DCIS Treatment Options
Ever since I got the voicemail. I feel different — my outlook is different, I breathe differently. My doctor’s nurse left a message informing me to come in the following morning with my spouse to discuss the findings of the biopsy. We knew this meant the cells are not benign.
Everything was different now. I had been struggling with identity issues related to being a stay at home parent and unemployed. I had been feeling depressed. I had been feeling concerned about my life goals. Now, I’m not yearning for anything. I’ve moved away from a feeling of wanting to take inventory, wanting to move forward, wanting to accomplish. I don’t feel that way anymore. I feel that would be indulgent– to want. I feel a strange calmness.
After I heard the message, I went through something. Nothing amazing or poetic, I didn’t see a different spectrum of lights or an amazing palette of colors or hear angels trumpeting. I just went through some typical Kuebler-Ross stages on and off, quickly, and out of order. I blamed myself for increasing my alcohol intake to a daily drink in the past year. I blamed myself for not running weekly and feeling lazy about working out. I felt anger about worrying so much over family members, so much that I had developed cancerous cells. I hoped and prayed that if my prognosis is good I would make significant changes to my diet and lifestyle. I got weepy looking around the schoolyard at dismissal time. I hoped to have many years of waiting for my 6 year old to be released by her teacher, to watch her classmates disperse to the field, parents, and play structure. I didn’t care about finding employment or my identity again. I knew what I wanted: to live and to be with my kids. It was a long night.
My OB-GYN met with us. I have DCIS in one breast. I am at stage zero. Ductal carcinoma in situ. She explained the Latin terminology. In one of the milk ducts in my right breast are cancerous cells, these cells are contained in that area. DCIS is highly treatable with a 99% cure rate. She said she really wanted us to know the facts and to understand that there are treatment options. “This is a time to re-evaluate what causes you stress. You’re going to get this taken care of this summer. This will be a small bump in the road.” She made an appointment for me to meet with a female oncology surgeon. “I hand-picked her for you. I think very highly of her and I think she’s a good match for you. I set up a consultation for you to meet with her next week.”
That day, my spouse and I made the walk down the hallway from the elevators to the reception area of the surgeon’s office. I looked around at the carpet, the color of the walls, the generic neutral watercolor paintings of seasides and wheat fields, the name plates on the doors with a sliver of vertical glass so that you can peek into the waiting room and see the same boring colored carpet, matching chairs and same boring color on the walls as the rest of the medical office building. I filled out a number of forms on my medical history, family history and questions related to my lifestyle. He repeatedly used the restroom, “Sorry! I think I drank too much iced tea.” Yea, and maybe you’re nervous. I worked my way to the end of all the paperwork. I know I have cancerous cells, but is all this necessary for five cells? We were curious to hear of the treatment options. Dr. Jen told us she had reviewed my mammograms, the assessments by the radiologists following the biopsy, and had reviewed the lab reports. She felt I was a candidate for either a lumpectomy or a double mastectomy. The former involved a month of daily radiation for 4-5 weeks plus taking a medication to suppress further cancer growth in my breast for at least five years. The lumpectomy could be done as a day hospitalization and would involve a week or two of recovery. The latter was an overnight stay, a 6-8 week recovery, but then no further treatment would be necessary. No radiation, no oral chemotherapy and no more mammograms. All the breast tissue would be removed, there would be no need to continue to closely monitor further the breast area. She encouraged me to look up the cancerous condition on reliable websites:
Later when I visited these websites I read that about ⅓ of breast cancer cases are DCIS. I read in many places it is highly treatable if screened early on. The prognosis is very good and very little worry should be involved. Many physicians wished to call it a lesion, rather than cancer. I wondered about the treatment options. I read that more women than before were opting for the double mastectomy. The number of women choosing to undergo a bilateral mastectomy has greatly risen in the past 5-6 years. Even those like me who had a very small number of cells found and who had no family history. These were women I could relate to — women who did not want any mental anguish about a recurrence of DCIS or any invasive type of breast cancer. I was at only a 5% risk for a recurrence of some type of breast cancer than those who have never been diagnosed and DCIS is 99% curable. However, there is still a risk.
I came across a detailed decision matrix on the http://www.cancer.gov/types/breast/surgery-choices website. I found this most helpful. More helpful than personal blogs. More helpful than my surgeon informing me of the two treatment options and their very similar healthy outcomes. Maybe I just needed time to process — to read, re-read the information on these websites, to think about how this would translate into my life for the next 3 months, re-read, consider the recurrence statistics, and then re-read. I made some phone calls and set up consultations for the next two weeks. I needed to talk to professionals to figure this out.