If you’ve heard the words “your biopsy came back as breast cancer” within the last two weeks, then your head is probably still spinning. You’ve heard about more medical specialists (breast surgeons, medical oncologists, radiation oncologists, geneticists, reconstructive surgeons, breast imaging radiologists, and then some) talk about your breast cancer treatment options than you probably ever cared to know. More dizzying, you’ve started to hear the arcane medical lingo with its mind numbing medical statistics.
Then you went on the Internet and started reading about this “newest” treatment or that clinical trial – until you’re sure that no matter where your doctors work, someone must be doing something newer. Right?
Well let’s just see if we can’t simplify things a little bit with two bite size concepts. For starters, no matter how complex the terminology and doctor-speak, you actually only want to know two things:
- Will I live better?
- Will I live longer?
Everything else, no matter how state of the art sounding, is nothing more than a proxy for those two questions. Urge your doctors to focus their answers in that format, and maybe your head will spin a little less. If they won’t answer in that format, at least you’ll know how to categorize the answers that you do get.
The second concept may be even more liberating. It turns out that after you dissect the statistics of all the different kinds of therapy you could choose as treatment for your breast cancer, the results are remarkably similar. That means that whether you have lumpectomy with radiation, mastectomy, pre-op chemo, post-op chemo, hormone therapy, or whatever, if it’s an accepted protocol in the US, then the outcomes are so close to each other that it’s not even clear that real differences still exist.
So what does that mean? Well, it means that if the results are the same, then you get to choose based on what will make your life more worth living. What a concept, no? Your personal desires matter! So, with that, some women get a great deal of pleasure and self-esteem from their breasts. They would probably do best with breast conservation therapy – lumpectomy and radiation. Some women want as little surgery as possible. They, too, might be happier with lumpectomy and radiation.
On the other hand, some women start to see their breasts as almost alien after the diagnosis of breast cancer. They don’t want to worry about what’s going on inside their breasts, and hate the idea of future mammograms, more doctor visits, and all of the biopsies and things that doctors do to make sure we all go crazy. Here, mastectomy might bring more solace and freedom. Finally, politically incorrect as it may sound, some women see an opportunity to be more cosmetically shaped after all the bad news and agony of breast cancer treatment. They may do better with bilateral mastectomy and reconstruction – perhaps even including a tummy tuck for the reconstructive part.
So, after all the doctors have given their speeches (and despite my tone here, they really are trying to help), take a deep breath and ask yourself a simple question: “Assuming that all of these treatments are going to make me live longer, what will I choose that will make my life the most worth living?”
-Your Bicycling, Skiing Plastic Surgeon