Some not so good news

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!