Statistics and Breast Cancer

According to the Northern California Cancer Center (http://cancer.stanford.edu/features/research_news/nccc-report.html), rates for breast cancer in all races/ethnicities have declined since 2000, and more dramatically since 2003. Among white women in Santa Clara County, the rates are 154 per 100,000 women.

I recently learned that I'm one of the 154.
With no family history of breast cancer, no personal history of smoking, a lean body type, successful nursing of my first child for more than 3 years, and a vegan diet for more than 20 years, I never expected to fit into that statistic. According to the American Cancer Society, my risk factors are that a) I'm female and b) I gave birth to my first after age 30.

Yet, with all of that, I now find myself with T1c cancer, meaning I'm Stage 1, but the cancer is invasive and the largest of the tumors is over 1cm. At the end of September I'll be having a mastectomy and sentinal node biopsy.

I suppose I should back up. I've been having mammograms every year for the past 5 years, ever since one doctor felt a little lump in my left breast. It turned out that the left breast was fine, but the right breast had a small bit of microcalcification. So, every year after that, I had a mammogram and the radiologists would check the 2002 films to confirm no changes. There never were any, until this June.

Following my annual mammogram, I was called back for more views, ultrasound and 3D ultrasound of both breasts. During that visit, the radiologist looked at everything and said he'd like to look at it a bit more closely and would send a report to my gynecologist. A week later my gynecologist 's nurse called me to say that the radiologist called their office and left a message, which he apparently never does, so it would be a good idea to meet with a surgeon to see if a biopsy was needed. When I met with the surgeon 2 weeks later, it wasn't a question of "if" but "what kind" of biopsy would be done.

On August 7th, my 41st birthday, I had an excisional biopsy of my right breast. At the end, I asked the surgeon how it looked and she replied, "mostly ok". With that noncommital response, I decided to just try not to think about it for the next 7 days until the results came back. The surgeon's office called 2 days after sugery asking me to come in the next day with my husband. So much for the "mostly".

The initial pathology was optimistic. Very early stage 1; 3 very small tumors, all DCIS (Ductal Carcinoma in Situ). It could be resolved with either breast conservation surgery and radiation, or mastectomy with no further treatment. The surgeon assured me it was 100% curable and to just spend the next few days thinking about which surgical option would work best for me. She expected the final pathology to come back the next week.

The final pathology came back almost 3 weeks later, and things have changed a bit. There were no clean margins in the biopsy, meaning the whole 2x2x1 inch tissue sample was cancerous. The cancer is not only DCIS, but also IDC (invasive ductal carcinoma) and the largest of the 3 tumors measures 1.1cm. This all means that mastectomy is the only surgical option, and I will be having a biopsy of the left breast on August 30 to see if it will be a double or single. It also means a sentinal node biopsy during the mastectomy. Following the mastectomy, I'll meet with an oncologist to go over the remaining treatment options which, at this point, appear to be: Chemo, Tamoxifen, and potentially some other hormone blockers (adjuvent therapies).

So there we are. Random breast cancer.