Is there a more poignant question coming from the lips of a breast cancer survivor than this: “Am I cured?” After the slash, poison, and burn of treatment, the months of trying to keep to a normal schedule of working and cooking and mothering while you feel like you’ve been run over by a cement truck, the constant fear-is the treatment working?-you get to the end, and tentatively, diffidently ask your oncologist: Am I cured?
The answer to that $64,000 question is “Yes.” Or “No.” Or “Well…” It all depends on what kind of cancer you have, how far along it was, and how your body reacted to the treatment.
Happily, the answer is a resounding “yes” for most of you with non-invasive cancer (“in situ,” e.g., DCIS). Ductal carcinoma (cancer) in situ (in one site) means that the cancer has remained confined to the ducts in your breast, and hasn’t broken through the walls of those ducts to move into the surrounding breast tissue. About 20% of all newly diagnosed breast cancers are DCIS; a smaller number are LCIS (lobular), which isn’t considered cancer, but rather a pre-cancerous condition. If you’re in the approximately 30% of women diagnosed with non-invasive breast cancer, current statistics show that after treatment - probably a lumpectomy, radiation, and tamoxifen - there’s a 98% to 99% chance your cancer is gone for good. Yes, you’re considered cured. Congratulations
How about the 70% of us diagnosed with cancer that’s spread? When your cancer has spread (i.e., it’s broken through the walls of the ducts or lobes in your breast and moved into the surrounding tissue; or you’ve got inflammatory breast cancer), the answer to “Am I cured?” becomes less straightforward. If your treatment seems to have gone well, and repeated testing shows no signs of cancer, you’re considered off the hook-for now. But once cancer has left its original site and moved to a position where cells can get into your bloodstream or lymphatic system, there are no absolute guarantees. One errant cell is all it takes to set up a new colony elsewhere in your body; perhaps soon, perhaps years and years later. Thus we endure chemo, a “systemic” treatment designed to eradicate cancer cells wherever they are. Hopefully the chemo kills every single cancer cell. But there’s no way to tell. “Am I cured?” Maybe. Hopefully. Check the statistics your oncologist gave you when you first met to discuss treatment; he or she probably listed “reduction in recurrence” rates each different protocol would give you. Are you cured? Well…
When cancer has spread from your breast to your lymph nodes, “Am I cured?” becomes a waiting game. You undergo the most aggressive treatment possible, then you wait. The years pass; 3 years, 5 years… After 5 years, your chance of recurrence takes a welcome dip. And, statistically speaking, it’s the rare woman who has a recurrence of breast cancer (as opposed to a new breast cancer) after 20 years. “Am I cured?” You’ll probably have a pretty definitive answer in 20 years or so.
When breast cancer has metastasized - i.e., set up shop elsewhere in your body, like your lungs, liver, bones, or brain-the answer to “Am I cured?” is “No.” Sadly, metastatic breast cancer is considered incurable. Not to say it can’t be put into remission. And with increasingly effective treatments, many women live for several years, or even more, with distant (metastatic) breast cancer. Elizabeth Edwards is doing it. You may have a cancer friend who’s in this category. Your treatment will be continuous, even if it dwindles simply to regular visits to the oncologist. Are you cured? No. But can you live a good and satisfying life? Yes. And until a cure for breast cancer is finally discovered, that’s the best goal for all of us.
PJ Hamel is senior digital content editor and food writer at King Arthur Flour, and a James Beard award-winning author. A 16-year breast cancer survivor, her passion is helping women through this devastating disease. She manages a large and active online survivor support network based at her local hospital and shares her wisdom and experience with the greater community via HealthCentral.com.