BRCA 1 & 2 Testing

A new test for the BRCA 1 and 2 genes that is easier and cheaper--and more accurate--was announced this week.

http://www.nytimes.com/2015/04/21/business/more-accurate-affordable-tests-for-detecting-breast-cancer-genes.html?smid=nytcore-ipad-share&smprod=nytcore-ipad&_r=0

I'm glad to hear this.  I tested negative for the genes, as did my sister, but we were worried because three paternal aunts had breast cancer, and one died of ovarian cancer.

Geneticist Mary-Claire King of the University of Washington has called for this test to be available to all US women over 30 yrs. of age.

When Cancer Is Not a Dance

Sometimes cancer is not a dance.

Instead of calling you to a long, slow waltz, it assaults you--a knock-out punch to the head.

You stumble back to your feet, but it grabs you from behind, spins you, throws you across the room.

You hit the wall and collapse.

You find yourself in the hospital, not receiving care but lying with bony hands around your throat, unable to swallow, finally unable to breathe.

                                                  --in memory of a friend who died April 17, 2015.

Rest in Peace: Laurie Becklund

After the lumpectomy, after the radiation, we are told to take an anti-estrogen pill daily for five years, and then we are pronounced "five-year survivors."

"Have a nice life," Laurie Becklund's doctors told her at that point.

The part they don't stress is that one in ten of us still has micro-metastases after our treatment and will develop problems with cancer later.

Laurie died of metastasized breast cancer on Sunday, Feb. 8, 2015, exactly two weeks ago.  Her breast cancer had returned 13 years after her first diagnosis in 1996, and she lived almost six years after it returned.  

Today her family and friends put on a five-star memorial service, which my husband attended.  (I choose to attend my usual monthly Women-Church liturgy.)  She was an award-winning reporter for the Los Angeles Times and had written several books.

Here's the final piece Laurie wrote, "As I Lay Dying," which appeared on a full page of the op-ed pages today in the Los Angeles Times.

http://www.latimes.com/opinion/op-ed/la-oe-becklund-breast-cancer-komen-20150222-story.html

William Faulkner never imagined that his novel, As I Lay Dying, would bear such strange fruit.

Laurie was born in 1948, as was I.  

She applied to be part of Stanford University's freshman class of 1966, but she was turned down.  The foolish selection committee still goes for students who have 1) achieved in sports, 2) held offices in high school government or edited high school newspapers or yearbooks, 3) achieved in music or the arts --in addition to having 4.0 grades.  

Instead of Laurie, the committee chose me and my neighbor Shelley Surpin, now an entertainment lawyer; neither of us did anything particularly noticeable with our talents, unlike Laurie.  Perhaps they chose me because they needed a few from Bakersfield and the San Joaquin Valley.  Laurie came from the San Diego area, where there were many qualified applicants.  

Note about The Ratio: one-third of the entering students were female.  Two-thirds of the seats in the class went to males.  If Stanford had not been such a sexist place, as well as sports-ist, Laurie would have entered the class.

Instead Laurie earned her BA from Immaculate Heart College in Los Angeles, run by a group of nuns who took the Vatican II direction to heart and soon shed their habits and their subservience.  Cardinal McIntyre tried to squelch them by shutting down donations to the college, which had to close.   

 http://en.wikipedia.org/wiki/Sisters_of_the_Immaculate_Heart_of_Mary

Pat Reif was among them, an activist for civil rights, against nuclear weapons, and for peace.  She later founded a master's degree program in feminist spirituality at Immaculate Heart College.

http://articles.latimes.com/2002/mar/28/local/me-reif28

In this environment, Laurie flourished.  She learned activism and advocacy for women.  It's not surprising that she went much further than the sweetie-pies who went to Stanford in 1966 and married a classmate, as did I.

Laurie went to Columbia School of Journalism and did important work for the LA Times.  She didn't marry until age 32.  

Her reporting exposed the government death squads in El Salvador in the 1980s.  

http://www.latimes.com/local/obituaries/la-me-laurie-becklund-20150210-story.html

Laurie, the trajectory of your life and that of mine crossed in several ways.  Our husbands both worked at the LA Times--and you too were among those talented journalists.   

Our lives both were touched by the Immaculate Heart sisters.

You had one daughter (wise in just one), while I had three.

Breast cancer entered your life in 1996 but waited until 2014 to enter mine.

You wrote several books as I edited just one (the reverse of our daughter totals).  You were a much better reporter than I.

