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Debbie L. · 11-22-2009, 01:34 PM

(warning, it took me so long to write this that I was timed out and had to sign in again, even though it still knew who I was. sorry for the length but Brenda and I do tend to get going)

Hi Brenda,

You and I have enjoyed this debate before (smile). Correct me if I'm wrong, but my understanding is that your style values finding small things. My thinking is that the biology and response-to-treatment is more important than size. Brain mets excepted.

I think when we've discussed this before, it's been about mets vigilance. I think that we've agreed to disagree - noting that it's partly a matter of style and personality although I do have other concerns (like the cost) about ultra-vigilance when we have no evidence of benefit. Again, brain mets excepted. And I do allow that there is the possibility that one day, we may learn that finding, for example, a small liver met and zapping it, as we do with a small brain met - will be an improvement that extends life. But we don't know that. There's a heck of a lot that we don't know.

But now we're talking about primary detection which in some ways is different (we do have bushels of evidence that seems to say that larger is worse and vascular/lymphatic invasion is worse). The argument to that, which makes sense to me, is that those things (larger, more spread) may not be, in themselves, worse things, or even things that happened because of time - but are simply markers that go along with the more-aggressive (faster growing, more invasive) cancers, and thus the worse prognosis relates to the biology that caused the larger size or farther spread.

You are right, we are all dying. But we are also talking here about saving lives in a breast-cancer-specific way and so I think "saving" lives is an okay way to phrase it. If the cancer doesn't return and some other fire gets us at 90 - well then we can say that we were saved from dying of breast cancer. Can't we? (except now there is the argument that some tumors may never threaten life and/or may regress on their own but my guess would be that those are not HER2+ ones).

What else. Oh yeah. Harms. I didn't even go there because I'm not sure it strengthens the argument. But the harms are not just to peace of mind. The extra radiation is a harm (especially perhaps to the BRCA+ cancers) and the biopsies carry the risk of any surgery plus there are some questions about what role the growth factors involved in wound healing might play r/t cancer occurrence and/or growth. And now with MRSA and other resistant bugs, any invasive procedure becomes more worrisome.

But I think the bottom line is that we're back to our ongoing agree-to-disagree place. You are sure that finding a cancer with BSE a month before you might have noted it by chance in the shower will offer you a longer lifetime - whether from a cure or from control of mets. I am not sure of that. I don't see any evidence that says that might be true. And it bothers me that we are/were spending so much money and effort to tell women to do something that we don't know will help them. I'd much prefer that we spent that money finding out more about breast cancer. Especially important right now is finding out which cancers really are a threat. For us on this board, who are HER2+, that may not seem very important, because all HER2+ cancer may be a threat. But with the majority of breast cancers, it's not so clear.

Debbie Laxague
PS: how do you make that quote box? I can do copy/paste and change colors/fonts but when I click on "quote" below, nothing happens. I'm on another list where the quote thing works, so I don't think it's my computer.

11-22-2009, 01:34 PM	#19
Debbie L. Senior Member Join Date: Jul 2006 Posts: 463	Re: How did you discover your cancer? (warning, it took me so long to write this that I was timed out and had to sign in again, even though it still knew who I was. sorry for the length but Brenda and I do tend to get going) Hi Brenda, You and I have enjoyed this debate before (smile). Correct me if I'm wrong, but my understanding is that your style values finding small things. My thinking is that the biology and response-to-treatment is more important than size. Brain mets excepted. I think when we've discussed this before, it's been about mets vigilance. I think that we've agreed to disagree - noting that it's partly a matter of style and personality although I do have other concerns (like the cost) about ultra-vigilance when we have no evidence of benefit. Again, brain mets excepted. And I do allow that there is the possibility that one day, we may learn that finding, for example, a small liver met and zapping it, as we do with a small brain met - will be an improvement that extends life. But we don't know that. There's a heck of a lot that we don't know. But now we're talking about primary detection which in some ways is different (we do have bushels of evidence that seems to say that larger is worse and vascular/lymphatic invasion is worse). The argument to that, which makes sense to me, is that those things (larger, more spread) may not be, in themselves, worse things, or even things that happened because of time - but are simply markers that go along with the more-aggressive (faster growing, more invasive) cancers, and thus the worse prognosis relates to the biology that caused the larger size or farther spread. You are right, we are all dying. But we are also talking here about saving lives in a breast-cancer-specific way and so I think "saving" lives is an okay way to phrase it. If the cancer doesn't return and some other fire gets us at 90 - well then we can say that we were saved from dying of breast cancer. Can't we? (except now there is the argument that some tumors may never threaten life and/or may regress on their own but my guess would be that those are not HER2+ ones). What else. Oh yeah. Harms. I didn't even go there because I'm not sure it strengthens the argument. But the harms are not just to peace of mind. The extra radiation is a harm (especially perhaps to the BRCA+ cancers) and the biopsies carry the risk of any surgery plus there are some questions about what role the growth factors involved in wound healing might play r/t cancer occurrence and/or growth. And now with MRSA and other resistant bugs, any invasive procedure becomes more worrisome. But I think the bottom line is that we're back to our ongoing agree-to-disagree place. You are sure that finding a cancer with BSE a month before you might have noted it by chance in the shower will offer you a longer lifetime - whether from a cure or from control of mets. I am not sure of that. I don't see any evidence that says that might be true. And it bothers me that we are/were spending so much money and effort to tell women to do something that we don't know will help them. I'd much prefer that we spent that money finding out more about breast cancer. Especially important right now is finding out which cancers really are a threat. For us on this board, who are HER2+, that may not seem very important, because all HER2+ cancer may be a threat. But with the majority of breast cancers, it's not so clear. Debbie Laxague PS: how do you make that quote box? I can do copy/paste and change colors/fonts but when I click on "quote" below, nothing happens. I'm on another list where the quote thing works, so I don't think it's my computer.