Surprising Things I learned about Breast cancer

Here are some of the more surprising cancer facts I learned:
a. Breast cancer does not kill, only metastasis kills.
b. Metastatic breast cancer is diagnosed in about 40,000 women in US, and kills most of them within 2-5 years. The statistics is even worse for most other metastatic cancers. More than 50% MBC patients presents with liver/brain/lung metastasis, sites with poor prognosis.
c. While millions of women are living with nonmetastatic breast cancer, only about 100,000-200,000 women are living with metastatic breast cancer (reason see b.). It qualifies metastatic breast cancer as an “Orphan” disease (if early breast cancer is a different disease)
Metastatic breast cancer drugs are often drugs originally targeted to other metastatic cancers. But most drugs are effective for 10%-30% of patients, and only for months.
d. New cancer drugs (even old cancer drugs that are tested for different cancers) takes >10 years to go from lab to clinical trials phase I-III and final approval.
e. Phase III clinical trials costs about $100,000 per patient and needs about 500+ patients to sign up.
f. Some patent-expired drugs with very good safety profile may be effective for cancer treatment (metformin, beta blockers, chloroquinine). However little money is available to take them through all phases of clinical trial.
g. Subtypes of breast cancers may respond to different chemo drugs completely differently. Hormone receptor/Her2 are very important classifications, but there is no reliable way to predict drugs targeting other pathways.
h. There is a shortage of metastatic patients signing up for clinical trials (reason see c. g.).

Ultimately no one “survives” cancer, even early breast cancer. Unless there is a cure.

Baby is born

My baby was born early November 2011. At the delivery, after 2 doses of AC, I have lost about 2/3 of my hair, all my new grown nails were a shade of grey, I was neotropaeic and had neupogen shots. But Andrew was born with full head of hair, and his nails were pink. In the 3 months since his birth, he was healthy and completely normal in development.

It's a big relief to me, and hopefully to other women in similar situations as I was in. The decision to chemo during pregnancy is not a walk in the park, but as far as I can tell, AC chemo does not cross placenta in significant amounts.

Big thanks to Dr Cardonick from Cooper Hospital has a registry running about pregnant women dxed with BC. She helped me make AC decisions and gave me a lot of online support.

http://pregnantwithcancer.org/

Revenge of the Killer Boob

The saga really started almost 2 years ago. November 2009, I noticed a lump in 10 oclock left breast. It seemed to have grown fast, I had it ultrasounded/mammogrammed. It was determined to be a harmless fibroadenoma. 2 month later, I noticed it had almost doubled in size, so I had it ultrasounded again, and confirmed its size increase to triple size and 4cm in the longest dimension. Putting it to top 1% of fibroadenoma in size and growth rate.

At that point, I had a lumpectomy to remove it and pathology return benign. Not comfortable with a fast growing and big tumor in my breast, benign or not, I asked for a prophylatic bilateral mastectomy and was told to essentially seek psychological counselling instead. Multiple oncologists concurred. I was comforted by their consensus and started to put this worrying episode behind me.

Feb 2011, I became pregnant with my second child. The pregnancy was uneventful until midway, I started to feel another lump at 11o'clock left breast. I was not worried and assumed it's pregnancy related. Until again, I noticed it seemed to grow fast, doubling in size in about 4-8 weeks. At around 28 weeks, I had it checked out with ultrasound, followed quickly by biopsy. Result came back: IDC, ER+, PR+, HER2-, grade3, Ki-67 (20-30%).  5 year recurrence rate 10-15%.

I was in shock and rushed to lumpectomy with sentinel guided lymph node removal. The sample was sent off to oncotype DX. results came back: lymphovascular invasion, isolated tumor cells in the 1 sentinel lymph node removed. Ki-67(20-30%) Her2-, ER+/PR+ (both just made the cut for oncotype positive).

So I was 30 weeks pregnant at this results. I had the following choices:

1. 2 doses of AC chemo starting 31 weeks, with baby onboard. C-section delivery at 37-38 weeks, 2-3 weeks after that the rest of dose dense AC-T

2. wait for baby to be delivered at 37-38 weeks then start dose dense AC-T after 2 more weeks.

3. deliver early at 34-35 weeks, then 2 weeks later start dose dense AC-T

option 2 did not sit well with me, given that I know my previous tumors both doubles in size in 2 months. option 3 risks baby's health. option 1 has been the standard of care for 10 years, even though there are not much data on its impact on baby's long term health.

I chose 1. Made a promise to baby: if he stays and chemo with me, I'll give him extra weeks to cook. Then I prayed for him and for me. Tomorrow I'll meet him for the first time, but already I feel we have been through a lot together.