Actress Rita Wilson's experience with breast cancer

Larkspur

This article appeared in the New York Times this week:

http://www.nytimes.com/2015/05/07/theater/rita-wil...

(I hope this link works!)

I was surprised to read that although Ms. Wilson had a double mastectomy, she didn't have chemo or radiation. I suspect that information isn't accurate. Anyway, kudos to her for going public with her situation.

DivineMrsM

I didn't have a dbl mastectomy, had a lumpectomy. And dealing with a stage iv diagnosis. Everyone is allowed to approach their diagnosis as they see fit, but I cringe a little at how Rita just jumps back in the game of life so quickly after surgery. I'm sure it's a good distraction yet it somehow seems odd. But I don't live the privileged life she has, able to hire anyone from a driver to a chef to housekeeper, and more, such as laundress, hairstylist, secretary, so maybe all she actually has to do is act in he play and be taken care of.

Snowgirl63

I read the article and yah made me cringe a little too. I just hope that for someone else reading the article that hasn't been diagnosed that they minimize what a person goes through when it does happen. We all need that support and care So much more than anyone who hasn't been there could even begin to understand. It's probably just her way of coping with what has happened. Maybe in time she will realize she can't minimize the impact. Although I have had to do it in my situation because I have a son who is 18 with a rare syndrome and would not understand. He's 18 now and my brave face is for him. Inside I'm still terrified but so very thankful for this site. I guess we all have our reasons for what we choose to share.

mmtagirl

it's not that unusual to return to work a month after mastectomies. I had a BMX last year and returned to work after four weeks. I have primarily a desk job so it wasn't too difficult. I was glad she talked about the reconstruction and expander fills. Most people don't understand the process of reconstruction and how it varies from Breast augmentation. Like Rita, I didn't think I would need chemo or radiation because of the BMX. After surgery and having a node full of Cancer I did a lot of soul searching and signed up for the PonderRx trial for women 1-3 nodes positive and hormone positive. I landed in the chemo arm and also rads. I worked through it all, albeit, not full time every week. My MO encouraged working. I am also happy to report ~1,5 years later I made it to the squishy side yesterday

suz1103

Thank you , if I may call you, Rita for speaking out so bravely and as usual with such wit, wisdom and honesty, I have have left mastectoy last Nov. and now must return to have ANOTHER needle core biopsy on left side to check 'funky looking node." Although I have been through this procedure once I am still petrified, plan on using as much 'relaxing chemical therapy' as allowwed and also am so blessed with a FANTASTICALLY supportive and loving husband, I have been a big fan of both and am now even more so...................... If you are facing this awful thing or possibly, I have developed one personal mantra that I really AM going to make into a shirt................. front- CANCER IS A BULLY and back- BULLIES NEVER WIN!!!! suz

jctreehugger

I think that is a nice article. We all have different ways of handling things, I worked full time through my surgeries and radiation, taking off literally a couple days, and I don't have a driver or a housekeepers. I admire her openness and I love her statement about how everyone is always looking at women's breasts anyway, that made me laugh.

ChiSandy

She most likely had DCIS, and it is not at all unusual after a BMX for low-grade (or even high-grade) DCIS to not need chemo or radiation. (With pure node-negative DCIS, chemo is usually not indicated, and normally radiation is given after mastectomy only if there is a recurrence or new primary tumor). Many women with very small low-grade DCIS opt for BMX because they don’t want radiation. It’s sort of ironic, OTOH, how many more of us with invasive disease chose lumpectomy & radiation.

AmyfromMI

Rita Wilson was diagnosed with ILC. I don't know the stage or grade. But, when I was diagnosed with stage 1 grade 1 ILC, I was given the option of a lumpectomy with rads or MX without rads. No chemo as my oncotype was a 15 and contingent on five years of tamoxifen.

LAstar

My impression has been that DCIS tends to spread more broadly throughout the ducts whereas higher stage IDC often presents as a lump, so lumpectomies get clear margins more frequently for IDC and don't require MX. My DCIS was stem-to-stern in my breast, so I had to have MX after 2 unsuccessful LX.

