Wednesday, April 24, 2013

Breast Cancer: Treatment vs Disease

I am reading the "bible" of Breast Cancer books; "Dr Susan Love's Breast Book", 2010 Edition, with her next edition due in 2015. An almost erotic book title for a rather un-erotic subject. Breast cancer and it's treatment keeps moving, the understanding constantly evolves.

The book's dedication is to "those women who have died from breast cancer - or the treatment of breast cancer". A chilling but realistic introduction.  Clearly every treatment has a possible benefit and the opposite.

The following items in the book I found were revelations, that I feel are little known and of great interest:

30% of all breast cancers caught in mammograms probably do not require treatments, as they will go away in time by themselves, or remain dormant, possibly never spreading, but we just don't know which ones they are, so all found are treated with surgery, as a minimum.

So quite a portion of actual diagnosed cancers can be fought off by the body, dissolved or become dormant, with special mention of lifestyle changes, such as losing weight or stopping Hormone Replacement Therapy (something no woman should be taking, knowing what we know now). This improves "the environment", described below as a "neighborhood". I wasn't aware that it was accepted that the body can destroy established cancers!

Reading about genetics is fascinating. There is a huge section in the book on it and how the code gets corrupted - it doesn't happen easily - there are many mechanisms built into the genetic systems that have to fail for this to happen. In context of the genetic aspect, the neighborhood is an analogy for the environment. Thus ceasing HRT or losing weight (as above) being "neighborhood improvements" which could influence the cancer tumour to recede, become dormant or even disappear.  Like a "bad kid" in a "good neighborhood", keeping the "bad kid" in check.

39% of women having died from other causes, upon autopsy, are discovered to have breast cancer, dormant or otherwise.

Anorexic women hospitalized in Sweden before the age of 25 for this disease, have among the lowest incidence of breast cancer over their lifetimes.  A clear indication that less nutrition and calories is a good weapon in preventing and fighting BC.  HOW this works is still just a bunch of theories though and coincides, of course with women from lower socio economic situations getting it less too.

Women who have their ovaries removed to battle breast cancer (not prevent, but a treatment to starve tumours of estrogen), have less estrogen of course, but for some reason the overall mortality outcome is worse. It seems ovaries do not just decline into nothingness when no longer required for reproduction - it seems they are valuable in many ways to the body. Dr Susan Love states they do what many middle aged women do, they simply "change jobs" as they go into middle age.  And menopause is not so much a cessation of ovary activity but a series of fluctuations.  What it is ovaries are doing which lengthens lives still is not known or understood fully. The known part, of course, is that estrogen production is known to protect against heart disease, the biggest killer of all.

Among the conclusions in the book are:

You can't "win at every hand" - for example, if you have high naturally occurring estrogen you are more protected from heart disease, osteoporosis - but more inclined to get breast cancer, with all the numbers crunching harder, the older you get (sounds like me).

One can only be philosophical. But doesn't it all make sense? It does to me. Our biological strengths/advantages, such as the estrogen supply, can become or contribute to a disease, and despite the brilliant design or evolution of our bodies, we are not meant to live forever.


I spoke to my surgeon recently and found out more about what will happen in surgery.  In regards to the sentinel nodes, they won't take all the nodes down the right side of my body no matter what, even if they find some cancer cells in the sentinel node(s).  So its like three possibilities, either just the sentinel node(s), as in one to three taken out for testing, and if no cancer cells are found there, the incision will be closed. If something is found then more nearby are removed, instead of all. He said even if the next group has positive nodes, whatever may be left behind will be dealt with radiation therapy, as the node area will catch some of that anyway and a bit extra will be given to the area if it looks like this situation. They are very careful with lymph nodes as they are valuable to the body as a draining and filtering system. Removal of them has various complications including the possibility of swellings and collections of water on that side of the body, something that can only be improved with various method, but not cured.

Additionally he told me, and this was new to me, once the tumour is removed it is taken away for an X-ray immediately to make sure the margins are clean/clear of touching the tumour.  If not clean, this is remedied within the same operation, to save a re-excision (another operation) at a later date. There is a chance, of course, that it still won't be completely clear margins, but it is good to know they are so very thorough, yet keeping in mind the overall health picture - less operations, anesthetic and as little as possible, removal of healthy tissue.

Well, getting a bit nervous now, to be honest. Not sure what it is that sets me on edge - perhaps the fact that there are three procedures on the agenda over two days, but it is all very unavoidable, so here goes, and I will update this blog when I feel up to it, hopefully within a day or two of surgery.

It feels so odd because, of course, I feel fantastically healthy in my everyday life. Last August I couldn't wait to have my hysterectomy; my large fibroid uterus was giving me terrible back pain, leeching my body of red blood cells and generally laying me out for more than a week per month with humungous periods (sorry, TMI folks).  I don't feel like anything is wrong with me this time?

The histology of the tumour I won't know until two weeks later, when I have my first post-surgery checkup.  I will be told how much radiotherapy I will require then, if any further surgery is required (I really hope not) and if tamoxifen will be recommended.

Over 2,500 women in NZ are diagnosed with breast cancer each year and have to undergo surgery.  New Zealand has one of the highest incidences of BC in the world, but unlike 30 years ago 80% of cases are now cured.

I am now part of the ongoing BC statistics, and have signed up to be a part of a statistical study of NZ BC patients.

I didn't expect to get BC, and I don't have a particular fear of the "big C", but nor did I ever think "it won't happen to me".  My maternal great-grandmother had breast cancer, originating with lung cancer (she was a smoker), complicated by diabetes, aged 73 (in 1973).  My maternal grandmother died of melanoma in her late 50s. My birth mother is alive and has diabetes.

Some time ago I read that anyone that gets old enough, will get cancer of some kind. It is just part of our built in "time bomb" genetics it seems.


Anonymous said...

Hi Pauline,
Great to hear about what's happening. I hope that the surgery goes as well as it can and I look forward to hearing how you are after it's done.
Take care,

Pauline said...

Thanks Alistair,

I am feeling really good post op. Its so nice to be in touch with people, old friends like you. I really appreciate your good wishes :-)