Cancer Chronicle
On December 13, 2022, I met with the breast surgeon, who said they didn't have the results back in yet, because of staff shortages. She talked about how mastectomies were not a choice they recommended these days—not with tumors less than 5 cm—because the survival rate is the same whether you get one or not, and mastectomies are harder on your system. Lumpectomies, where they remove the tumor itself and part of the surrounding tissue, are done on an outpatient basis; mastectomies involve staying in hospital for a night or more. Easy choice.
Met with the doctor on December 20—she said it's Triple Negative Breast Cancer. That doesn't sound too bad, does it? Surely a "negative" cancer diagnosis can't be too bad? Yeah, not so much.
So my fears as of December 20th were:
Spoilers!
The Uncovering Triple Negative Breast Cancer page is pretty useful.
TNBC is most commonly found in women younger than 40, African-American, or have a BRCA1 mutation (change) in their DNA. I don't have those characteristics; none of my direct family has had breast cancer, and genetic testing did not show that mutation. Cancer becomes more likely the older one gets, no matter what.
Until a few years ago, the likely return of cancer in a TNBC patient was 2-3 years after treatment. However, new protocols have been identified (and we're following) and have improved that considerably. But there's no real sugarcoating it: TNBC is the worst form of breast cancer because there aren't comprehensively successful therapies. Historically, it recurs frequently and more rapidly than other types of breast cancer, and recurrences are often "distant," meaning that cancer comes back in places other than the breast. The protocol the University is using on me is the most current, and it has had some good results in shoving back the recurrence schedule.
The protocol is:
Then we'll see. If I'm lucky and it works, this might stave off recurrences. If I can survive five years, I will likely be over it. Here are some of the articles I've been reading.
Waiting to Start Chemo
On December 13, 2022, I met with the breast surgeon, who said they didn't have the results back in yet, because of staff shortages. She talked about how mastectomies were not a choice they recommended these days—not with tumors less than 5 cm—because the survival rate is the same whether you get one or not, and mastectomies are harder on your system. Lumpectomies, where they remove the tumor itself and part of the surrounding tissue, are done on an outpatient basis; mastectomies involve staying in hospital for a night or more. Easy choice.
Met with the doctor on December 20—she said it's Triple Negative Breast Cancer. That doesn't sound too bad, does it? Surely a "negative" cancer diagnosis can't be too bad? Yeah, not so much.
So my fears as of December 20th were:
- that the insurance won't cover the drugs enough
- that Ed will be sick with something we don't know about
- that Ed will be isolated from help
- that I have an unidentified brain tumor
- what the heck is TNBC?
Spoilers!
- Yes, except for a $6,000 deductible each year and co-pays, everything is covered
- He's okay, more or less
- We're working on that
- I was grossly congested from allergies
- TNBC is awful, but recent medical advances may very well save my bacon.
Triple Negative Breast Cancer
Because of ongoing medical research, several breast cancers have been identified that have been found to include estrogen receptors, progesterone receptors, or excess HER2 receptors. These cancers can be "unlocked" with specific treatments targeting the receptors and essentially cured. Triple-negative means this type of cancer does not have any of the three recognized receptors, and, so far anyway, the treatment must be focused on the entire body rather than the specific tumors.The Uncovering Triple Negative Breast Cancer page is pretty useful.
TNBC is most commonly found in women younger than 40, African-American, or have a BRCA1 mutation (change) in their DNA. I don't have those characteristics; none of my direct family has had breast cancer, and genetic testing did not show that mutation. Cancer becomes more likely the older one gets, no matter what.
Until a few years ago, the likely return of cancer in a TNBC patient was 2-3 years after treatment. However, new protocols have been identified (and we're following) and have improved that considerably. But there's no real sugarcoating it: TNBC is the worst form of breast cancer because there aren't comprehensively successful therapies. Historically, it recurs frequently and more rapidly than other types of breast cancer, and recurrences are often "distant," meaning that cancer comes back in places other than the breast. The protocol the University is using on me is the most current, and it has had some good results in shoving back the recurrence schedule.
The protocol is:
- low dose chemo (once a week for 12 weeks)
- high dose chemo (every third week for 12 weeks)
- lumpectomy
- radiation
- chemo pill
- A dose of an immune booster every three weeks accompanies it through the end of 2023.
Then we'll see. If I'm lucky and it works, this might stave off recurrences. If I can survive five years, I will likely be over it. Here are some of the articles I've been reading.
- Cortes, Javier et al. "Pembrolizumab Plus Chemotherapy in Advanced Triple-Negative Breast Cancer." New England Journal of Medicine, vol. 387, no. 3, 2022, pp. 217-26, https://doi.org/10.1056/NEJMoa2202809.
- Derakhshan, F. and J. S. Reis-Filho. "Pathogenesis of Triple-Negative Breast Cancer." Annual Review of Patholology, vol. 17, 2022, pp. 181-204, https://doi.org/10.1146/annurev-pathol-042420-093238.
- Garrido-Castro, Ana C., Nancy U. Lin and Kornelia Polyak. "Insights into Molecular Classifications of Triple-Negative Breast Cancer: Improving Patient Selection for Treatment." Cancer Discovery, vol. 9, no. 2, 2019, pp. 176-98, https://doi.org/10.1158/2159-8290.Cd-18-1177.
- Irvin, William J. and Lisa A. Carey. "What Is Triple-Negative Breast Cancer?" European Journal of Cancer, vol. 44, no. 18, 2008, pp. 2799-805, https://doi.org/10.1016/j.ejca.2008.09.034.
- Jia, Hongyan et al. "Immunotherapy for Triple-Negative Breast Cancer: Existing Challenges and Exciting Prospects." Drug Resistance Updates, vol. 32, 2017, pp. 1-15, https://doi.org/10.1016/j.drup.2017.07.002.
- Kalimutho, Murugan et al. "Targeted Therapies for Triple-Negative Breast Cancer: Combating a Stubborn Disease." Trends in Pharmacological Sciences, vol. 36, no. 12, 2015, pp. 822-46, https://doi.org/10.1016/j.tips.2015.08.009.
- Wang, Chao et al. "Triple Negative Breast Cancer in Asia: An Insider’s View." Cancer Treatment Reviews, vol. 62, 2018, pp. 29-38, https://doi.org/10.1016/j.ctrv.2017.10.014.
- Yin, Li et al. "Triple-Negative Breast Cancer Molecular Subtyping and Treatment Progress." Breast Cancer Research, vol. 22, no. 1, 2020, p. 61, https://doi.org/10.1186/s13058-020-01296-5.
- Zagami, Paola and Lisa Anne Carey. "Triple Negative Breast Cancer: Pitfalls and Progress." NPJ Breast Cancer, vol. 8, no. 1, 2022, p. 95, https://doi.org/10.1038/s41523-022-00468-0.
Waiting to Start Chemo