What’s next? The tumor has been excised and good riddance to it, but it was step one of several. The big decision now is whether to get chemo.
A breast cancer tumor by itself won’t kill anyone, no matter how big it gets, so long as it stays put. But invasive cancers seek to go forth and multiply. If you have a cancerous tumor, it’s a given that you’ll also have stray cancer cells circulating in your body. Often, they’re harmless. But if those cells start dividing and forming a tumor, you’re in trouble.
So, it might not be enough to take out the tumor. You might need to send poisons to attack the strays. That’s what chemo does.
The prevailing wisdom has been that chemo shouldn’t be necessary for a small lump caught early. But I’ve learned it’s not so much the tumor’s size that matters, as its biology.
I know from my pathology report that my tumor is moderately aggressive, so despite its small size and no spreading to the lymph nodes, it might have already sent scouts around my body, looking for new territory to conquer.
There’s no way to search my whole body to find out—but we can look at the genetic make-up of my tumor and compare it to those whose tumors came before mine and were catalogued and tracked by researchers. Does my cancer look like the cancers that play nice and quietly go away? Or, does it more closely resemble those that “take a lickin’ and keep on kickin’”?
OncotypeDX is the most commonly used genomic breast cancer test in this country. It calculates the chances that you’ll have a distance recurrence of cancer in ten years, by comparing your tissue to a panel of 21 genes. (“Distant” means somewhere other than the breast. The harsher word is “metastasis.”) When I learned about the test, over a week ago, I asked Dr. Grant to order it for me.
I’d hoped for reassurance, or at least a hard piece of data to direct my next step, one that pointed right or left so I would know which way to go.
It turns out that the test is good at predicting high or low recurrence, but it falls silent on those in between.
It turns out I’m in between.
So, I’m still at a loss on chemo.
There’s another test, less frequently used, but popular in Europe. It’s called MammaPrint and looks at a panel of 70 genes. Since Dr. Grant ordered the first test, I asked if he would order it for me. He thought my oncologist (who I haven’t met yet) should place the order and offered to call him.
But when he called back, he said Dr. Ormsby was reluctant to order the MammaPrint and wanted to speak to me first. My appointment with him is still 10 days away.
I didn’t want to wait, and Dr. Grant sympathized. He put in the order.