Chemo and Breast Cancer

Digger,

I had unclean margins that were not removed.

True story: This small-town Alaskan (me) was seen by her onc after surgery in Seattle, who failed to tell her about the unclean margins, and with his usual lack of communication, just sent her off for an MRI for a questionable "spot" on the xyphoid.  The dark spot was there but was determined to be benign. Said Alaskan had pre-arranged flight reservations and figured there was no reason to hang around any longer, and flew home.  Two weeks later while still completely ignorant of the dirty margins, she happens upon her PCP in a hallway, who, being an exceptionally low-key guy, mentions calmly that maybe she will "have to" return to Seattle... I'm not sure what he thought caused me to end up back home with dirty margins. Anyway, I was totally in the dark as to why I would have to go back.  Meanwhile, my tumor board in Seattle got together and scratched heads, and eventually determined that rads would take care of the problem.  So I never did have the margins removed. 

impositive, thanks for clarifying what you meant when you said that BC is systemic.  

When I read your explanation, my first reaction was "well, yes, that's true".  Something caused those cells in our breasts to mutate and that underlying cause - whatever combination of genetic and/or biological and/or environmental and/or lifestyle factors - likely affects our whole body (and thereby is systemic) and very well might be affecting other cells in other parts of our bodies. So what you said makes sense.  And it is supported by the fact that those who are diagnosed with BC are somewhat more likely to be diagnosed with another cancer at some point in the future. Someone in the DCIS forum asked about that recently and I found this following:  http://www.medpagetoday.com/HematologyOncology/BreastCancer/2286 

But then I thought about it some more.  I still agree with you in many cases but not in all cases. I think in fact sometimes cancer cells do spring up in the breast spontaneously without any connection to anything else going on in our bodies.  Don't cells sometimes just fail?  Our bodies are imperfect and our cells and genes don't last forever. Is it also not possible that a particular combination of biological/environmental/lifestyle factors that we were exposed to had an effect only on specific genes that only affect cells in the breast?  Because while it's true that those who are diagnosed with BC are somewhat more likely to be diagnosed with another type of cancer at some point in our lives, it's also true that in the end most of us do not develop another type of cancer. 

I found this article which has a very interesting discussion about the history of our understanding of cancer:  http://science-education.nih.gov/supplements/nih1/cancer/guide/understanding1.htm 

To your question about whether it's true that the majority of women with BC never see a recurrence or metastasis, I'll refer back to the SEER stats that I posted, along with all the links, a few pages earlier. There is no information on local (in the breast) recurrence rates, but I think it's fair to interpret the data to say that if someone did not survive BC, this means that they had a distant recurrence, i.e. they developed mets.  On the other hand, if someone survived long-term, then it's fair to assume that they did not develop mets. According to the SEER data, the 19 year survival rate for those diagnosed in the years 1985 to 1989 was 65.2%.  Chances are that there were some women who were diagnosed during those years and who developed mets but who were still living 19 years after their initial diagnosis.  Maybe another 5%?  That would suggest that approx. 60% of the women diagnosed during those years did not go on to develop mets.  

Unfortunately long term survival data is not available yet for those diagnosed more recently but we can do some rough extrapolating. The 10 year survival rate for women diagnosed in the '85-'89 period was 73.5%. The 10 year survival rate for women diagnosed in 1998 (the most recent 10 year data available) was 83.6%. So 10 year survival increased by 10 points from '85-'89 to 1998. Conservatively, if we assume that only half of that 10% go on to long-term survival (i.e. 5% did not develop mets at all but the other 5% did develop mets but survived longer), this would mean that of those women diagnosed with BC in 1998, 65% will not develop mets. Since survival rates appear to be continuing to increase, we can assume that for those diagnosed today, the percentage will be at least as good if not better.

So in answer to your question, yes it is true that the majority of women diagnosed with BC will never see a distant recurrence / metastisis.  

So AlaskaAngel,



If I understand your story correctly, said Alaskan (you) had dirty margins after surgery, but you also had follow-up radiation.



If I understand impositive correctly, she also had dirty margins but declined any conventional (I.e. a second surgery to remove the remaining cancer, radiation, chemo or other drug treatment).



These are of course personal choices, but while we're discussing who's having progression and who's not, it's important to know exactly what the facts are.



Haven't heard back from impositive, but I believe those were the choices she made.

Digger,

In short, yes. I was just responding to the mention sounding like anyone would be nuts to not eliminate dirty margins. It happens, and the it isn't always the patient's idea in the first place, but doctors who fail to be professional with the patient.

