Everything from this point on is optional, but there's optional, and then there's optional. When your radiation oncologist says that it's up to you whether to do radiation, and that there's no firm data on the likelihood of recurrence, but breast cancer recurrence used to be 40%, and now it's probably less than 10%, though there's really no hard data on that (too many variables, not enough studies), but *regardless*, radiation therapy should knock down whatever it is by half to two-thirds, you take that seriously. (Yes, it took me a moment to parse all those numbers, but basically, let's say the chance of recurrence is 10%, then radiation therapy would knock it down to 3-5%. I like those odds better.)
They're going to call me Monday to schedule the set-up appointment for the radiation, probably at the end of next week. Apparently, I get three tiny tattoos on my breast as part of the process -- dots, basically, to mark relevant location for targeted radiation. It's not as sexy as it sounds. (If I were ever vain about my breasts, I've had that knocked out of me by now. The poor things definitely look like they've been around the block a few times!)
Radiation will be every weekday (they say to allow about half an hour at the hospital, though the actual procedure is just a few minutes) for six weeks, so I should be done with it right around Thanksgiving or a bit after. Fatigue (cumulative) is the main side effect, although apparently I will also have a noticeable tan on that breast. Which I find kind of funny.
And then after the radiation oncologist, you meet with the medical oncologist, and she says it's up to you whether to do a year of Herceptin, but she strongly advises it, because it comes with *another* 50% recurrence reduction. And you say okay, let's go with that. Can I handle going in once every three weeks for the next year to get poked in the port and then sit in the infusion chair for a few hours? If you'd asked me a month ago, I might have said no, because I was so sick of it by then -- but I've had a bit of a rest, and am feeling more stalwart. Especially since it turns out that what I had before was Herceptin + a kind of chemo, and this will be just Herceptin, so should have even fewer side effects -- I might not notice any, in fact! I think I can handle it, so Herceptin is on. First appointment is next Friday.
But then some parts are less clear. Standard of care says that I need to be offered Taxol, which is another kind of chemo. But we talked over a bunch of specifics about my particular case (how my cancer responded to the prior drugs, success of the surgery, etc.), and we both decided we're fine with skipping that one. I am very glad to be done with chemo (and this also means I can start radiation right away, rather than waiting to be done with the Taxol). Chemo isn't nearly as bad as it used to be, thanks to the much improved anti-nausea drugs, but I wouldn't call it fun.
And it turns out that while I am basically forbidden from getting a hormonal IUD again, it doesn't really matter, because she strongly recommends my starting ovarian suppression therapy (because ovaries pump out a lot of hormones, and my cancer is the kind that's very susceptible to those, if I'm understanding right). It means a shot once a month, for, oh, the next ten years or so, until I would be old enough to be expected to naturally be in menopause; it's basically artificial menopause.
Am I thrilled about getting a shot once a month for the next ten years? No. Am I happy to be done with periods? Gods, yes. If cancer weren't a factor, would I take that trade? I'm not sure -- I might, actually, because I really hated dealing with periods that much. But cancer *is* a factor, and this lowers the chance of recurrence even more, so while I have a week or so to think about it and research a bit (because I haven't really looked into this part at all), I probably will go ahead and start that too.
It's interesting, trying to balance the value of time-consuming / painful / tedious medical procedures against a somewhat unknown risk of recurrence. It'd be nice if there were a magic device that would just pronounce me CURED, and tell me (and my doctors) that we didn't have to bother with any of this. But while science may be an exact science, our understanding of it is not that actually all that exact yet. We take all the information we have, we make the best decisions we can. Prepare for the worst, hope for the best, roll the dice and see what happens.
There are days when I look at my silver hairs, when I feel the creaks in my body when I get out of the chair I've been sitting in too long, when I remember that my grandparents died in their 60s, and at 44, I feel old. And then there are other days when I remember that one great-grandmother lived to be over a hundred, and I have her genes too, along with much better nutrition and medicine than she had access to. I remember that I've only been a grown-up for a little over two decades, and I might have six more decades of adulthood to go. And I feel very young indeed.