Notes to My Family: November 10, 2010

Hi Family,

As most, if not all, of you know by now, almost 3 weeks ago I was diagnosed with Ductal Carcinoma In Situ (DCIS), which is considered Stage 0 Breast Cancer.

This means that from what they can tell from the stereotactic core biopsy, the cancer is trapped in place in the milk ducts and is not moving or growing.

That said, they don't know exactly how often this condition becomes an invasive cancer (they think it may be up to 50%); therefore, it must be treated. It is found, diagnosed & treated in the same ways as invasive cancer.

In my case, at the end of September, the nipple of my left breast began bleeding. My gynecologist felt almost certain it would be nothing serious but just to be thorough she took my blood, prescribed my first ever mammogram (good times!...NOT) and a sonogram, and referred me to a breast surgeon. The mammogram showed extensive suspicious microcalcifications throughout the entire left breast, which prompted the referal for a biopsy...and thus kicked off this journey I have only begun on.

If you haven't already noticed: there is no lump! There is not always a lump when you are talking about the earliest stage of breast cancer. Very important! That bloody discharge was the key and probably makes me a very lucky girl.

As I said, the microcalcifications are very extensive and cover the entire breast, from top to bottom, front to back. This means there is no way to get them all out and conserve the breast. Therefore, I will be undergoing a unilateral mastectomy of the left breast, with immediate implant reconstruction.

Given my young age, lack of family history & healthy lifestyle, I was approved for genetic testing, to see if I had a mutation of the BRCA 1/2 genes. The test came back negative. This is good news for our family. That said, they believe there are breast cancer-causing gene mutations out there that have yet to be discovered.

The cancer is ER/PR+. That means that the cancer cells are sensitive to estrogen & progesterone (naturally occurring in the body), which will help them grow. The treatment for this is to prescribe Tamoxifen, a drug that blocks the hormone receptors on the cancer cells so that they can't get access to the hormones. This is given to reduce the risk of recurrence or a new cancer. Generally you take Tamoxifen for 5 years. While you are on Tamoxifen pregnancy is to be avoided. If we felt strongly that we wanted to have children sooner than 5 years from now, it may be possible to stop the drug after 3 or 4 years, given that you do benefit from each year you are on the drug; however, given my young age & all the years I have to live & possibly get a recurrence or new cancer, it's probably best to do the full five years.

Radiation may or may not be required after my surgery.

Surgery will be on December 2nd at Lenox Hill. It takes up to a week to get back the pathology from the surgery and find out the extent of the cancer. Let's hope they don't find any thing else. I am also having a sentinel node biopsy, where they biopsy just the first 2-4 lymph nodes in the armpit area. So, let's hope for clean nodes and no invasion in the breast tissue!

I wanted to make sure everyone had the basic information, at the very least to add to your records of your family medical history.

Check to see if I got any emails wrong or left anyone out. I'll try to keep everyone updated.

Love you all!,
Diane :)