Beesie..survival rates may be increasing because more women are getting dxd at very early stage due to better imaging and more fequent imaging in the last decade or two....hence there are more numbers in 'survival' stats....because the chances of surviving very early stage BC are quite good. Spontaneous remissions of very early stage BC are also thought to be quite common now. I would argue that the percentage of spontaneous remissions of early stage BC are encouraging enough for us to consider dietary and lifestyle changes prior to as well as after a BC diagnosis.

Stats for MBC show little change in survival in the last few decades.

I keep reading that modern treatments, including chemo, haven't substantially improved BC survival rates, but then I find data like this from1969 and it makes me wonder... (see pages 297 and 298)  

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2008277/pdf/brjcancer00471-0062.pdf

Re dirty margins.  Mine led to my mast.  Pathology showed my breast was 'full' of cancer that had not shown up on any scans.  Some of the spots were as big as and bigger than the one that did appear on scans.  When I hear about women leaving dirty margins I worry that they are making their decision based on scan results.  

AlaskaAngel,

Just to clarify, I wasn't implying that someone is nuts for leaving dirty margins, I'm sorry if you inferred that.  Who am I to say anyone is nuts?

What I did mean to convey, however, is that having or leaving dirty margins does have implications, and that's all I was trying to say.  Everyone of course makes their own decisions regarding their choice of treatment, but again, all choices have implications.  And leaving dirty margins without any further conventional treatment does have implications, and so I think if we're discussing the likelihood of a person's BC progression, it's important to know what that person's choice was regarding whether to leave the dirty margins as is.  That's all I was saying.

Beesie, I love your contribution on the chemo threads. I like that you are impartial and I believe you are someone who geniunely cares about others. Your research is awesome. Sharing our research, thoughts and etc is good. This is why Leia put this out there. I think she wants discussion. It's ok that we don't all agree. If we all thought the same thing there would be no discussion...right? Even the alternative bc sisters differ on treatments, but we are all fighting the same disease and give one another info that will help us in our search for answers.

The internet isn't the best form of communication. For me, I think faster than I type and for this reason may leave out important words that may completely change the meaning of what I really want to say. Or, we just mis understood what a person was trying to say or they said it in a way that may cause mis understanding.

I hope we won't let this stop us from working together, and sharing what we are learning. We need you here Beesie, Princess, Alaska Angel, Impositive, Leia, Medici, thatslife, susie, digger and everyone else who have taken the time to share their thoughtful opinions and research.

(((hugs))) to all of you!

Leia,



Thanks for all your posts as well. I appreciate the shout out from you.



Any particular reaso why it's important for you to know the specifics of my diagnosis?



I unfortunately learned the hard way not to reveal any personal information here on BCO. It wasn't until I had been on BCO for a while that I learned of such weird terms as trolls, sock puppets, etc, as well as other posters using multiple user names to advance certain agendas. A little too creepy for my tastes.



Therefore, I imagine if it's really important for you to find this personal information about me, you can perform a more thorough search on me.



Why is this information important for you? Why do you need to know this about me?

Good for you Kaara! So do I!

Heidi: I'd guess others are in the same boat as you.I was diagnosed with stage 3, grade 3 her 2 positive cancer at 47, and had no problems saying yes to AC and taxol. I have a husband and 3 children. I am now 48. I had a mother who smoked for 40-plus years and complained when dying of breast cancer at 67. I'm sorry - I have no problem listening to folks who have trained to heal what I'm suffering from. I feel I know a lot. I don't know everything.

From what I can tell, the analyses about pro's and con's of chemotherapy continue to fail to include a comparison for early stage bc that is based on chemotherapy plus choices like rads, SERMS like tamoxifen, and AI's like Arimidex  vs ovarian ablation by other means plus choices like rads, SERMS like tamoxifen, and AI's like Arimidex.

Are they afraid that if a true comparison is done, there wouldn't be much reason for early stage bc patients to do chemotherapy?

Heidihill,

You did not put Orac's complete conclusion in your post. This is the paragraph that preceded your cut and paste:

The bottom line is that, contrary to what you will hear from cranks and alt-med supporters who believe in "alternative" cancer cures, in the case of early stage breast cancer, chemotherapy saves lives. In women with breast cancer, it decreases the risk of their dying from breast cancer by approximately one-third. This is nothing to sneeze at, as it means thousands upon thousands of women who would have died but did not, thans to chemotherapy. This study simply represents yet another in a long line of studies, another strand in the web of evidence, that support the efficacy of chemotherapy in prolonging the lives of women with breast cancer. It's not perfect, and it has a lot of potential complications, but it works and in many cases it's better than the alternative.