One of the (many) challenges of breast cancer treatment is the extraordinary change that happens to our bodies. Not just the obvious changes – missing breasts, scars, hair-loss if chemotherapy is part of the treatment regime – but the unexpected changes too. Weight changes, skin changes, fluctuating energy levels, tinnitus, dry nails, altered metabolism, neuropathy. The list goes on. The physical transformations are accompanied by psychological changes too; stress, anxiety, depression, PTSD. Even the most relaxed people can find it difficult to stay permanently upbeat when the whole world seems to be caving in around them.
In spite of the sea of pink, in spite of all the hoopla about survival rates* and in spite of the endless fighting-talk about cancer warriors, battles and survivorship there is no gloss or glamour about breast cancer. This isn’t a Disney blockbuster complete with pink princesses, an assortment of vertically challenged helpers and a handsome prince who’ll undo the evil spell and save the day. It’s more like a Hammer House of Horror production. Zombies – rogue cancer cells resistant to initial medical intervention – might re-establish themselves in a multitude of locations anything up to twenty years after treatment, possibly even longer.
There’s no Disney is this realm. All we have, all we ever really have is the grit and determination to make it through diagnosis, surgery, chemo and/or radiotherapy into whatever future lies beyond. That future is not the one most of us anticipate. Regular medical check-ups, long-term side effects, living in a body that no longer feels like your own, mulling over the question no-one can adequately answer…Will it come back? Gloss and glamour don’t see us through these things. Just as cakes in a French patisserie look so much better than those in my locale, underneath all the icing and decoration they’re not much more than eggs, sugar and flour just like the cakes in my local supermarket. Gloss and glamour can sometimes help us feel better about ourselves – when we look good/healthy/almost normal on the outside it allows us to more easily blend in with the rest of society. But it doesn’t take away what’s on the inside – scars, reconstruction (or not), pain (physical, emotional or both) and whispering niggles that pervade the recesses of the mind.
What if some zombies remained…
What if they reawaken…
What if they take control?
French Patisserie, gloss and glamour galore
It seems there is no easy solution. From the point of diagnosis we’re on the cancer conveyor belt. For some of us cancer is slow-moving and discovered early. Treatment, whilst challenging, typically doesn’t involve chemotherapy and its long-term implications for health – the risk of cardiac issues or a second malignancy at some point. There’s a very good chance people who discover a slow-moving cancer will go on to lead a long and healthy life.
For others the cancer is more aggressive, fast-moving and difficult to treat. Higher grade hard-to-treat cancers tend to affect younger women and several of these sub-types have greater propensity to recur. Many of my blogging friends have these kinds of cancer. For others still, the cancer has already broken free of its original starting point via lympho-vascular invasion. Many people are familiar with the concept of cancer spreading via the lymphatic system. It also spreads via the vascular system – our blood. Treatment for individuals with metastatic cancer is life long and although its possible to live with metastases for a number of years, the average is a meagre 26 months. During the life-span of this blog – 7 months – I’ve already mourned the deaths of cancer blog companions.
As Dr Suzanne Herbert stated in the 2011 article ‘A pink ribbon race, years long’ (NY Times)
While the pink-ribbon campaign has raised awareness about breast cancer, it masks a relentless killer. People like the pretty story with the happy ending… you always hear stories about women who ‘battled it’ and ‘how courageous’ they were. Cancer doesn’t care if you’re courageous. It’s an injustice to all of us who have this. There are women who are no less strong and no less determined to be here, and they’ll be dead in two years.
Despite ongoing discussion about the usefulness (or not) or mammograms and the associated potential for over-treatment, the fact remains that our ability to screen cancer is limited and our capacity to predict whose cancer will metastasise is, at present, totally inadequate. What is clear is that anyone who discovers inflammatory, or high-grade HER2 positive / triple-negative breast cancer will need treatment. These sub-types are not slow-moving and have a much higher propensity to break free of the breast to take up residence in bone or other organs. Unfortunately hormone sensitive, seemingly small and innocuous cancers can also develop zombie-like characteristics, reawakening years after initial treatment concludes.
