On a scale of 0 to 100...

While my tumor was vacationing among the redwoods at the Genomic Health Labs in California, my surgeon was placing bets with me, and my oncologist, that my recurrence score would come back at 20 and put me square in that gray area of no definition -- the Intermediate Zone! On a scale of 0 to 100, the Intermediate Zone hooked in at 18 and zipped off at 32. To state the obvious, those patients who fall in line between 32 and 100 have a high risk of breast cancer recurrence, with a group rate average of 31%. The information gleaned in this testing helps the oncologist determine the proper treatment regimen to better their prognosis. Those in the intermediate group had a group rate average of 14%. And those in the low-risk group, (0 to 18 on the scale), had a group average of 7%. If everything aligned just right for those in the low-risk group, chemo or hormone therapy might not be a necessary part of their treatment options.

So, where did I show up on the graph? I came in as a dark horse, with a score of 16. My surgeon lost his bet. My oncologist, also surprised, called the lab to confer with one of the scientists. This was definitely good news. My score of 16 earned me an average rate of distant recurrence of 10%. I'd take those numbers to Vegas. I don't know if it's a fair interpretation, but I see it as a 90% chance the breast cancer is a personal anomaly and the risk of me getting it again is only 10% higher than someone who has never had breast cancer at all. Of course, I could be totally off base in thinking that. I also realize that regular mammograms and MRIs down the road will be utilized to see if I'm a wizard or a goat.

I have a copy of the report and it contains more than I can interpret, with verbiage such as "Oncotype DX® Breast Cancer Assay uses RT-PCR to determine the expression of a panel of 21 genes in tumor tissue. The Recurrence Score® is calculated from the gene expression results, with a range from 0 to 100." I have no clue what RT-PCR might be. But what does jump out at me from that word scramble are the words "21 genes". That's a lot of analysis. The report also noted the clinical study included female patients with Stage 1 or II, Node Negative, ER-Positive breast cancer. My club! My ladies! Myself.

So, I asked Dr. B., does this mean I don't need chemotherapy after all? Would estrogen-blocking hormones and radiation be enough to do the trick? She pointed out on the lab report that, while I was estrogen-positive and hercep negative, which was good -- I was also progesterone negative. This, in combination with the fact that the study doesn't take into account the size of my tumor, made her feel chemo should still be part of the package. I asked, "if it were you..." and she nodded yes. She was also comfortable with the prescribed four rounds of chemo, three weeks apart, being the proper dosage.

Okay. Let's get it scheduled. My only concern now was my worsening right knee. It was quite swollen behind the knee and it was painful to walk. Could be a baker's cyst. Could be something more involved. Dr. B. suggested I see my primary doctor to see if it could be treated before chemo started. Anything invasive during chemo could lead to infection and that was to be avoided at all costs.

I had a week for resolution. It was to be my worst week yet.