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Today I’m meeting my oncologist, Dr. Ormsby. I’m convinced that he wants me to have chemo without further testing, so I don’t plan to like him. I’m ready for a battle.

It doesn’t help that he has the most earnest face. He’s tall and very young-looking and hand-bumps both me and my friend, Lynn, who has come along to be a second pair of ears.

After we take our seats, it’s immediately clear that I’ve misunderstood Dr. Ormsby’s reasons for not ordering the second genomic test. He already thinks I don’t need chemo.

He’s fed my data into a predictive program and arrived at the best guess of a 1% benefit of doing chemo.

Chemo is highly toxic. It works by circulating poisons in the body to attack stray cancer cells, either by altering their DNA so they can’t divide, or by killing them outright. The drugs can’t distinguish whether cells are cancerous, only whether they’re dividing quickly. That’s why chemo is so nasty—it’s an indiscriminate killer. Hair follicles and white blood cells divide rapidly, so for starters, you lose your hair, and much of your immunity.

If it’s a 1% benefit, no way I’m doing it. Dr. Ormsby agrees. Still, since the other test has been ordered, we should hold off on treatment and see what it says. But, Dr. Ormsby thinks it’s all but certain to put me in the low risk category.

Since chemo is so unlikely, Dr. Ormsby moves on to talk about hormone treatment, which is straightforward by comparison, a simple decision tree. Was your tumor triggered by hormones? If yes, you will need hormone treatment; move on to the next question. Are you post-menopausal? Yes. That means you’ll be taking aromatase inhibitors for five years. (If no, you’ll take Tamoxifen for 10 years.)

What’s aromatase? It sounds like a perfume so strong that it paralyzes anyone in sniffing distance. In fact, it’s the body’s way of making estrogen after menopause. And if you have estrogen-triggered breast cancer, you want to shut down aromatase, by taking an aromatase inhibitor, or AI.

Of the three drugs available, Dr. Ormsby favors Anastrozole (Arimidex) because it’s tolerated best by his patients.

I’d read up on the options before the appointment and wondered if I’d be better off with Tamoxifen. The side effects of AIs include bone density loss and high cholesterol. My cholesterol has always been screaming high despite all my salads. You’d think I was living it up at Macdonald’s given my numbers. As to bone loss, at just under 5’, I already look like the “after” picture for osteoporosis, and then some. I’m not prepared to give up any more.

But this is about survival. It’s about killing the cancer and keeping it killed. Dr. Ormsby says the survival numbers are better for aromatase inhibitors than Tamoxifen, and given my overall health, I’ll probably do quite well with it. 30% of his patients don’t experience side effects at all.

He orders a bone density test for me, and with another hand bump, Lynn and I are off.

I am elated. No chemo!! I text Bob who is in Boston for his son’s knee surgery. I call Virginia in Seattle, and Norma in Salt Lake City. I tell my kids, my book club buddies, and anyone who will listen. I don’t have to have chemo, hurray!!