choosing it

We can do more testing. It seems we always have the option of More Tests. It also seems to be the case that regardless of how much testing we do, there is a hefty amount of my own decision-making necessitated by whatever information sits before us. The picture is always incomplete.
Monday we met with an oncologist from U of M. Somehow I anticipated that she would come in, sit, down and tell me straight - either I need chemo or I don't, right? Not so much. "We tend to lean toward it, but we also acknowledge that there are lifestyle and personal considerations. We also acknowledge that many patients do not need it," says the kind-faced doctor. She talks to us like we are children, like we are the last people on earth who could be expected to understand anything about our circumstances.
There is a test I can have done called the oncotype test that analyzes the genetic make-up of my cancer cells and gives me a score that categorizes my risk for recurrence - a low enough score means the doctors would feel comfortable with me not having chemotherapy. Scores are categorized into three risk pools - low, medium, high. Because of my age, the doctor suggested that even a low score that was close to the middle range would elicit chemo recommendations from U of M's tumor board (that's the name of the team of doctors who review the cases together). The test, however, like everything else about cancer, is an imperfect tool for assessing the risk of women my age. The test was designed with older breasts in mind and owing to the infrequency of 28year-old breast cancer patients, there is little data about its efficacy for young women. The oncologist seemed to contradict herself as she then said it could be a useful tool, but that assessing the data would include some guesswork. "We just don't know," she said as though she were addressing a kindergarten classroom. Essentially, I'd have to fall into a very small category of low risk in order to avoid a chemo recommendation and that seems mathematically improbable.
Still, it's up to me to choose, and here is where the numbers get me. If I were to do nothing from here on out, there is a 75% chance that I would be perfectly fine, cancer-free and healthy in ten years. Decent odds. And if we were talking about $20, I'd probably take them, but instead we're talking about my life so the remaining 1 out 4 sounds like a big number. That's a lot of people, 1 in 4. Using the hormone-suppressant drug therapy reduces this risk to about 18% which is better, but to put it in terms of people, that's still almost 1 out of 5, and isn't much more comforting. Adding chemo to the mix reduces these numbers to 10%. Better. I don't love these numbers. Nothing about them makes me swoon with any sort of comfort or notion of lasting salvation from over-zealous, productive malignancies, but one set of numbers is obviously preferable to the others, right? The crazy thing is that no matter what, 75% of patients are being over-treated. I am much more likely to be one of those patients than one of the other, less fortunate ones. That said, I am scared shitless. I'm terrified to go through this again, to know that if I did go through it again, chances are it would be with metastatic disease that had grown in my bones, liver, lungs, or brain. To know that at that point it would be too late to think about living cancer-free, that instead I would live on a regimen of disease management. But it probably won't come back. Finally, a set of odds is stacked in my favor.
Still, a feeling lingers, thoughts that chill me, nagging what ifs, impossible to answer. What if I didn't do the chemo, though the doctors seem to advocate for it? What if I went on with life now instead of three or six months from now? Could I actually do that? Could anything but the most rigorous treatment plan allay my fears of having cancer again? And if it did come back, or more accurately, reemerge in some distant part of my body ten years from now when we hopefully have a child, and I hadn't done everything in my power to stop it, could I live with myself?
I choose chemo. I choose its temporary side-effects over years of greater uncertainty. I choose the set of treatment options that I think offer me both the greatest peace of mind and the greatest opportunity to live the life I wanted before this nightmare began. And I'm doing it because I know with every bit of me that if I didn't, I would never move on, that fear would leave me crippled, and at this point I think cancer has taken enough from me.
Hashing out this decision, something clicked. A scene suddenly set for a classic old Western showdown between me and cancer. Cue the tumbleweeds.
I'm moving forward with everything I've got. And I haven't felt so frightened, so sure, or so alive in months.