jennifer lynn kuhlmann merck

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Some stories just need to be told backwards … because telling them frontwards is too difficult. This is going to be a little like telling you the punchline to a joke before telling you the joke (except it’s not funny at all). My husband always gets frustrated when I (inadvertently) do this to him. But I think this is the only way I can dig into this particular story.

Here’s the bottom line: I have breast cancer. On another day, I’ll tell you how I got here. But today, I’ll tell you about an important decision I’ve made.

After much research, prayer, and consideration, I believe I have arrived at a treatment plan for my ductal carcinoma in situ (DCIS). In the course of my research, I came across an interesting statement by Dr. Monica Morrow, of the Memorial Sloan-Kettering Cancer Center in New York City, formerly of the Northwestern Memorial Hospital Cancer Center in Chicago:

“‘You need to take the time to understand your options,’ Northwestern’s Morrow stresses. ‘If there’s ever a disease that’s worthwhile seeking a second opinion on, it’s DCIS.’” This was helpful confirmation for the path I chose to pursue.

During January and February, I met with medical oncologists and radiation oncologists at St. Alexius Medical Center in Hoffman Estates, Loyola University Medical Center in Maywood and Rush-Presbyterian-St. Luke’s Medical Center in Chicago, and consulted with a medical oncologist at the Mayo Clinic in Rochester, MN. What has become clear is that the particulars of my situation make a decision regarding proceeding with treatment a bit controversial.

Discussions with the doctors, as well as my review of the literature over the past two decades demonstrate several assertions:

1. Local excision (lumpectomy) is the universally agreed upon first step in treatment. That’s good, since I’ve already done that : ).

2. Radiation following lumpectomy is considered standard treatment for DCIS.

3. Tamoxifen (hormone therapy) for 5 years is considered standard treatment for DCIS.

4. There are varying opinions and lots of research has been done and is being done to attempt to identify sub-groups for whom radiation and/or tamoxifen do not make a sufficiently significant difference to outweigh the the risks to either or both.

So, my focus has been on figuring out the ramifications of #4 for me, that is, could I be in one of the sub-groups for whom it would be reasonably safe to not pursue radiation or tamoxifen.

Of course, as you might imagine, the bottom line is that we don’t know and research is ongoing. But having weighed everything I have thus far, I’ve come to a decision to not do radiation, to give tamoxifen a try, and to proceed carefully with mammograms every six months for a while so as to keep an eye on things.

I’ll start tamoxifen in the next few weeks and may take it daily for as much as 5 years. Many breast cancer cells (including mine) receive a growth message from estrogen. The way that tamoxifen works is that it “‘pretends’ to be estrogen and attaches to the receptors on the breast cancer cells, taking the place of real estrogen. As a result, the cells don’t receive the signal to grow.” (www.breastcancer.org) Tamoxifen has the benefit of reducing my risk of ipsalateral recurrence (same side), as well contralateral occurrence (opposite side).

So, the next part of this journey begins. I feel confident in the information I have gathered and in the processing I have done to make this decision. Thank you for your prayers and advice. They have meant a lot to me.