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Cancer Decisions May Change With Age and Research Advancements


Cancer decisions get to be made based on each person's unique situation.

Cancer in my 80s might look different to me than cancer in my 40s did. I don't know … yet. If I am physically and mentally healthy and able at that age, I might be more aggressive with cancer treatment decisions than I would have otherwise. I don't know. I do know that watching my mom, in her 80s, go through the cancer treatment decision process was difficult.

Who understands older patients? Who is their voice? Hopefully, they get to have their own voice heard. At 46, I wanted to fight my breast cancer with everything that was available. For my mom, at age 80 at first diagnosis, her choices were different. That was sometimes hard to support and it was my job to support her choices.

My mom chose to have only a lumpectomy. She decided against radiation and chemotherapy but she did take hormonal therapy. When the cancer reappeared in the breast three years later, she was fortunate it had not spread outside the breast. She bravely chose a double mastectomy without reconstruction. Again, she did not choose radiation or chemotherapy. Again, I accepted and tried to support her decisions.

Mom had other health issues in addition to her recurring breast cancer. She could have chosen to do nothing, remove just the breast with the recurrence, or take off both breasts. She was the one who decided she would feel more comfortable and symmetrical with both breasts removed.

I learned to support her and frankly, to bite my tongue. It was not my body or my decision. I tried to ask the doctors thoughtful questions, so she could understand and make her own treatment decisions.

When her breast cancer came back a third time, the breast oncology surgeon said that nothing remained except hospice care. The medical oncologist initially thought a newer "chemo lite" treatment might be a possibility. Unfortunately, it was only a fleeting hope until her full-body scan showed an advanced tumor in her brain. I was her adult only breast cancer survivor child and I think I took the news harder than she did. Our current society does not do death well. We do not openly talk about it or prepare for it.

Life does not offer guarantees for anyone, regardless of age. Most breast cancer patients memorize "bone, brain, liver, lungs" because these are the places where breast cancer spreads. Each of us is trapped in a moment in time that has very specific diagnostic, prognostic and treatment tools. One of the biggest areas of change in breast cancer is the expansion of genetic testing. At seven years out from my own initial breast cancer diagnosis and at my oncologist's suggestion, I had more genetic testing after Mom died.

If I had known that I was PALB2 genetic mutation positive seven years ago, would my treatment decisions have been different? Absolutely. I would have chosen a double mastectomy rather than a lumpectomy, and I would still have had chemotherapy.

Now I wish I had removed both breasts seven years ago, but I also wanted to do what seemed "reasonable" and rational at that time. At the time, the medical oncologist and the surgical oncologist both assured me that a lumpectomy was reasonable. I wanted to be proactive and to act but not over-react to my diagnosis. Now with 20/20 hindsight and a fresh genetic test result, I wish I had made a different choice. We are all trying to hit a moving target in an ever-changing playing field. My suggestion: Make the best decision with the best currently available data and always move forward while respecting each other's choices.

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