The Top Three

So now what? I was told I had this "in-between" pre-cancerous marker called LCIS; I read about what it was, what it did and what it means through medical journals but, in all honesty, what do I need to do next? It kept coming back to three options:

1) Take Tamoxifin ( a chemo drug) for five years to lower the probability of getting invasive breast cancer.

2) Be vigilant and do an MRI once a year with a mammogram at the sixth month mark- every year.

3) Have a preventative bi-lateral mastectomy with reconstructive surgery.

Since my breast surgeon immediately suggested the Tamoxifin route, I made an appointment with an oncologist at the Joan Karnell Center at Penn Hospital to discuss putting poison into my body. Are you getting the feeling that I am ruling that one out even before I meet with him? I mean, I am a person that refuses to take aspirin for God's sake and now I am going to put a drug into my body where the side effects include blood clots, strokes and uterine cancer. Oh..and add in that it throws your body into menopause (lovely) for an onset of hot flashes, nausea and skin irritation among other fun symptoms. Of course, not everyone experiences those side effects but I will guarantee you that I would be one of the ones that do. Guarantee it!

I brought Bob with me since I read that you are supposed to bring someone to listen to what the doctor says in case your brain begins to wander or you freak out. I am pretty level headed so I knew I wouldn't start to cry or not listen but I wanted him to hear what I heard so he could be a sounding board later on. After explaining that Tamoxifin had been tested in 10-year studies and that it had significantly reduced the risk of breast cancer in patients, the doctor pointed out that the studies are unsure of what happens after the ten year mark. Does the risk go back up? I would only be 57 and, remember, my mom died at 56. He then looked straight at me and said, "Arlene, you would be a good candidate for prophylactic mastectomy. But first get the BRCA 1/2 gene test done to see if that helps in your decision process."

I also needed to add that while I was in the waiting area, I was next to the area where women (and men) were receiving their chemo treatments- some in wheelchairs, others not. I flashed back to my own mother and how sick she was during that period of her life. Yes, of course, this was in the 80's when she went through radiation and chemo and the drugs have been much improved over the years but I was so scared thinking about having to do that. I honestly think deep down that, if I had to, I could summon up the courage to go through all of that but it would take a lot to find it. I don't think I am strong enough. Wow..that was really hard to admit.

Which is why the second option- be vigilant, exercise and eat right- seemed more passive than aggressive. And I am not necessarily a passive, laid-back individual to say the least. Add in that if (or when) you found cancer, now you would be older and less healthy to endure chemo and/or radiation plus the possibility of THEN having to go through a mastectomy. Why not head it off at the pass while I am still healthy and young (er)? I am not one to take a wait and see attitude so it seemed that the mastectomy route was best for me. Where I kept wavering was the fact that my breasts would be removed and that I would not have any feeling in them- for ever. Plus..maybe, just maybe, I might never even get invasive breast cancer. Would I do all of this for no reason? What happens if I get hit by a Philadelphia crazy taxi driver and die after enduring the pain of a mastectomy or I get stomach cancer instead of breast cancer? What if.......?

At this point, I had already scratched off option 1. My strategy was to meet with a genetic counselor to take the BRCA 1 and 2 test and then meet with the plastic surgeon. My thought process was that the gene test would either add an additional risk to the already elevated risk factors while the plastic surgeon would inform me of what I would look like after the surgery. I also thought it would be great if I could speak to someone who went through a mastectomy so that I had a better idea of what it would entail. Now...where would I find that person or persons???