[dlaxague]

I don't think your concerns are petty. Not at all. I do think that it's wrong for people to write to you and tell what you should do. I know that they have your best interests at heart and are sincerely trying to help. But as Believe said, this is a personal decision and you must follow your heart.

Either choice (scans now, scans later) can be defended as good medicine. So as many others have said, we can't tell you what to choose, but we can tell you that somewhere inside, you possess the right answer. You just have to get quiet and listen, and then move forward with confidence because you've made the right decision for you and for your family.

There are two schools of thought here. One says that ultra vigilance is the best approach to monitoring metastatic disease, because if you discover something and jump right on it, it's more likely to be controlled sooner and better and perhaps with less toxic methods.

The other school of thought says that the above approach may seem intuitively better but that it has several disadvantages. One (that you've identified) is the anxiety that ultra-vigilance can cause for some people. Another is that this approach can use up the available options more quickly, so that in the end, it shortens one's time of living with mets. This school would recommend scans only for symptoms, or to monitor treatment of active disease. The theory again being that the cancer either responds to treatment or does not respond - that it's more about the biology of the cancer than about the amount of the cancer. The only caveat here is that this approach does not apply to brain mets - there it is clear that the smaller it is when detected, preferably before symptoms announce it, the more and better the options are for dealing with it.

My sense is that on this list, most people attend the first school. On other lists, and face-to-face, I know women who attend the second school and are very happy with that style. Again, personal decision. But to make the right choice for you, you do need all the information, presented in a balanced way.

Some oncologists are firmly planted in one school or the other. Others tailor their approach depending upon their patient's desires.

You could split the difference. Brain scan now, the rest deferred until January. You didn't say what kind of scanning your onc had in mind.

Keep us posted - about how you come to the decision, okay? And know, absolutely, that it will be the right decision for you.

Love,
Debbie Laxague