Ovarian Suppression
First, The Good News
In my last post, I talked about how I was going to be spending the next week focusing on getting through my first MRI since my NED diagnosis on 9/23/20. This was THE test, as far as I was concerned, that would determine if I had any cancer in me. Obviously there is no way of knowing for sure if there’s any cancer, as I’ve said before, you can’t see a cancer cell. But this MRI would be the clearest picture I would have of my breast tissue and lymph nodes. And the good news is, I have no evidence of malignancy! No cancer visible! I got that news on January 18. It took a few minutes to really hit me, as I read, and then re-read the report. But getting that news made all of the suffering worth it for me. All of the chemotherapy, immunotherapy, hormone therapy, radiotherapy, surgery, I did all of that to read, “no MR evidence of malignancy within either breast.”
Receiving that news, though, made me realize that I need to think seriously about whether I’m willing to go through all of the treatments I’ve received and risk recurrence by not continuing in hormone therapy.
Why Hormone Therapy Matters for My Diagnosis
When I was first diagnosed with cancer, I remember thinking “well they know I have cancer so why can’t they just cut it out and that’s it?” I didn’t understand that it’s not so much that you have cancer, it’s the pathology of the cancer (what it’s made of, what’s feeding it). I had four tumors. Three in my left breast (multifocal) and one in my right (unifocal). All four tumors were strongly positive for both estrogen and progesterone. Their sizes and percentages were: .4cm 86%er/92%pr + DCIS, 2cm 95%er/91%pr + DCIS, 1.0cm 91%er/95%pr , .6cm 94%er/96%pr + DCIS.
One tumor, the largest one, was positive for the HER2 protein. HER2 positive tumors are more aggressive. Ten years ago, these kinds of cancer were more or less a death sentence. Now, with the development of Herceptin, there is a targeted therapy that is used to treat these tumors. I received Herceptin & Taxol because my tumor was HER2 positive. I received radiation because I still had breast tissue (radiation only treats locally). The most important part of my cancer treatment plan is hormone therapy. Hormone therapy is the one thing that I didn’t think would be a big deal. It was a non-issue. “Just take a pill for ten years and you’ll be fine,” I thought. I was wrong.
My estrogen and progesterone are feeding whatever cancer cells might still be floating around in my body. Hormone therapy works to block the cancer cells from feeding off my hormones. Unfortunately, because I’m premenopausal (which means I am producing a lot more estrogen than someone postmenopausal) I am taking a pretty big risk not being on hormone therapy. I can’t take Tamoxifen. I had a reaction and it’s not an option. I never considered that Tamoxifen wouldn’t be an option. So after receiving my MRI results, I have spent weeks going back and forth about whether or not I would succumb to the only other options I have: ovarian suppression & AIs.
When my original oncologist told me that if I couldn’t get off Paxil (which you cannot take while on Tamoxifen) then they can always shut down my ovaries, I laughed. I literally laughed out loud in the office. He thought this was an ok thing to offer a woman who was only 37 and only had early stage breast cancer. It wasn’t an option for me. Ovarian suppression hasn’t been an option for me since my diagnosis, just like chemotherapy wasn’t an option. I told my husband, mom, friends, medical team, and myself that there was no way I was going to do ovarian suppression. I refused to go into instantaneous menopause at 37/38. For the last month, I’ve tried to decide if I am willing to do ovarian suppression, or if I roll the dice and risk recurrence. It hasn’t been easy, and I’m still not sure what I’m going to do. But I do know this, if I could hike and go to college while getting weekly TH chemotherapy, then I must be strong enough to still hike and go to college and live my life when having ovarian suppression.
My biggest concern with ovarian suppression is that it will affect my stamina and energy levels. The list of side effects for each of the drugs is pages long, but out of all the risks, my biggest concern is how doing ovarian suppression will impact my ability to hike and be active. I know Tamoxifen effected those things. I know being postmenopausal will too. So do I succumb? Do I give in? It feels like cancer treatment is less about fighting and more about giving in. How much am I willing to risk and how likely am I to have cancer again? I don’t know. I don’t have answers. And worst of all, I could do all of this and still get cancer again.
In a few days, I will meet with my oncologist to go over my hormone levels and discuss ovarian suppression. I weighed all of the potential side effects of each of the drugs and decided that if I agree to hormone therapy, I am willing to try Zoladex for ovarian suppression and Letrozole for an Aromatase Inhibitor (which I won’t start for several months if I do ovarian suppression). Zoladex is an implant that is placed under your skin monthly to suppress your ovaries, so once it’s in, I’m committed for a month. But, it’s only a month, not forever. I keep telling myself I can always try it and if I don’t like it, then I don’t have to do it again. I keep reminding myself that I was menopausal for three months while getting chemotherapy and I survived, but for some reason this just feels so much scarier. So much more permanent. Like I’m losing another piece of myself to this deadly disease.
Cancer takes. And it takes everything you have to live with it. Because if we are honest, every person with a cancer diagnosis will live with it until they die. So what I have to decide now is whether I continue in my course of treatment. Is hormone therapy that important? That’s what I ask my team members and they all tell me that my tumors were strongly positive so yes it is important. Do I trust that it will work? I’m still not sure but chemotherapy, etc. did. Maybe the treatments do work. But what am I willing to trade for? I’m still not sure.