You died this month from metastasized breast cancer; I still live.

Cancer may get me in a few years, or maybe my end will be with Alzheimer's disease.

The important thing is that we were each created and loved by God and did our best to serve our Maker.

We both strove to answer the question posed by Evelyn Underhill in her book The Spiritual Life:

...what function must this life fulfill in the great and secret economy of God?

Checkpoint Inhibitors

I didn't realize that my own body has ways of fighting cancer.

T-cells attack and kill many invading cells, including cancer cells, but some cancers have a way of telling T-cells to go away.  

Doctors at Johns Hopkins University and elsewhere have developed a way to block the chemical reaction that sends the T-cells away.

Listen to this report today on NPR News:

http://www.npr.org/blogs/health/2015/02/09/373292216/harnessing-the-immune-system-to-fight-cancer

Triple Negative

A friend just got a diagnosis of breast cancer and had her lumpectomy on Wednesday. 

Today, five days later, she's a breast cancer survivor and probably on her way to a full recovery.

 

Good news: her lymph nodes (those that drain the breast, called sentinel nodes) were not involved! 

The margins around the removed tumor looked good too.  Yay!

With those two factors and with God's help, I think she has this beat. 

The bad news is that the cells of her tumor test as triple negative: no estrogen receptors, no progesterone receptors, and no overproduction of the Her2 oncogene.  

Cells of this type are very fast-growing, but chemotherapy really knocks them out. 

I've met women who have 20-30 years survival after Triple N.  

Note: you make friends with a lot of cancer survivors after a breast cancer diagnosis.  

The book I find helpful:

 The Breast Cancer Survival Manual, 5th ed., by John Link, MD (NY: Holt, 2012). 

Scary statistics

The American Cancer Society posted its estimated statistics on new breast cancer cases for 2014:

...estimates for breast cancer in women in the United States for 2014 are:

• About 232,570 new cases of invasive breast cancer
• About 62,570 new cases of carcinoma in situ (CIS) of the breast will be found (CIS is non-invasive and is the earliest form of breast cancer).
• About 40,000 deaths from breast cancer
• Breast cancer is the most common cancer among women in the United States, other than skin cancer. It is the second leading cause of cancer death in women, after lung cancer.

http://www.cancer.org/cancer/breastcancer/overviewguide/breast-cancer-overview-key-statistics


It's scary to be one of the new cases--but I'm grateful that it was discovered at Stage 2 and that I am not one of the 40,000 deaths from breast cancer.

At least not this year.

Now It's Stage 2

Today I went to pick up my Survivorship Resource Binder called Life after Breast Cancer: Easing the Transition.

It was a gift to me for agreeing to be in a study of cancer survivors and reporting on my physical and mental state of being one month after completing radiation treatment (and agreeing to report again six months later).

I finally finished the 10-12 questionnaires and went in to pick up the binder.

The person who gave it to me pointed out the key pages summarizing my case and titled "Cancer Survivorship Care Plan."  They had been written by my doctor a few days earlier.

"Tumor type & stage: Invasive tubular carcinoma, T2"--not a surprise.

But the next line said, "Pathologic stage: Stage II (Early cancer with a good prognosis."

"Stage 2?" I asked.  "I thought it was stage 1."

"No, stage 2," she confirmed.  Like me, she was reading what the report said.  She hadn't written it.

"I didn't know that," I said.

She moved on to review the rest of the treatment plan and then presented the entire printed binder to me.

I accepted it graciously, but afterward in the car I read and re-read the summary of my case.

Stage 2?

"When were you going to tell me this?" I wondered.

Would I ever have known this if I had not agreed to be in the study and received this nice binder?

Stage 2 seems a lot scarier than Stage 1.  I had been so confident all summer because it was "just stage 1."  

I sat in the car and cried.  

What if the doctors at Women's Imaging Center had not suggested an ultrasound after the mammogram?  Was it Dr. Iyengar or Dr. Jabour who made that call?  

What stage would the cancer have been if it had not been discovered until February of 2015?

I will never know the answer to these questions.  My brush with cancer was closer than I thought--and who knows, I may still have some cells of that cancer somewhere in my body, growing and multiplying. 

Studying my books on cancer afterward, I realized that probably the length of the cancer removed was the cause of the change of the estimated stage.  

It was not quite 5 cm long--almost two inches--not the smaller size estimated before surgery.  Probably the stage had been revised to Stage 2 just after the surgery, but no one had told me.