Tuesday, February 7, 2012

My Genomic Score

After surgery, I learned that my "margins were clear" and that there was no evidence of cancer in my lymph nodes.  Excellent news.  In the old days, the doctors still wouldn't know whether to recommend chemotherapy.  Chemotherapy is a horrible thing--it can cause all sorts of medical problems, and even death.  And of course, the hair loss.  But at the same time, if can prevent a recurrence of cancer.  But until recently, deciding on chemotherapy or not when there was no indication of metastasis was a crap shoot.

Now, they have a test called the oncotype dx.  They send off your tissue after surgery to do this test.  It must be enormously expensive because they actually called me to get me to authorize it.  They said, "your insurance company has approved the expenditure.  You have met your deductible, so you will not have a co-pay.  Your doctor recommends the test.  Would you like it?"  umm, yes!  And then I had to wait, and wait, and wait.

On this test, a high score is over 31, and any doctor would recommend chemo.  Under 18 and the doctors do not recommend chemo.  In between, once again, it's a crap shoot.  You have to make a difficult decision whether to undergo chemo or not.  The doctor does not know what to tell you. As I waited for my results, I wondered about my score.

"I know what my score will be," I told Steve.

"You think it's in the middle. Because you cannot stand uncertainty and that would be uncertain."

So true.  I was absolutely convinced that my test results would fall into the grey zone.  And then I would opt for chemo.

Despite this decision, I was on pins and needles waiting for the results.  I called the lab, which indicated that the  doctor would have them by Friday.  I called the office and tried to change my appointment to Friday, but they said he isn't in the office then, nor on Mondays.  My blood started to boil.  Where the heck was he, playing golf?  Then I remembered that on Mondays and Fridays he does something other than golf.  Like, um, surgeries?  Oh, yeah.  I was all ready to be mad as a wet hen, but I guess a surgeon has got to do surgeries....

But, miraculously, the results were back Thursday. My score is 9!  HOORAY! Far under 18.  This means the risk of recurrence in 10 years if very low. The average rate of distant recurrence (meaning recurrence of cancer in your lungs, liver, bones or brain) for someone like me is only 7%. So chemotherapy is not recommended.  Radiation yes, Chemo no.  This is good--chemo can kill you and makes your hair fall out.  Radiation causes sunburn.

I am a redhead who grew up in Alabama.  I am an expert on sunburns.

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