Tuesday, September 22, 2009

Breaking the Cookie ... ta-da-ta-da-ta-da-da- dum ...

So. The inscrutable Kato (my medical oncologist) sat down with me yesterday morning. He smiles his worn smile and says: "based on the results of the Oncotype DX* test I would not benefit from chemotherapy." And, why the surprise? 

Rewind: this is the same onc who, if I had unquestioningly followed his prescribed standard of care protocol, would have started chemo . . . LAST WEEK! The "Red Devil"** being pushed first and heavy!

Rewind: the Oncotype DX is the test I researched, brought to him, and insisted be conducted!
Why the 180? Because ... ta-da-ta-da-ta-da-da- dum ... the Oncotype DX determined that my Recurrence Score ("RS") is 16 / 100.***
What does this mean, besides the fact that the toxic soup has been pulled from my menu? Well, women with a low risk RS will receive little, if any, benefit from chemotherapy after surgery. Hmmm...

So. I asked, why I had to ask for the Oncotype DX test to be done?
So. I asked, why was it not offered to me as a matter of protocol, especially in light of the 180 in his medical recommendations?

The inscrutable Kato simply and calmly stated, because my tumor was so large. "You see," he says, "The 'problem' with Oncotype testing is that it usually does not test tumors greater than 5 cm." Hmmm...

So. I asked, does the size of my tumor give him reason to question my RS score and the subsequent determination? He said: "No, not at all." Hmmm...?

Sidebar: When all of the MedPros thought my tumor was no larger than 5 cm not one of them, and certainly not Kato, even hinted at the possibility of Oncotype testing -- they spoke only of chemo and radiation -- and their incredulity that I did not want to do either. Additionally, post-mastectomy, I spoke directly to Genomic Health, the lab that conducts the test. I wanted to confirm the criteria of the test and applicability to my situation. I was told I was a "fit" -- all 6.2 cm of me.

Walking out of Kato's office yesterday I felt like I had just "dodged the proverbial bullet." More so than after and since the mastectomy.


Side Notes:

* Women with early-stage invasive breast cancer receive a standard risk assessment that includes their age, stage of the cancer, grade and size of the tumor. New, sophisticated tests, such as MammaPrint+ and Oncotype DX allow women with estrogen receptor-positive, node-negative tumors to also obtain a refined risk assessment that predicts their risk of recurrence and how much chemo will help. In my situation, prior and up until the results of my Oncotype DX test results each and every one of my MedPro squad were adamant that I commence chemo within one-month after my mastectomy. Their argument: my age (47) since "younger" women have a statistically higher risk for recurrence; and the size of my tumor (6.2 cm).

** "Red Devil" (a.k.a. "Red Death") refers to Doxorubicin; trade name Adriamycin; also known as hydroxydaunorubicin). This lovely pharmaceutical has a plethora of side-effects. Acute side-effects can include nausea, vomiting, and heart arrhythmias. It can also cause a decrease in white blood cells (making you highly susceptible to infections), as well as complete hair loss. When the cumulative dose of doxorubicin reaches 550 mg/m², the risks of developing cardiac side effects, including congestive heart failure, dilated cardiomyopathy and death, dramatically increase.

*** The Recurrence Score, a number between 0 and 100, also signifies the likelihood of metastatic recurrence within 10 years of the initial diagnosis. An RS of 17 or below is considered "low risk," meaning the breast cancer has a low chance of recurring. My RS essentially states that out of 100 women, statistically, 16 will have a metastatic recurrence within 10 years. Will I be one of the 16? Well, even if I am, chemo won't be any help -- and most importantly, would not have had any impact even if I had opted for it presently.

+   MammaPrint is the European version of the Oncotype DX test. The biggest difference, however, is that to conduct a MammaPrint the tumor tissue has to be "fresh off the surgical site." The only place in the U.S. that you can have a MammaPrint conducted is ... ta-da-ta-da-ta-da-da- dum ... PHOENIX. Why? Because T-Gen, HQ'd here in Phoenix (where my surgery was done), just recently bought the MammaPrint patent. And, according to Kato, T-Gen reps are wining and dining all the Arizona breast cancer surgeons. Guess my surgical oncologist (one of the top 3 in the Phoenix area) must have missed (or had too much of ) either the wine or dine. (BTW - I asked Kato why he thinks I was not presented with the MammaPrint as an option. He smiled, and said: (did you guess?) "Probably because my tumor was so large" (!!!) ) Hmmm...

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