Breast-Conserving Surgery & Recurrance

"One in five British women who have breast-conserving surgery require a reoperation."

http://www.latimes.com/news/science/sciencenow/la-sci-sn-breast-conserving-surgery-20120713,0,647297

www.latimes.com

I had an inner red flag go up when I was offered lumpectomy vs. mastectomy. The stats say longevity is the same, but there is a slight risk of recurrance with breast-conserving surgery. After two lumpectomies, it was discoverd that I had a second form of breast cancer that was "wide spread" in the same breast with the invasive tumor.  Once I had the bilateral mastectomies, the pathology showed atypical cell changes in the non-cancerous breast.  It looks like I surely would have been one of the recurrance statistics and it might not have been that long before recurrance would have reared its ugly head.  The MRI was not helpful in detecting the wide-spread ductal in situ cancer during my decision process for lumpectomy vs. mastectomy. Am I just an odd duck (don't answer that) or should we be trying to find a way to identify the cancers like mine that are lurking in the shadows, likely to recur, so those women can go straight to mastectomy? I am thoroughly content and even grateful that I decided to hack off  both the offending parties that were gearing up to have a cancer fiesta and kill me!  It would not have been worth it to me to have my breasts an extra six months or a year and half before facing another biopsy or more surgery.  It would have been an unnecessary burden to live with the thought that more cancer could be growing and spreading to my lymph nodes or anywhere else for that matter.  Doctors cannot guarantee that recurrance will be caught before metastasis happens.  I know that my mind is more at ease with my decision, despite having to live with the consequences of losing my breasts.  I still stand by my blog post, "The Tenth Circle of Hell," which identifies the choices and decisions faced by a newly diagnosed woman with breast cancer as those among the most gruelling mental tests in life.  My heart goes out to all who have to wear those shoes.  We need to come together to create a user-friendly, critcal-thinking algorithm to assist our breast cancer sisters in discerning what path to take for their unique situation.

HURRAY for the AMA!

In 2009, the US Preventative Services Task Force recommended that routine mammograms start at age 50 instead of age 40.  It is easy for me to remember how livid I was when I heard this because I still feel the same way.  If I had waited until I was fifty to get a mammogram, my two kinds of breast cancer would have surely metastasized before being discovered.  Thinking about that makes me feel expendable in the eyes of the federal government.  Subjectively, I seem to know of a lot of women under the age of 50 with breast cancer.  I have to ask, "Why don't our lives count?"

My family history is not considered "high risk," which would trigger earlier screening.  I would have never found the invasive tumor tucked up by my chest wall, nor the widespread ductal insitu on self-exam. In fact, after the tumor was identified, chipped and "wired" for sentinel node testing pre-op, a second mammographer took three tries to locate the tumor to verify wire placement.  Scary, I know, but that is why I credit my mammographer, Lori, at Legacy Meridian Park Breast Health Center with saving my life.  Her expert gathering, tugging and stretching revealed the little bastard when others might have easily missed it.  Because of Lori's commitment to excellence, I sit here today, writing to advocate that others be given the same chance for early detection as I was given.  

The good news is that the recommendations triggered a firestorm of disagreement, with the American Cancer Society and other physician associations voicing support for mammograms for women under the age of 50.  Now the American Medical Association has taken a strong stand regarding USPSTF recommendations which also include prostate screening for men.  I am most grateful to the AMA for their involvement.  With their clout, combined with the strong voices of other clinicians, American men and women will not be restricted to USPSTF guidelines which could limit access to screening and ultimately save lives.

As a side note, last year while watching the evening news, I happened to see Providence and Legacy cancer services television advertisements back-to-back.  The Providence Cancer Institute ad was first and a physician spoke about cancer care and screening and stated that they recommend mammograms starting at age 50.  Just as my blood began to boil, the Legacy Health ad started with our spokesperson recommending mammograms at age 40.  My boiling blood dropped to lukewarm and I was pleased and proud to know that I had chosen the right team!

