Tamoxifen vs. Beets

I really like my new oncologist, Dr. Kennedy. Some people have been confused that I am seeing an oncologist now…when I don’t even have cancer anymore…and wasn’t before…when I had cancer.

I think this is how it works for most breast cancer patients. You see a surgeon first. Mine was Dr. Rocco. She and my radiologist, Dr. Vernacchia, examined all my diagnostic reports and decided what kind of surgery I needed. ( I guess in some cases it makes sense to have chemo or radiation first, but most of the people I talk to started out with lumpectomies or mastectomies.) After the surgery, you go to see one or both of two types of oncologists. You see a radiation oncologist if you need radiation. You see a chemical oncologist (I think that’s what they are called) if you need chemotherapy or other pharmaceutical treatment.

Because my three areas of cancer were all well-contained, and completely removed along with the rest of my right breast, I don’t need radiation or chemotherapy. (This is such wonderful news!) Dr. Rocco asked me to go and see April Kennedy so we could discuss Tamoxifen, a drug that might lower my chance of getting recurrent cancer.

http://www.cancer.gov/cancertopics/factsheet/therapy/tamoxifen

I already knew I didn’t want to take it. But, I respect Dr. Rocco so much, that I was determined to stay open minded during the discussion. After I met Dr. Kennedy, I respected her an awful lot too…so I really did try hard to see her point of view.

Before I met with her, I went through what has become, in just three months, a thoroughly familiar process. A friendly medical assistant weighed me, measured my height and took my blood pressure. I was thrilled to see I’d lost the ten pounds I gained in the four weeks following my diagnosis (I'm back to 164). I was happy to note that my blood pressure is still very low (104/69), but I was disappointed to hear that I am only five foot nine and a half inches tall. (I’m sure I remember being 5’10” and three quarters when I was a teenager.)

I only had to wait a very short time in the exam room before Dr. Kennedy appeared. She is tall like me, and fair. She wore no make up, and a pretty cloud of clean, but un-brushed, blond hair framed her friendly face. She smiled a lot and invited me into her office to talk. That was nice. I am sick of sitting on exam tables.

She gave me a lot of background information about breast cancer in general, my particular type of breast cancer, and all the treatment options I wouldn’t be needing. She seemed genuinely delighted for me that I was doing so well and had been so completely cured.

This was nice too, but I was getting antsy to get to the real topic of the day. I asked her straight out, “Should I be taking Tamoxifen?”

“Oh! You have to!” she answered without pause. She seemed so certain about it, I worried that we wouldn’t be able to have a good conversation. I really wanted to weigh all the risks and benefits before we decided for sure. I wanted her on my side, and I was afraid of making her and Dr. Rocco upset with me if I didn’t want to take this stuff everyday. But, my worry was misplaced.

Dr. Kennedy explained everything very carefully. Then, with equal care, she listened to my side. This is what I thought:

I was happy to hear that I would only need to take Tamoxifen for 5 years. I’d thought it was going to be an everyday-for-life medication.

I was happy to hear that it would reduce my risk of developing recurrent breast cancer by 50%. That’s great! My risk right now is about 1%. That is like standing in a room with 99 other people and knowing one of us will get breast cancer again. Taking Tamoxifen is like 100 more people pouring in, and still only one of us is going to get it.

However, this drug would also increase my risk of uterine cancer (!) from something like zero percent, to 1%.

I just couldn’t make sense of this. Why would I raise my risk of uterine cancer from 0% to 1% when I was only dropping my risk of breast cancer from 1% to .5%?

Dr. K seemed to think it was worth it because uterine cancer is very easy to detect. If you have it, you start menstruating at odd times. Then, they just go in and remove your uterus and you are all better.

I, however, am afraid I wouldn’t even notice if I was bleeding at the wrong time in my cycle. Even after two decades of having one, I am still in total denial about my period. Every 28 days or so, I feel a little queasy and think, “Gosh, what did I eat? I don’t feel so good.” A few hours later I notice that the toilet bowl looks pink after I pee in it. I puzzle for a moment, “Did I eat beets yesterday? Beets wouldn’t make me sick to my stomach, would they?” A few moments later, I always feel like I’m on a V8 commercial, smacking my forehead with the palm of my hand when I realize the truth.

Even if I could be totally assured of detecting it early, I don’t want to raise my risk of getting uterine cancer! I’d much rather keep my current risk of getting breast cancer. It seems similarly easy to detect early, now that I am on the lookout for it. Also, the treatment is less terrifying. Maybe if I still had two breasts, I might think loosing my uterus was a better deal. It would be, after all, an invisible loss. It wouldn’t change the external shape of my body.

But, since I’m already missing my right one, loosing the left one doesn’t seem like as much of a tragedy. After all, it would even me out. More importantly, it is a process I have already been through and therefore much less terrifying that having my uterus removed.

As I’m writing this, I can’t believe this is the choice it came down to. It’s like one of the hypothetical questions I like to ask my friends.

“If you had to eat the same three foods for the rest of your life, what would they be?”

“If you were paralyzed from the waist down, would you have your legs amputated so you could get around easier, or would you keep them in case someday you could be cured?

“Which would you rather have surgically removed, your breasts or your uterus?”

Because I chose “breasts!” we didn’t even talk about the other possible side effects of taking Tamoxifen. Dr. Kennedy said I made a very good point and she seemed to totally respect my decision.

After our discussion, we went back to the exam room and she checked my incision area for swelling or infection. She was also looking at it to establish a baseline because I am going to see her once a year from now on, just to get checked out. I will also be scheduling annual check-ups with Dr. Rocco once a year. So, I’ll be getting a manual exam every 6 months, plus a mammogram each July.

I think this plan, along with a rigorous schedule of self-exams, will be enough to catch any recurrent breast cancer early enough too keep it from being lethal. And if i get another malignant tumor, I'll just have a second mastectomy and be done with this whole mess!

I still can’t decide if I would have my hypothetically paralyzed legs amputated, but I know for certain that if I could only have three foods forever, they would be:

Brown rice (because I love it and it’s so healthy and versatile.)
Tofu (because it’s a good source of protein and healthy fat and also very versatile.)
and, believe it or not,
Beets!