Did I Really Need to go Through What I Did?

I used to think I had been pretty lucky during my breast cancer treatments.  The doctors had decided, based on the pathology of the tumor which was eestrogen receptor positive, that I should have 4 rounds of AC chemotherapy, which I sailed through for the most part.  I didn’t get sickly, heck I even put on weight during chemo.   I remember how the chemo nurse explained the first day that I would most likely get sickly from the chemo, and I just looked at her and said, "I just don’t have time for that nonsense."  I was determined that chemo would be just another speedbump in the road of my life.

The "A" in AC is for adriamycin is a particularly nasty toxin, or as described at the PRO-Pharmaceuticals website, "the drug shows a remarkable toxicity."  Remarkable.  It has a remarkable color, too.  It reminded me of cherry jello that had just been mixed but not yet set, as the nurse loaded up the very huge hypo.  I did not use a port, instead having the intravenous line set up each time, through my arm.  Adriamycin must be administered with a lot of fluids or it can burn through your vein.  During the last round, the line had shiften and the adriamycin started leaking out of my vein onto my skin.  I never saw the chemo nurses move so fast as to clean that off of me, and adjust the line, so that the toxins went into my vein and not back out.

My cells were definately depleted, my white cells tanked immediately after the first round, which made it necessary to have an injection of neulasta the day following chemo (I was allowed to give the injection to myself so I didn’t have to go back to the doctors office), even though I did not feel sickly or tired.   Ten days after the second round,  my blood tests revealed that my red cells had dropped to unacceptable levels, which required me to be subjected to aranesp shots. 

All through this I never stopped.  I’d have my treatment on a Wednesday, Friday would be my "bad" day, in which I slept most of the afternoon and night, and then on Saturday the boys and I were off on a hockey trip.  It just seemed to work out that the boys had games in other states just after my treatments, yet I never once missed a game.  At the time I also helped a friend clean houses, and other than doctors appointments, I never missed a day of work.  This, I attributed to my strong determination that I would not let the treatments rule my life.

But, today I find that I may not have had to go through all that.  Granted it was a realtively short period of time out of my life, and I feel that I succeeded in not letting that stop me from leading a "regular" life.  Nevertheless, it was a draining experience, in many ways.

Dr. Eric P. Winer, an author of the paper who is director of the
Breast Oncology Center at the Dana-Farber Cancer Institute in Boston,
explained the guidelines’ message: "Virtually every woman with a tumor
larger than a centimeter should get chemotherapy. Period. End of story."

But,
Dr. Winer said, over the past couple of years "that question has been
reopened in a major way." The new study, he added, is part of the
re-examination.

The study analyzed data from three large clinical
trials that tested different chemotherapy regimens. One gave two
standard drugs with or without a third drug, paclitaxel. Another
compared drugs in low, moderate or high doses, and the third asked
whether it was better to give the drugs more intensely, in two-week
cycles, or whether three-week cycles were best. The women also had
surgery and radiation as appropriate, but the studies focused on the effects of chemotherapy.

The analysis, by a group of leading breast cancer researchers, led by Donald Berry, a statistician at M. D. Anderson Cancer Center, asked whether some women were more likely to benefit from chemotherapy.

The
conclusion was that even though the studies involved very different
chemotherapy regimens, one variable always stood out: whether a woman’s
cancer was estrogen receptor positive, meaning it was fed by estrogen,
or estrogen receptor negative, meaning it was impervious to estrogen’s
effects.

"All the benefits were in the estrogen receptor negatives," Dr. Berry said.

"Then
I asked, What is going on here?" he continued. The answer, he and his
colleagues report in the new paper, is that hormone therapies with
drugs like tamoxifen that starve cancers of estrogen are so powerful —
reducing the death rate by 30 percent in women with estrogen receptor
positive tumors — that chemotherapy helps those women much less than it
helps women with estrogen receptor negative tumors.

On average, the researchers report, a women whose cancer does not
respond to estrogen has a 23 percent greater chance of surviving five
years, disease free, if she has chemotherapy. For a woman whose cancer
is fed by estrogen, chemotherapy increases her chance of surviving that
long by 7 percent, which is not statistically significant.

I remember a little more than 2 and a half years ago that chemo for me could give me a 25% chance of surviving 5 years.  Even 25% is a pretty dismal number for the period of 5 years, in my mind.  But, 7%?  Somehow, I feel cheated after reading this article.  You know that I have already printed out this article to discuss with my onc next week.

But, this post is not just about doctors not knowing how to treat breast cancer, or if you prefer to look at it in another light, doctors that are still learning about properly treating breast cancer.  Nor will this post give any guidelines about how doctors should treat breast cancer, simply becasue I am not a doctor.  Nor is this post about the exploitation of millions of beast cancer patients and survivors by the pharmaceuticals, which have reaped billions of dollars.

What I am trying to point to in this post is the medical communities continuing lack of concensus on treatment for breast cancers as well as the apathy of society to address the epidemic numbers of women effected by breast cancer.  I watch the news on breast cancer treatments, new and changing, and I can’t help but wonder why it is taking so long for serious and meaningful changes to occur.

What has happened over the years really over the last century, is that surgeons took over the care of women from their family physicians.  Surgery was supposed to be he "cure."  However, the reality is that breast cancer continued to touch more and more women each year.  Over the past 3 or so decades, those responsible for a "cure" has once again changed hands to oncologists.

Early on, society started to wage their own war against breast cancer, settling on prevention.  The problem with this tactic, is that if you, as a woman, did not get your mammogram, or did not see the signs of breast cancer, you are viewed by society and doctors, as being negligent.  "Early detection saves lives."   Yet, this negates how incidious breast cancer can really be.  It negates that when a mammogram does detect breast cancer, the tumor, for some of the breast cancers  could very well have been growing for the last 8 or more years.   It negates the fact that early detection is not prevention of a disease.  It is also the biggest guilt trip put on individual women by society.

The early prevention campaign to the reliance on oncology (extremely toxic drugs) also condems women with breast cancer to inextricably be tied to the politics and economics of the disease.  We live on a double-edged sword, one side linked to, and often dependent on, the medical community including the pharmaceuticals, and the other side is the excrutiatingly slow response of society to view and try to understand how breast cancer effects women, particularly the disparities seen between white women and women of color.