After my first meeting with the breast surgeon, I met with an oncologist to discuss a treatment plan. It was information overload! Cancer is like a parallel universe — a whole other world with it’s own language and unfamiliar concepts. I had to quickly assimilate all the information in order to understand how the cancer would be treated.
Not all of it made sense at first. I admit that I had to just trust the oncologist at times and proceed with his recommendations. However, I’ve never been one to simply let things happen to me. I need to feel a modicum of control, and being informed always helps with that. I began reading about breast cancer and carrying a notebook where I take notes and write down all my questions as they come to me. Then, I can ask the doctors during office visits. If I don’t write it down, I am bound to forget.
I know. There are probably a dozen more modern and sophisticated ways to take notes using smart devices, but a notebook works for me.
I’ve been learning about breast cancer for almost a year now. I’ve come across many articles that clarify how breast cancer happens and debunk myths about risk factors, but I haven’t seen much in terms of misconceptions we might have about how breast cancer is treated. Below are four areas where I had the wrong idea about breast cancer treatment.
But first, I must share this cartoon with everyone. It reminded me of my seven year old son who thought I was an X-Men mutant when I tried explaining cancer to him. He always asks a million questions (like his mama), and I always get myself in trouble providing answers!
Misconception #1: Cancer is only treated with chemotherapy.
Actually, there are various types of therapy available to treat cancer. In my case, each part of the treatment would target a particular characteristic of the cancer or it would attack cancer in a specific location. The oncologist recommended that I get chemotherapy, Herceptin, surgery, external radiation (possibly), and Tamoxifen.
The chemotherapy’s job is to target rapidly dividing cells anywhere in the body. It is considered a systemic treatment because it’s not limited to the affected area in the breast. It works all over your body, but it can’t discriminate between cancerous and healthy cells. This is why some chemo drugs have undesirable side effects such as hair loss and irritation of the linings in the stomach and mouth.
Herceptin is a targeted therapy that affects mostly cancer cells and is less likely to harm healthy cells. This drug binds to the HER2 receptors on the cancer cells so that they don’t receive growth signals. It also tells the immune system to destroy cancer cells to which it is attached.
External radiation is a localized treatment that targets cancerous cells in the affected area using a radiation beam. The beam damages a cell’s DNA so that it cannot divide or repair itself. Rapidly dividing cells are most affected by radiation but other cells in the line of the beam may also be damaged.
Tamoxifen is a hormonal therapy used with estrogen receptor positive breast cancers in premenopausal women. They have different drugs for postmenopausal women. Tamoxifen binds to the estrogen receptors so that the estrogen cannot stimulate cancer cells to grow.
I would end up getting all of the above except the radiation therapy. I got six cycles of chemotherapy through an IV, with each cycle given every three weeks. The Herceptin is also administered through IV every three weeks but for an entire year. I’m still on Herceptin, and my last infusion will be on November 6. Hooray!! The Tamoxifen is a pill that I take daily for the next ten years.
Misconception #2: If my PET scan shows no evidence of metastatic breast cancer, I won’t need chemotherapy.
Before beginning chemotherapy, I had to get a PET scan to see if the breast cancer had spread to other parts of my body. To perform the scan, they injected me with radioactive glucose. Since quickly dividing cells feed on glucose, areas of your body that are taking up the glucose light up on the image. By the way, after my scan, they told me that I was radioactive and that I should stay away from kids and pregnant women for at least six hours. Yikes!
According to the PET scan, the cancer had not metastasized. For a quick minute, I thought that maybe I could just have the mastectomy and be done with everything. After all, the cancer had not spread elsewhere, and the purpose of the chemo is to attack cancer cells all over your body. The oncologist quickly burst my bubble of hope, pointing out that the PET scan would pick up focal points of cancer but not small clusters or rogue cells that may have escaped. Since my cancer was HER2+, it was considered aggressive and very possible that there were undetected cancer cells circulating somewhere in my body.
Misconception #3: All chemotherapy is created equal.
I thought that chemo was chemo whether you had breast cancer, lung cancer, ovarian cancer, etc. In fact, there are lots of different chemotherapeutic drugs, and doctors mix and match them to better target your cancer. My little cocktail was TCH, where each letter stands for a different drug. The H is for Herceptin, which as I mentioned above is actually a targeted therapy. The T and the C designate the chemotherapy drugs Taxotere and Carboplatin, respectively. Taxotere targets quickly growing cells in a particular phase and stops them from dividing. Carboplatin damages the DNA of quickly growing cells, regardless of the phase they are in, so they cannot divide.
Great…I was having not one but two chemo drugs, each with it’s own set of side effects. At least this treatment would find every little cancer cell and destroy it. Right? Well…no, maybe not.
Misconception #4: The chemo drugs will kill each and every cancer cell in my body.
Chemotherapy only attacks actively dividing cells, but some cancer cells could be in a state of rest. That’s why they give you various cycles of chemotherapy — to try and catch cells that may have been dormant during the previous cycle. Unfortunately, you can’t have chemotherapy for an extended period because the drugs are very toxic.
It’s possible that I still have cancer cells lingering in my body, but the hope is that they will die off on their own or my immune system will get rid of them. Also, the hormonal therapy (Tamoxifen) should help keep any remaining cells from multiplying.
Understanding each of these points was so useful to me. I don’t like putting unnecessary drugs in my body, so it was important for me to know the role of each part of the treatment regimen. However, breast cancer is a complex disease, and treatments are increasingly customized. Another person might follow a different treatment protocol than mine.
Unless you are participating in a clinical trial, many oncologists follow standard of care guidelines which provide evidence-based treatment recommendations for cancer according to its defining characteristics. You can find these guidelines on the National Comprehensive Cancer Network (NCCN) website. The American Society of Clinical Oncologists (ASCO) also provides periodic updates to breast cancer treatment guidelines when new evidence is released. I check these sites periodically to make sure I’m aware of the latest recommendations. Although it’s important to trust your doctors, it’s equally important to be informed so that you can take an active role in your health care decisions.
Did you have any misconceptions about breast cancer or its treatment? If so, what were they? Let me know in the comments.