Breast Cancer Decision Points

One of the many things I didn’t know about breast cancer before I got a front-row seat was just how many choices it entails. I didn’t realize that so much of the experience wouldn’t have clear-cut, yes/no answers.

You’re confronted by your first choice before you even know you have cancer. When my mammogram revealed suspicious specks, I was presented the choice of a stereotactic or surgical biopsy. I opted for the stereotactic biopsy on the spot, because it didn’t require outpatient surgery. If I had it to do over I would have chosen differently, but that’s a topic for another day. Your experience may be quite different; just be sure to ask about the pros and cons of each procedure.

Once breast cancer is confirmed, the choices start piling up. They vary depending on what type of cancer you have, your family history and your risk tolerance. You may find yourself on the borderline between radiation and chemotherapy, or between surgery and radiation like I was.

I had stage 0 ductal carcinoma in situ, which means the cancer was confined to the milk ducts and hadn’t become invasive (yet). The typical treatment course for DCIS is either breast-conserving surgery followed by radiation, or mastectomy.

I hoped to knock out the DCIS using breast-conserving surgery and radiation. But after two attempts didn’t get the clear surgical margins we hoped for, I decided to stop messing around and get the mastectomy. I opted for a single mastectomy although I know women who chose the bilateral. This is a highly personal choice and only you know what’s right for you.

Your next choices involve reconstructive surgery, with the first and biggest choice being whether you want it or not. I knew I wanted it, so I had to decide whether I wanted tissue transplant surgery or an implant to reconstruct the breast. I opted pretty quickly for an implant, which required choosing between saline and silicone implants. I preferred silicone but I know women who preferred saline, just as I know women who preferred tissue replacement.

The decision-making process doesn’t end there. You can leave the reconstructed breast as is, or you can have a nipple reconstructed and color tattooed in. I opted yes here as well but know women who decided not to take this last step.

And finally, since you may have lost symmetry, you may also choose to have the other breast worked on. I used to say mine resembled a bowling ball and bowling pin until I had the other one lifted so they’d match better. I had this done during the second-stage reconstruction on the mastectomized breast. I’m not sure what other countries do but in the United States, insurance has to pay for this additional cosmetic surgery if you’ve had breast cancer.

These choices can seem overwhelming so be sure to give yourself time to think. The key to making the right ones is to do what’s right for you and won’t keep you awake at night or second-guessing yourself down the road. I’ve never regretted any of my decisions and I wish the same for you.

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5 Reasons I’m Grateful For Breast Cancer

I would maintain that thanks are the highest form of thought, and that gratitude is happiness doubled by wonder.
-G.K. Chesterton

(I decided to rerun my Thanksgiving post from last year because nothing has changed; I’m still grateful. Here’s wishing everyone reading this a wonderful Thanksgiving.)

As Thanksgiving approaches and we start reflecting on what we’re thankful for, cancer is probably not real high on anyone’s list. But it is on mine, and here’s why.

It was caught early. My cancer hadn’t spread yet so I didn’t need chemotherapy. It was so early stage it wouldn’t have shown up in a self-exam, so I’m also very thankful for digital mammograms.

It gave me a lifelong appreciation of medical professionals. I’m lucky in that I have a wonderful family doctor I’ve seen for more than 15 years, but with mostly annual visits I never gave health care much thought. Getting breast cancer gave me a front-row seat to the medical profession, as my journey involved five surgeries and dozens of visits with a general surgeon, plastic surgeon and oncologist in addition to my doctor. I will always be grateful to them for their skill, humor and compassion. Their nurses and staff, and the hospital nurses who took care of me during my overnight stays, are also high on my gratitude list.

They’re perky. Probably the less said about this one the better; but suffice it to say my plastic surgeon is beyond gifted when it comes to reversing gravity’s effects.

It made me realize how much people care. This one is practically a cancer cliché but think about it. Clichés are trite because they’re overused, but perhaps they’re overused because they’re true. We go through so much of our lives caught up in our routines that we hardly notice the people we care for, and who care for us, until something like cancer happens. Finding yourself surrounded by so much love and care is both humbling and uplifting.

