Okay, so the Mayo docs have relented on the clinic’s policy to the extent that they’re offering me a choice: if I want to take a chance that the 2014 no-ink-on-tumor guidelines for excision margins are safe, they will give me radiation and hormone treatment. Or, if I prefer not to run the 20 percent risk of recurrence and 10 percent risk of invasive cancer, then they will lob off the offending boob.
Which, they wonder, do I prefer?
A man of my acquaintance thinks I don’t understand anything I read on the Internet, especially if the reading level exceeds that of, say, Cosmo or People magazine. I imagine the editor of Mathematical Biosciences and Engineering would disagree, but that’s neither here nor there. Assuming he’s right that I’ve been overthinking this thing, I’ve done a little cost-benefit analysis, based on my subjective feelings about the matter and informed only by facts available in the most dumbed-down sources available to us pretty little air-headed girls.
Interestingly, here’s the result, quite the opposite of the direction in which I’ve been tilting.
So in this thing, a negative number represents exactly that: a negative. A positive number represents a desirable outcome. A zero indicates either that the circumstance is not applicable or that I don’t care about it one way or the other.
I’ve tried to think of all the aspects entailed in keeping the boob and in having it amputated, and of all the implications entailed in each aspect. Probably I’ve missed some…but I’ll bet I haven’t missed much that matters, at least to me — and this is supposed to reflect my subjective preference.
In terms of whether to keep the boob or not, both options are very negative. We have now heard not one but two heavy-hitting oncologists, both women and at least one of them nationally respected, state that if they personally were faced with this choice, they would try to avoid radiation. I have never reacted well to hormone therapies of any kind, birth control included, and you may be sure that whatever side effects aromatase inhibitors evince, I will be enjoying those. One of them is joint pain. With chronic back pain and sciatica that sometimes flares to the point where I can barely walk down the hall to the bathroom, I don’t feel I need more joint pain. So the fact that each of these therapies has negative side effects, some of them life-threatening, is a bad thing. And even with radiation therapy, the Mayo crew estimates risk of recurrence at 20% and risk of invasive cancer at 10%.
Obviously, the mutilation, the violent surgery, and the ensuing pain of a mastectomy amount to a bad thing, too.
So we’re trying to figure out which is the least bad of two bad options.
And lookit here! Keeping the breast accrues more than twice as many negative points than getting rid of it!
Then we have the fact that these doctors — and one doctor in the wild — are pressuring me to get reconstructive surgery. From what I’ve been able to tell, reconstruction has some failings, most of which result in further surgery or at least disfigurement that you have to learn to live with. Because I am not my boobs, I do not believe that (as one quack informed me) I will quickly become suicidal if I don’t have a fake boob pasted on my chest.
But, just in case I’m staring at this question through a glass darkly, I decided to ask the Excel Ouija board about reconstruction, too. The options presented in my first effort, “Do It” or “Skip It,” seemed a little vague, as it was difficult to know how to score “skip it.” So I tried again with something roughly like a cost/benefit comparison: what are the benefits vs the drawbacks of a) going ahead with reconstruction and b) declining reconstruction?
Here, the result accords more closely with my inclination: the point value of the benefits for no reconstruction outweigh the drawbacks by about three to one. The drawbacks of reconstruction outweigh the benefits by more than three to one. (Would be nice if I’d typed that correctly, but I’m not jumping through the hoops to build and upload a new jpeg for ONE character!)
So. I think this quantifies my point of view on the issue: given two bad choices, the least bad option is mastectomy.