Here's the news
Sarah has breast cancer. The cancer is in her left breast. It's aggressive
(grade 3) and invasive (stage II), but it has not spread, as far as anybody can
tell. After a lot of chemotherapy, a mastectomy (or two), and hormone therapy,
there's a very good chance that Sarah will be completely clear of breast cancer.
And the details
At the end of 2011, Sarah found a lump in her left breast. She'd had a lump
four years ago which turned out to be fibrocystic (benign), and the doctor had
mentioned at the time that such lumps would likely come and go, so she wasn't
terribly surprised. She had an OB-GYN appointment already scheduled for January
of this year, and at that appointment she mentioned that another lump had
arisen, and he sent her across the street (to the Baylor clinic, which is
staffed by doctors on the faculty of the Baylor College of Medicine) for a
mammogram, ultrasound, and biopsy.
The Baylor clinic's breast center is awesome. Sarah had the mammogram, then an
ultrasound, and then the head radiologist came out to repeat the ultrasound. At
that point she told Sarah that she thought the lump was pretty bad--likely
cancer. Essentially she gave Sarah the same speech, in pretty much the same
way, that Sarah so often has to give to her clients. They then went ahead and
performed two sets of biopsies. One set that was ultrasound-guided, and another
set that was x-ray guided (stereotactic). The results of the biopsies were that
she has a 3.5 cm mass of both ductile carcinoma in situ and invasive breast
cancer. Pathology determined that the cancer is Stage II (invasive) and Grade 3
(aggressive), and that it is strongly estrogen responsive and mildly
progesterone responsive.
Next, Sarah met with an oncologist at Baylor, had an MRI done of both breasts,
had a BRCA1 and BRCA2 genetic test performed, and had a fine needle aspirate
done of one of her lymph nodes. The oncologist at Baylor recommended three
months of chemotherapy (4 3-week cycles of AC), followed by a mastectomy,
followed by another three months of chemotherapy (4 3-week cycles of taxotere),
followed by five years of tamoxifen. The MRI found no cancer in the other
breast, and no enlargement of the lymph nodes. The genetic mutation test was
negative, as was the fine needle aspirate. As far as anybody can tell, the
cancer has not spread to the lymph nodes or the other breast, and hopefully no
where else as well.
Sarah then went to MD Anderson for a second opinion, since MD Anderson is one of
the best cancer hospitals in the country. The oncologist at MD Anderson had
Sarah repeat the mammogram and ultrasound done by Baylor, and also had the
pathology re-read, in every case coming to the same conclusions about the cancer
as Baylor. The MD Anderson oncologist then recommended a very similar
treatment: chemotherapy consisting of 12 weeks of weekly taxol infusions (taxol
and taxotere are both taxanes), followed by 4 3-week cycles of FAC (adding
another drug to the AC cocktail), followed by surgery, and then 5 years of
tamoxifen. The reason to have the chemo done before the surgery is that is then
possible to use the tumor's response to monitor the effectiveness of the
chemotherapy.
MD Anderson is a pretty big machine, but the people there have been really
nice, and in many cases these are the best people in their fields. Sarah is
therefore going to have her treatments done at MD Anderson.
More details
It's hard to wrap one's head around having cancer at age 37. Sarah's coming to
terms with it all, but it's really hard.
Sarah's health insurance is quite good. It's a PPO with co-payments for physician
visits, an 80/20 plan for surgeries, MRIs, and other big-ticket items, and a
$3000 out-of-pocket maximum. That means we can budget for the medical expenses.
The major financial impact of Sarah's cancer will be the fact that if she can't
work, then she doesn't get paid. Her practice has promised her that she'll keep
her job and her benefits, though, which is really good news. She's also going
to try to work as much as she's able. During the taxol phase of her treatment
she's planning to take a day off for the infusion, and the following day off to
rest, and then she's hoping to work a fairly regular schedule. The FAC cycles
will certainly take more out of her, so she's probably going to have to take the
first week off, and then work the next two weeks during that phase. Then she'll
have to take time off after surgery to recover.
While this is all going on Sarah will be able to ride, until her surgery, as
long as she feels up to it, but she won't be able to train or compete. That's a
real shame because Ronan has been getting much braver this winter, and Brook has
been just awesome.
Meanwhile, Sarah is riding until she has to stop, and she's started looking at
wigs. (Yes, she will lose her hair, although it will grow back once she's done
with chemo.) Her boss says Sarah has cancer, so she can wear whatever color hair
she wants!
