My wonderful husband has been taking very good care of me: driving me to the ER and to the orthopedist, preparing and bringing me my meals, getting my pillows, refilling my drinking bottle, helping me get around, and making me laugh, which really is very good medicine. He has been amazing, just as he was when I was recovering from my surgeries.

I'm determined not to gain more weight just because I can't exercise right now, and, as soon as it's medically possible, I'll be back "out there" on the trail, walking my post-cancer pounds away. This is just a setback, and I have already laughed about it! Why, it's as easy as "stepping in a hole"! So now, I know exactly how that expression came to be.

Healthy Habits Preventing Breast Cancer?

Last Tuesday, a study was published stating that almost 40% of breast cancer cases could be prevented by good health habits. When I was diagnosed, I weighed roughly the same as I had 30 years ago, had been lifting weights since 1980, and had been avoiding alcohol, as I knew that drinking alcohol increased my risk. I also ate healthy foods, limited my red meat intake, drank water instead of soda, and ate a low-fat diet: for example, my daily lunch consisted of carrots, yogurt, and fruit.

Studies like this can mislead women into a false sense of wellbeing- as most breast cancer cases clearly can't be prevented by the behaviors they describe. I hoped that avoiding alcohol would lower my risk, but I never believed that doing this would prevent me from getting breast cancer: all you can do is practice a healthy lifestyle, and hope for the best.

 

The majority, or 60% of breast cancer cases, are not influenced by someone's health habits, but it is still a good idea to practice healthy behaviors. I was thin when I was diagnosed, and gained weight during treatment; so, I'm happy that I didn't weigh 20 or 30 pounds more at the time of my diagnosis, or, I would be faced with losing even more now as I attempt to reach my precancer body weight.

Preventing breast cancer, unfortunately, isn't as simple as the study makes it seem. I would hate for other women to think that a healthy lifestyle will spare you: mine certainly did not spare me. Be healthy, yes; but most importantly, get screened on a regular basis; this is the health practice which could, and will, actually save your life.

What Cancer Cannot Take From You

When you learn that you have cancer, you'll view your life up to that point as "B.C.": "before cancer", and "A.D.": "after diagnosis". Cancer will be your focus for at least the next few months, mentally and physically. It will take over your life during your active treatment, and you will most likely lose part of your body to it. Cancer has co-opted your present, and your future. Your sense of invulnerability has been stolen from you. You have the right to be angry, but you have to work through this, and ultimately realize what cancer cannot take from you.

Long after your active treatment, cancer will steal things from you on a smaller scale: I take my anti-cancer medicine each day as part of a planned five-year course, knowing that it will greatly increase my chances of long-term survival. The associated side effects of the medicine are a daily reminder that I'm still fighting not just the cancer, but weight gain, greatly increased vasomotor episodes, gastrointestinal issues, and lingering fatigue. I have felt at times as if I'm seeing another "me" in the mirror, and it's difficult to remember the tiny, energetic person whom I no longer see there. Sometimes two years in the past ("B.C.") seems like a lifetime ago. 

When I wrote earlier about the cruelty of Alzheimer's Disease, robbing the patient of his/her identity, gradually taking them from their loved ones right before their eyes, with the only relief being certain death, I said that Alzheimer's is a far crueler fate than cancer; and I still believe it.

I know this beyond any doubt: I am still "me", and cancer is not going to change my personality, or make me focus on what I have lost, instead of what I have gained from this experience. My sense of humor is still intact. I still find joy in each day; I feel very fortunate to be alive, and well. I still have my smile, and I will never lose it! How would I ever have known how strong I could be, and how much I could endure? So, yes, it has taken something from me, but I have found a way to appreciate what it has given to me, also.

We are all tested in one way or another; you will be amazed at what you can overcome, and how powerful your will to live really is. Cancer can take your essence away from you, but only if you allow it. I'm not going to let that happen.