After the shock of my pathology report and the information that they’d found DCIS (ductal carcinoma in situ) I left a message with my surgeon’s receptionist asking that my surgeon give me a call.
DCIS is considered a pre-cancerous condition because the cancer cells are confined within the ducts within the breast. It’s not yet invasive cancer. It’s usually categorised as either low grade (best and least likely to become cancer) or high grade (worst and most likely to become cancer). The DCIS in the tissue they removed from my breast is high grade.
You want any kind of cancer removed from your body with what they call ‘a clear margin’. This is essentially a wall of healthy cells that cover the tumour. If you don’t have clear margins there’s the possibility they’ve left some active cancer inside your body and the options usually include having another operation to see if they can remove that bit, or having a mastectomy. I wanted to talk to my doctor about why I wasn’t having either.
It’s not that I doubt her decision. In fact, it’s not just her decision. My surgeon meets as part of a multidisciplinary team to discuss all patients. The team includes a pathologist, and oncologist, a radiation oncologist, a breast care nurse and a patient advocate. This idea of a team approach is relatively new and, in my opinion, absolutely brilliant. Instead of one person making a decision about the best course of treatment, a whole group of them get together. My particular team is full of brilliant people, many of them considered to be among the very best in Australia. I am in very good hands.
The recommendation for my treatment is radiation.
I got a message on my phone yesterday from my surgeon letting me know she would ring me at 8.30pm after she had put her children to bed. Yes, she’s that dedicated.
I had a very encouraging talk with her. Let me see if I can explain things as well as she did.
During surgery, they removed a piece of skin and tissue from my left breast which, in simple terms, was roughly the shape of an elongated cone with the bottom cut off. The top of that cone is my skin (the outside surface of my breast) and the bottom of the cone is the tissue that would have been sitting up against my chest muscle.
The primary tumour was entirely within this cone. Clear margins. This is a great result.
The DCIS was in the bottom part of the cone and didn’t have clear margins. The part of the cone where the DCIS was at the edge of the tissue sample is in the centre of the bottom of the cone. Imagine you cut the bottom off a drumstick. That chocolate bit you can see is the DCIS. Now imagine the cone is healthy tissue. There was no sign of DCIS anywhere around the outside of the cone. If there had been, my surgeon would have been worried, but because it’s completely contained within the bottom edge of the cone she’s confident I don’t need further surgery.
This is because she’s removed tissue all the way down to my chest muscle and she’s been able to look at the fascia, or surface, of the chest muscle and can see that there’s no sign of cancer there. She assures me that cancer in the fascia is easy to see. If she’d seen any she would have included some of that muscle in the removed tissue.
She has also told me that the tools they use for surgery burn away tissue and it’s possible that some tissue has been lost from the bottom of the sample because of this. There may have been a margin but it’s been burnt away during surgery.
I am greatly reassured. Onwards to radiation.
If only I hadn’t had to deal with an anti-radiation zealot this week! “Radiaiton causes cancer!” he asserts. “It turns cancer cells into breast cancer stem cells which give you cancer!” Argh!
Having checked the research I can report that he’s kind of, sort of almost correct. There is some evidence that indicates that radiation MAY turn some cancer cells into breast cancer stem cells which MAY then turn into cancer. What he apparently fails to comprehend is that radiation is also killing existing breast cancer stem cells at the same time, so the overall result is a net loss in the total number of breast cancer stem cells. This is why radiation continues to WORK! If all it did was turn breast cancer cells into stem cells then radiation patients would be dropping dead like cicadas at the end of summer.
The alternative is that the highly trained, multidisciplinary team that are making recommendations regarding my treatment are either involved in an elaborate conspiracy to keep radiation oncologists employed even though they are killing people or that the highly trained, multidisciplinary team that are making recommendations regarding my treatment are failing to notice the stunningly high recurrence rates in patients that have radiation therapy. Neither of these hypothesise seems even remotely likely.
Meanwhile this possibly well meaning and incredibly dangerous person seems determined to misinform cancer patients about the risks associated with radiation. And he’s not alone. Unfortunately, this man was once a registered doctor (since struck off – but only suspicious ex-cops like me would be inclined to check that) so he sounds very convincing.
Here we go again.
Regular readers will recall my blog on all of the nonsense out there trying to convince people not to have chemotherapy. It seems that many of the same people are determined to undermine radiation therapy.
As if cancer patients don’t have enough to deal with.
Once again I’m going to make my decision based on data and research which shows my chances of survival are greatly improved if I have radiation therapy. My radiation oncologist was able to access a data base and give me statistics about the extent to which this treatment has been shown to prevent local recurrence of the cancer and metastasising cancer. To get these numbers, he fed in the grade, type and size of my cancer along with some other personal details. The figures are sufficiently impressive in my case that I’m prepared to go ahead. He’s also explained all of the risks associated with this treatment, including a small risk of a different type of cancer and the possibility of heart trouble in 25 years. I said at the time that if I get heart trouble in 25 years I’ll send him a thank you card.
The man telling me not to have radiation says you can’t trust data and research. I told him I’ve chosen not to trust the research he’s citing to ‘prove’ I shouldn’t have radiation therapy. Apart from the fact that he seems to have missed the point of the research, one of the researchers was later required to disclose his association with a pharmaceutical company that manufactured the substance they recommended for reducing the problem they reported. I know that doesn’t prove he has a conflict of interest or that he was pressured regarding the findings, but it’s enough to be cautious.
My advice if someone tries to scare you about your treatment is to talk to your doctors. Most of them are very experienced with (and probably more than a little weary of) all of the anti-treatment arguments. Some of them even have support staff available to sit down with you and talk you through all of the issues. Breast care nurses can also be a great source of information, depending on their training and experience.
At all times I find it helpful to keep this in mind: And suggestion that all of the doctors and health care professionals are conspiring with large pharmaceutical companies to boost profits is ridiculous.
When you’re a cop you know that the more people you involve in a conspiracy, the more likely it is to be discovered. Once you get above five or six people it’s almost a certainty that someone’s going to talk. Humans are not very good at keeping secrets. And yet we’re supposed to believe that hundreds and hundreds of professional people are acting against our best interests? That’s just ridiculously improbable.
The treatments we have for all types of cancer are less than perfect. We are not (yet) at the stage where we can talk about a reliable cure for breast cancer but survival rates have continued to increase year after year. Why is that?
Yes, it’s possible that some of that might be due to improvements in the life styles of patients but not so much that this alone would account for it. What that means is that the existing mainstream medical treatments have continued to improve and more and more people are surviving for longer and longer after their initial diagnosis.
I am more likely to survive now that I would have been if I had been diagnosed ten years ago. Much more likely to survive than if I had been diagnosed 20 years ago. I have the medical profession to thank for that.
Anyone that tells you otherwise is unable or unwilling to understand the evidence.