A cancer diagnosis is quite a journey, as you go from zero to 100, forced into a crash course on a subject no one wants to know intimately. You quickly find out that there is no template to follow. Though many have gone before you, each road is different.
As a patient, one thing you also find, which can be unsettling and confusing at times, is that the patient often has a large amount of say regarding the treatment decisions depending on your tolerance for risk and the treatment plans presented to you by your oncologist. For example, some patients would jump at the opportunity to undergo chemotherapy if the chance or cancer recurrence could be theoretically reduced by two percent, while others would not put themselves through chemo if the chance of recurrence were reduced by 10 percent. It all depends on the patient and the data provided about the best treatment approach at the time of diagnosis. And different doctors put more weight on one proven test, versus perhaps more experimental findings. So, imagine diving headfirst into a field that you know nothing about, knowing your life could be drastically altered or shortened depending on the information found about the kind of cancer you have, trying to understand the treatments available, and then making these huge-life decisions, often while you are trying to be there for your children and recover from the last surgery.
We quickly found out after the biopsy that my tumors were estrogen and progesterone positive, which means the cancer thrives on both hormones, so for me, hormone therapy would be most effective to combat recurrence and metastasis. Hormone therapy includes turning off estrogen and progesterone in my body by both turning off my ovaries and by blocking cancer cell receptors so the cells do not receive their hormonal food and multiply. So, while I knew hormone therapy would be key, sometimes chemotherapy can also be of great benefit for my kind of cancer. But we have all known or have witnessed some of the really difficult long and short term side effects that can accompany chemo, so this was something I wanted to avoid, if at all possible, though at the same time, I remained open to chemo if it would dramatically improve my overall prognosis.
To help answer the question, “Will chemo be of benefit for my form of cancer?” my oncologist steered me toward a well-studied and expensive test called the ONCOTYPE DX which looks at 21 genes from the tumor cell samples to help determine the chance of recurrence; it also helps predict whether or not chemotherapy will be of benefit. When you are the patient, madly researching and orienting yourself to the idea of putting yourself through chemo, a test like this sounds very helpful, and it has proven to be a sound guide for thousands of women. Why put yourself through the incredibly difficult path of chemo if your form of cancer will not respond to chemo?
So, if your Oncotype score is low, no chemo is needed, if the score is high, chemo is proven to show definite benefit. Unfortunately, my ONCOTYPE score came back in the dreaded middle range, where research is vague, and certainly more study of this subset of women is needed and is currently underway. Based on my mid-range Oncotype score, my primary oncologist connected to Sloan Kettering said NO to chemo, and my second opinion oncologist connected to Yale said, there is a theoretical 3% decrease in the recurrence rate with chemo in addition to the hormone therapy. Three percent may sound small, though if you are sitting in a room of 100 women, and you know three more women will walk out alive, this number becomes quite significant.
After much back and forth and more research navigating this new land, my oncologist said, “Thanks to more recent advances in biotech, there is another test we can do called the Mammaprint which also looks at the genomic make-up of the tumor cells.” The Mammaprint studies 70 genes, and though it only has five years of documented trials, it was a huge relief to learn through the Mammaprint that my tumor cells did not respond to chemotherapy, so hormone therapy alone would be my course of treatment. Tests like the Mammaprint and Oncotype have saved thousands of women 3-6 months of chemotherapy, were in the past, and even now, the old regiment was to throw chemo at the specific kind of cancer I have. Clearly, continued funding for biotechnology is the path of the future. And with the skyrocketing costs of healthcare treatments, this kind of crucial diagnostic and treatment information has the potential to save patients not only months and months of debilitating, agonizing therapies, biotechnology breakthroughs are KEY to saving patients and taxpayers millions of dollars on unnecessary treatment costs.
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