---

Putting Breaking Medical News Into Practice

33353

AMA Bucks USPSTF on Mammography

By Emily P. Walker, Washington Correspondent, MedPage Today

Published: June 19, 2012

Take Posttest

CHICAGO -- The American Medical Association's House of Delegates has come out in support of screening mammography for women starting at age 40.
The new policy is in conflict with the controversial 2009 recommendation of the United States Preventive Services Task Force (USPSTF) that routine screening mammography for breast cancer was unnecessary in women younger than 50.
The House of Delegates stopped short of recommending that "every woman should get routine screening mammograms every year starting at age 40." Strongly debated in Tuesday morning's session, that language was rejected by the delegates in favor of a lighter "should be eligible" phrasing.
In a further slap at the federal task force, the House of Delegates voted to adopt a resolution stating that the AMA "expresses concern regarding recent recommendations by the USPSTF on screening mammography and prostate specific antigen (PSA) screening and the effects these recommendations have on limiting access to preventive care for Americans."
The firestorm that followed the USPSTF recommendations attracted congressional attention from legislators, and HHS Secretary Kathleen Sebelius eventually issued a statement emphasizing that the USPSTF does not set health policy.
A number of medical groups, including the American Cancer Society, the American College of Radiology , and the American Congress of Obstetricians and Gynecologists disagreed with the USPSTF recommendations and said women younger than 50 benefit from having routine mammograms.
The USPSTF again set off a controversy in 2011 when it said that healthy men do not need prostate cancer screening with prostate specific antigen (PSA) because the test does not save lives and often leads to unnecessary testing, interventions, and treatment. The conclusion came after the USPSTF reviewed data from five large randomized clinical trials of PSA testing, which all found found no mortality benefit among men who underwent screening PSA testing and were followed for 10 years.
The PSA recommendation has been controversial in the medical community, especially after a major European trial showed routine testing in healthy men resulted in about a 21% reduction in the rate of prostate cancer deaths after 11 years of follow-up.
In both instances, speciality medical societies were not happy that they weren't involved in drafting the cancer screening guidelines, and on Tuesday, the AMA adopted another policy encouraging the USPSTF to implement procedures that "allow for meaningful input" from specialists.
The USPSTF is an independent panel 16 volunteer members, most of whom are clinicians in primary care or preventive medicine.

---

Take Posttest

Emily Walker
Washington Correspondant
Emily P. Walker, MedPage Today Washington Correspondent, covers Congress, FDA, other health agencies in Washington. She also covers an array of healthcare events in the nation’s capital, focusing on intersection of policy and medicine. After earning a BA in journalism and political science at Western Michigan University, she worked at the Kalamazoo Gazette, Congressional Quartely, and wrote for several medical newsletters.

The Chemo Fairy

The Chemo Fairy made her debut in spring 2011, when my friend Diane, yet another breast cancer"victim,"  was nearing the end of her chemo treatments.   I wanted to celebrate her last chemo appointment by arriving in a goofy pink outfit with giant boob cakes to share.  To make use of my recent "rack vacancies," I stuffed the bra with pink ribbon mints and breast cancer bracelets to hand out to everyone.  We had so much fun, I knew the Chemo Fairy would certainly make future appearances.  That is when the outfit began to evolve.

Dr. Olson joined the fun.  He is an awesome oncologist, wonderful human being and an all around good guy!  It says a lot when nurses choose him if they get cancer.

Anybody want a mint or a pink bracelet?

 Diane, an endoscopy nurse, has an equally warped sense of humor.  A month later, "What goes around, comes around," proved true when she showed up to my first colonoscopy dressed as the "Colon Fairy!"  Yes, she had goofy glasses, rubber gloves and came bearing a "colon cake" complete with anatomical details, including a polyp!  What a nut!  Because I was polyp-free, she presented me with a blue "clean colon" ribbon that hangs in my bathroom to this day!

Tiffany is surprised by the Chemo Fairy at her last Chemo in June.  She is a true Chemo Warrior and did better than I did during Chemo.  Part of it is that she is younger, cuter and thinner than I am, but I don't hold that against her!  I had orderd new fairy costume components for Tiffany's day, but alas they did not arrive in time.  I substitued a short tutu with my new "liquid metal" hot pink leggings which kept sliding off my backside whenever I bent over.  Unplanned comedy...anything to cheer up the chemo lounge!  After I was done yucking it up with all the patients and "blessing" them with my wand and handing out boobie cakes, I flitted out the door in a less than graceful fashion, tugging at the back of my hot pink leggings to keep my underwear covered.  Apparently, after I left, a patient asked, "Does the Chemo Fairy come every week?" 

By the time Louise's Cancer Birthday Bash came around a week ago, all the pieces were here and so, this is as good as it gets!    Loise used her party to raise cancer awareness, promote local bands, collect food for our food banks and auctioned off donated items to raise money.  The entire event was terrific, just like the lady who planned it! 

The Chemo Fairy doesn't want to keep all this fun to herself and would like others to join the Chemo Fairy Club and share photos of your exploits and outfits. 

A great and inexpensive place to buy pink ribbon mints that are individually wrapped, pink silicone bracelets, ribbon lapel pins and rolls of pink ribbon stickers is at orientaltradingcompany.com. 

I got my wig and hot pink eyelashes at candyapplecostumes.com, very affordable and great service. 

My tutu was custom made by "lil tutu princess" on Amazon.com.  She added a row pink ribbons with rhinestones all around the waist! 

The leggings came from onlyleggings.com.  They were the only ones I found to have sizes in the hot metallic pink leggings up to 3XXL.  I suggest you order larger than you are to avoid my "mooning" problem.

I got my pink hightops from Zappos.com...love them. They do run big so don't buy over your usual size.

I picked up my wings at a dance store (for ballet and square dancing) as well as the first short tutu. 

I have made pink cupcakes using a stawberry cake mix, frosted them with cream cheese frosting, then topped them with a watermelon candy ring stuffed with either a cherry sour ball or a raspberry gumdrop.  Everyone loved the Boobie Cakes!  I have also purchased a ribbon cake pan and a ribbon cookie cutter. 

Those are my ideas and I would love to hear yours!