Yesterday my son took off work to schlep out to the Mayo with me and hold my hand as I entered the Land of Sickness. We were to meet with a high-powered surgeon to whom I was referred by my long-time doc and old friend, Tim Daley. After a brief wait, we were ushered into the catacombs.
You would not believe the difference between the way you’re dealt with at St. Joe’s and at the Mayo. First off, we were met by a nurse practitioner who handed me a whole book on breast cancer and a notebook filled with business cards & phone numbers of people to call at the Mayo, with all sorts of information, with what to expect, and on and on. She asked a bunch of questions, filled in forms, and moved on. Then a PA came in, did an exam and asked more questions.
And finally Her Royal Majesty arrived. And what an incredible lady that one is!!!
She also examined me, and she’d already read the pathologist’s reports and studied the mammogram. She was annoyed that St. Joe’s hadn’t done another mammogram after the biopsy to confirm that they’d placed the marker tags correctly, and said now that has to be done. Then she said the following:
At this point she believes these are ductal carcinomas in situ (DCIS). They are not exactly cancers; they are pre-cancers. She assessed them as “Stage 0,” about as close to harmless as they can get without being nonexistent.
Not all DCIS lesions develop into cancer, and if they do, they develop very slowly. They could turn into cancer in a year, two years, ten years, twenty…or maybe never. However, the problem is that ALL breast cancers start as DCIS. Because there’s no way (yet) for doctors to know which DCISes will become invasive cancers, which ones will just sit there, and which may even fade away, the wisest course of action is to have them removed by way of surgery. But that’s all that is necessary. And there’s no hurry.
The current standards for lumpectomy no longer require such a wide margin of healthy tissue to be removed around a DCIS, and so the procedure is relatively minor compared to what one would have expected in the past. Once removed, the things have to be examined by a pathologist, but if they are what she believes them to be, there will be no need for any other treatment. No radiation. No hormone treatments. No chemotherapy.
She thinks these critters have been in there for years — she explained in detail why she thinks so, based on the known growth rate of papillary carcinomas — and were simply not seen on earlier mammograms when my lush besoom was denser and the machinery was less sensitive.
She explained that radiation therapy is an option, but that it would reduce the already extremely low probability of a recurrence by about one or two percentage points. I asked her whether, if she were in this position, she would opt for radiation.
“No,” she said, “I wouldn’t have radiation. But then…that’s just me.”
Looked at her and thought, Lady, you are one hell of a lot smarter than me and you are staggeringly expert on this subject. If you’re not havin’ it, neither am I.
So I scheduled a lumpectomy for August 7. She said one should be up and about in a day or two and back in the swimming pool after two weeks.
How amazing is that?
And, we might add, how effin’ outrageous…
The radiologist at St Joe’s said to me, in reporting on the biopsy results over the telephone, “I’m sorry to have to tell you this, but it’s cancer.” Period. Evidently that was a slight exaggeration…
This was after I had been told, by another radiologist there, that there was a 50% chance those little lumps were cancer. So they had me prepped to believe I already have cancer, and then they delivered exactly that news.
In fact, they’re not benign…but neither are they actually cancer. Not yet, anyway. Nor are they going to become cancer in the very near future.
My friend KJG, on hearing this, remarked on the difference between the medical treatment you get in hospitals in affluent vs. not-so-affluent neighborhoods. Ain’t it the truth, apparently: few places get more affluent than northeast Scottsdale. And another friend remarked, after admitting to a skeptical turn of mind, on how much St. Joe’s stood to gain by corralling me into six or eight weeks of daily unnecessary radiation treatment.
So it looks like a confluence of lucky events rescued me from a great deal of painful, pointless, and dangerous trauma:
- Old Doc Daley moved from his mid-town practice to the Mayo shortly after the clinic opened in Scottsdale, all those years ago.
- I managed to keep myself on the Mayo’s rolls after hitting Medicare age by sticking with him.
- St. Joe’s ER damn near killed me with the crassest kind of neglect when I had appendicitis some years ago, and so I wouldn’t have surgery done at that hospital, not on a bet.
- And past experience has convinced me that you should ALWAYS GET A SECOND OPINION before letting anybody do any kind of procedure on you or put you on some drug.
Always. Get. A. Second. Opinion.