It gave me part of myself back. One of the obvious benefits of cancer is reconnecting with friends and family, but old loves like art and music may reappear in your life as well. In my case, I started writing poetry again. I hadn’t written or published anything for nearly 20 years and I really thought that part of my life was over. I’m so grateful to have it back and I hope I never lose it again.

But enough about me. How about you? What are you thankful for?

Telling Someone You Have Cancer

When I was diagnosed with DCIS/stage 0 breast cancer, my initial reaction was “WTF!?” with a bit of “Well, here we go” resignation mixed in. It was shocking but not surprising, if that makes any sense.

The next thing that hit me was that I would have to tell my relatives and close friends what was going on. I spent a big chunk of that first weekend on the phone with my husband Bruce’s and my siblings. It wasn’t fun to make those calls, but it wasn’t horrible because my cancer was caught early.

Telling the people closest to you is a no-brainer. Where it gets interesting is when it comes to people you don’t know as well. It’s not quite elevator conversation.

“What’s new with you?”

“Oh, just a little bout with breast cancer. But hey, how about those Huskers?”

I told only a handful of people at work when I was first diagnosed. I told more people after the mastectomy. By that time, I was writing essays about my experience for the Omaha World-Herald and was “outing” myself to some extent anyway, but I was also more comfortable talking about it when the tough part was over.

I think part of is not wanting people to look at you differently or treat you like some kind of victim. The other part is that getting a cancer diagnosis isn’t going to change who you are. If you’re very open about your life, it’s doubtful you’ll suddenly become secretive. If you were private before your diagnosis, you still will be. I handled the news pretty much the way I handle everything. There are a few people I share the most personal things with, and the rest are “Fine, and you?”

You may encounter people I call the “All About Me’s.” It’s natural for our stories, including our cancer stories, to remind people of their own stories, but there’s something a bit different about this crowd. You’ll know, because they’ll manage to make you feel like a bit player in their movie; it’s all about their emotions and reactions. I’ve found with this group it’s best just to smile and say, “Thanks.”

The other thing I learned is that my cancer story didn’t just belong to me. If you have a partner, this is their story too and they need to be able to share it. I talked about how my diagnosis affected Bruce in an earlier post. He needed to be able to tell the colleagues he trusted, just like I did. And that was fine, except I’ve never had so many people hug me at his employer’s annual golf fund-raiser. Luckily they all calmed down by the Christmas party.

Just remember, this is your story. You have the right to share it with as few or as many people as you wish.

A Year in Breast Cancer

Warning: Here comes the obligatory first-anniversary blog post. I started this blog on November 8, 2009, after giving it a lot of thought and being encouraged by friends.

I originally started blogging because I wrote a book about my experience with breast cancer. Blogging is on your social media “to do list” for that, but I quickly learned the book is beside the point. Yes, I hope people buy the book and I hope it helps them. And yes, I enjoy writing.

But the real point of this blog is to share personal observations and news items that may help other women with breast cancer, and men with cancer too. I’m gratified to have heard from men who say they’ve had similar experiences and emotions. While we experience cancer as individuals, many aspects are universal. We all have moments of fear, anger, doubt and improbably, joy. We all need to decide on a course of treatment, and learn how to communicate with doctors who may be going way over our heads at times. We need to figure out how to tell our families and friends, and how to cope.

When I started this blog, I remember wondering if I’d run out of things to say. I learned there’s a snowball’s chance in Hades of that happening, as there are new developments nearly every day.

It wasn’t long after I started blogging that new American guidelines for mammograms came out, igniting a firestorm of opinion (including mine). It’s difficult to be told for years you need annual mammograms starting at 40 and then hear, “Never mind.” Mammograms at 40 have become a belief system, and you don’t turn belief systems on a dime. I’m sure the panel members had no idea their findings would be so controversial.

New drugs and treatments were tested, schools were up in arms over “I Love Boobies” bracelets, October brought the usual onslaught of pink. I had my second clear post-mastectomy mammogram. Women continued to join the pink ribbon tribe, while others reached the end of their battle. The Race for the Cure and the search for a cure continued. 

If you’ve been reading me for awhile, I’d like to thank you. If you’re just discovering this blog, I hope you’ll stick around.