For many – possibly the majority – of breast cancer patients the future is by no means certain. This disease can rear its ugly head again years or even decades later and there is no gloss or glamour when, as Dr Herbert puts it, a relentless killer is in our midst. 25 – 30% of breast cancers go on to become metastatic. Metastases are incurable. Personally, I’d rather risk over treatment now than take a ‘wait and see’ approach. In my case wait and see would severely curtail the remaining years I might expect on this planet. Cancer may go on to do that anyway but at least I and my loved ones know I went through treatment, lots of treatment, rather than leaving things entirely to chance. If I’d relied on the clear mammogram result in December 2011, ignored the small dimple and almost impossible to distinguish mass discovered in May 2012 the chances are that by December last year the cancer would’ve set up home elsewhere. Just twenty weeks after a clear mammogram, the cancer I discovered had already made its way into the surrounding lympho-vascular system and sat 1mm beneath the skin.
I support the view that women shouldn’t be afraid of their breasts, that confusion exists about the implications of DCIS and whether or not it will go on to become invasive hence its treatment is open to question. I agree that our current screening methods fall short in far too many instances and the sea of pinkness surrounding breast cancer trivialises a life-changing disease for those who are unlucky enough to be over-treated and for those who are unlucky enough to die irrespective of treatment.
Prevention is better than cure but since we know no means to prevent cancer at this time we are forced to rely on detection, treatment and attempts to cure, no matter how crude those processes may be. Cure does not equal relative five or ten-year survival in the eyes of anyone with breast cancer and whilst predicted ten-year survival is good, in my view it’s still not good enough.
||Relative Survival (%)
|*The ten-year survival rates have been predicted for patients diagnosed in 2007 (using the hybrid approach).
|Note: Survival for one and five years is for England only and for ten years is for England and Wales (Cancer Research UK)
The photo below on the left is one of my rare attempts at gloss and glamour – I was never particularly good at it but if an occasion arose I scrubbed-up reasonably well. This was an in-laws wedding, before the spectre of breast cancer entered my life. The picture on the right was taken yesterday 345 days into life in the shadow of breast cancer. Surgery, reconstruction and six rounds of chemotherapy have all come and gone and I’m still a cancer patient. Part way through herceptin, awaiting further surgery and possibly facing Tamoxifen for 5 years or more.
The events of the past year mean I rarely contemplate gloss or glamour for any occasion these days. Waking up each morning and reconvening herceptin (currently suspended due to side-effects) is excitement enough. The cancer patient look – moon face, spartan hair, a tiredness that’s etched deep into my eyes and skin – is also impossible to disguise, irrespective of gloss and glamour. Grit and determination have long-since become my only mantra. Without them I doubt I’d have reached this point whilst avoiding a major infringement on my sanity.
*Survival has improved for some, for others it could be termed lies, damn lies and statistics.
According to statistics from NCI’s Surveillance, Epidemiology, and End Results (SEER) program, the 5-year relative survival for women diagnosed with inflammatory breast cancer during the period from 1988 through 2001 was 34 percent, compared with a 5-year relative survival of up to 87 percent among women diagnosed with other stages of invasive breast cancers.
A 2007 study of more than 50,000 women with all stages of breast cancer found that 77% of women with triple-negative breast cancer survived at least 5 years, versus 93% of women with other types of breast cancer. Another study of more than 1,600 women published in 2007 found that women with triple-negative breast cancer had a higher risk of death within 5 years of diagnosis
Breast cancer treatments such as Herceptin that target a marker called HER2 have dramatically improved outcomes for women with this type of cancer. But nearly half of these cancers are resistant to Herceptin from the start and almost all of them will eventually become resistant. Research has shown that women with HER2-positive breast cancer have a more aggressive disease, greater likelihood of recurrence, poorer prognosis, and decreased survival compared to women with HER2-negative breast cancer.