new treatment guidelines for some women with early stage breast cancer? is it me, or does anyone else hear kenny rogers singing his song, " the gambler"?

last night on the cbs evening news, i heard a report about the possible change in treatment for some women with early stage breast cancer. the study was reported in the new england journal of medicine- the gold standard of medical journals,  in my opinion. there was not enough information,( for me )  so i went to the cbs news website and listened to the report again. from what i could gather, was that in women with early stage breast cancer, and considered to be very low risk- tumors that are estrogen receptive, no lymph node involvement ( i assume, do not quote me on this one), and small size tumors, chemotherapy may not be the answer. instead of the traditional chemo cocktail, these women were given an estrogen blocking drug only. the recurrence rate was less than 1% after 5 years. this is a major breakthrough in treatment, i think.

i think that early detection of breast cancer is essential, of course, in order for this to be a viable treatment option. and i still think that it is a bit of a, as kenny rogers would put it,  gamble. of course i believe that treatment for every cancer is a gamble to some degree . it is crucial for the patient to gather as much information as possible and get second opinions, if possible, before deciding on what treatment may be best for them. this refers  back to what i am always saying- everyone needs to be their own  best patient advocate. research, research, research and ask plenty of questions along the way.  no one has a crystal ball, unfortunately, so no one is certain that the choices that are made today will be the correct ones, as far as treatment and recurrence are concerned.

in my case, for example, i was not certain at first if i would need chemotherapy. my general surgeon said that he usually could tell a patient if they would be needing chemotherapy or not. he said in my case, he had absolutely no idea what the oncologist would say. ( figures, right?). the staging of breast cancer has changed dramatically from what it once was. no more just stage 1,2,3,4. now there are many factors to consider- is it estrogen/progesterone receptive? how large are the tumors? what type of breast cancer is it? are the lymph nodes involved? etc, when i asked my oncologist what stage i was in, he just looked down and shook his head. he said that it was not cut and dry any longer. all i could pin him down on, and believe me i tried, was that i was at " moderate risk" and yes, i would need chemotherapy.

i also read a study about patients who have had  thyroid cancer and then were diagnosed with a second primary cancer. this was a study that was conducted in taiwan ,with a population size of about 19,000 patients. two things struck me, almost literally. first, for patients who had had thyroid cancer, there was a 33% increase in the risk of a second primary cancer, breast cancer being one of the " choices". another horrifying result of the study was that the median survival rate after the diagnosis of the secondary cancer was only 4.7 years. (the full article title is: second primary malignancies following thyroid cancer: a population based study in taiwan, eur j. endocrinol 2013. 169.577-85)
after freaking out a little bit, i realized that several facts, that i needed to consider, were missing from this study. what stage thyroid cancer did these patients have? how was it treated? what type of cancer screening did the patients have? what stage was the second primary cancer and how was it treated? health care in taiwan, i assume, is different than health care in the united states. i am not saying one is better than the other, just different.

i think that all  cancer treatment is a gamble. the best that  anyone can do is to gather information and make, what we think, is the best decision for ourselves. no one has all of the answers. i decided to be aggressive with my breast cancer treatment, and my physicians agreed. i have my big thyroid cancer check up in a little over two weeks. you can bet that i am going to discuss the article on thyroid cancer and second primary cancers with my endocrinologist. one of my doctors told me that i have " the most positive attitude" about my cancer. i think that it is important to be positive, but at the same time, realistic. who knows what the future holds for any of us, but all of us need to make our time count and enjoy every minute of it.