Beesie

LAstar, that's my understanding of DCIS as well, and was also my experience - my DCIS had spread through the ductal system to pretty much fill my entire breast. A MX was my only option, not because I had a small invasion, but because there was so much DCIS in my very small breast.

I recall reading a study years ago that confirmed that it is in fact more common for women with DCIS, particularly grade 3, to have widespread disease than it is for women with IDC to have such large tumours. So yes, more women with DCIS than IDC actually require a MX in order to fully remove all of the disease in their breasts.

Rita Wilson did have ILC, which developed after she had been monitored for years following an earlier diagnosis of LCIS. Since LCIS tends to be bilateral, and since ILC has a greater chance of being bilateral than IDC, it makes perfect sense that she had a BMX, even if her ILC was early stage enough to not warrant chemo.

LAstar

Thanks, Beesie -- it makes me wonder about the theory of DCIS progressing to IDC. If DCIS is more widespread but then progresses to IDC, then one would expect women with IDC to also have trouble getting clear margins in LX. Maybe there is something different about the DCIS that spreads versus remains in one place? Maybe DCIS that becomes IDC changes so quickly that it doesn't have time to spread? Some women do have DCIS in their margins after LX for IDC, but it seems curious that we don't see a larger pattern.

Beesie

LAstar, you've hit on what I've considered for 11 years to be one of the biggest mysteries.

It's pretty much agreed that something in the range of 90% of all cases of IDC develop from DCIS, and it's very common to find small amounts of DCIS in the pathology of women diagnosed with IDC (often it's listed as an incidental finding on the pathology report and is never even discussed with or mentioned to the patient). Similarly, women who have large amounts of DCIS, particularly if it is high grade, are at significant risk (as high as 40%, from some reports I've read) to be found to also have a very tiny area of IDC (often just a microinvasion or something just a bit larger).

So why is it that:

- in some cases, a tiny amount of DCIS initially develops but then almost immediately evolves to become IDC and the cancer develops from that point forward as IDC

whereas

- in other cases, DCIS develops and continues to spread through the ductal system as DCIS, but somewhere in the middle of all that DCIS, a tiny area of IDC develops - but doesn't continue to spread as IDC.

I think that there must be something biologically different between these two very common development patterns of breast cancer, even though both include DCIS and IDC, and both almost certainly started as DCIS. In one case, the patient might end up with 1.8cm of IDC and 2mm of DCIS, whereas in the other case, she might end up with 7+cm of DCIS and 1mm of IDC (as in my case).

I have bookmarked dozens of studies that look at different theories of what biological/molecular factors might cause some cases of DCIS to evolve to become invasive cancer, while other cases of DCIS don't ever develop beyond DCIS, but I have never seen any study that attempts to explain these two different patterns of DCIS to IDC development.

LAstar

I knew you'd have a great answer, Beesie. We just need a few million in grant money and we could get to the bottom of this.

This sounds crazy, but I wonder if the DCIS spreads because it is looking for something that will help it make the change to IDC.

Beesie

"This sounds crazy, but I wonder if the DCIS spreads because it is looking for something that will help it make the change to IDC."

Not crazy at all. Quite interesting, in fact.

Any ideas on where we can find a few million dollars?

JohnSmith

Fwiw, according to this link, Rita was originally diagnosed with LCIS (Lobular Carcinoma In Situ) years ago. New biopsies in 2015 confirmed PLCIS (Pleomorphic Lobular Carcinoma In Situ) and additional opinions upstaged the PLCIS to PILC (Pleomorphic Invasive Lobular Carcinoma). Pleomorphic has the potential to be more aggressive, although it sounds like she may have caught it early, either Stage I or II.

In terms of surgery, many women opt for a double mastectomy (BMX) since getting "clear margins" in Lobular is often very challenging for surgeons. This is due to the lack of the sticky cell-to-cell adhesion protein, Ecadherin, which results in diffuse growth. (At the genetic level, Lobular cancer cells lost the ability to make this E-cadherin protein. Without this protein, the ILC cells can spread in a discohesive pattern).

lacelace

do you have side effects from the hormone therapy? Why did you switch. Is your dr saying 5 years. Mine is now saying 10 @amyfrommi