"Hi friends, I live in Italy, and have been diagnosed this year with Invasive Ductal breast cancer. I am 54 years old, and 12 years postmenopausal. I have been living in Italy for the past 22 years, although I was born in and grew up in the United States."
Health Care Costs
"Italy has a public health system, and so we don't need to hassle with private insurance and the whims and decisions of individual insurance companies. (Instead, we have our own set of hassles!) Normally, people are required to pay a small 'ticket' for doctor visits and exams, amounting to a small percentage of the true cost. But when we are diagnosed with a serious chronic disease, we are awarded a ticket exemption for all medical needs that the government acknowledges as being directly related to our illness."
Screening and First Controls
"Italy is developing a fairly decent (but with much room for improvement!) free screening program for breast cancer. The screening programs are locally administered, so the details differ a bit in different parts of Italy. In my town, the screening is offered to women between the ages of 50 and 69, and involves a mammogram every two years. (Initial screening is mammogram only, no echography [ultrasound] or other exam, but if things show up or look ambiguous on the mammogram, they do call you back for further exams.)
"I received my first invitation to get a mammogram shortly after my 50th birthday. I received a letter in the mail, telling me that I had an appointment already set up to get a mammogram, and was to report at the stated date, time, and place. No need to call to confirm, unless I wanted to change the date of my appointment. This was a very good thing for me, because I had totally neglected all aspects of my healthcare since moving to Italy, and thus surely would never have thought about getting a mammogram on my own (or maybe would have eventually thought about it briefly, but wouldn't have done it). The letter said that we would receive the results of the mammogram in the mail. As far as I remember, after getting my first mammogram, I never received any result in the mail, and never thought about it again. I received my next screening program letter four years later. (So, yes, what should have been my second exam got skipped. I didn't notice.) The failure to notify me of my mammogram results and the problem of getting skipped on the screening two years ago is actually pretty typical of Italian 'functioning'. The screening program just doesn't have enough workers to keep up with the task it has taken on. So it seems to be standard procedure that people actually get notified only if a problem is actually noted on the mammogram, and it is very, very common for people to get skipped in the screening appointment scheduling. (None of this is very tranquilizing, of course, but they are, at least making a big effort.) Those who are on the ball can, of course, make their own appointment to get a mammogram through a different system. However, the normal waiting lines to get a mammogram are often up to a year long. That's Italy. I have learned by talking to other patients here, that people who find their own lump can, if they have a good, helpful doctor, get an mammogram appointment much more quickly, however.
"I did get a letter notifying me of my assigned screening appointment shortly after my 54th birthday. Went, got my mammogram, and didn't think about it again. Well -- not until ONE MONTH LATER, when I got a phone call telling me I needed to come back for a re-check. By then, I had pretty much forgotten that I'd even had the mammogram, and was happily and ignorantly going on with my life. At my call back appointment, I was first told by the technician that there had just been a technical problem during the computer transmission of the data of my mammogram to the doctors (who were located in the room next door!). The mammogram was re-done, and I was asked to wait, while the technician stepped into the room next door 'to make sure they got the data'. He came back saying the the transmission was fine this time, but the docs wanted to see me. The doctors gave me a different story. They said that technical problem was actually due to the fact that I have very small dense breasts, so they wanted to do an echography exam. At the end of the exam, they finally told me the truth, although a bit watered down. The mammogram had shown an abnormality possibly consistent with cancer, and the echography confirmed that. I needed a biopsy. They scheduled me an appointment to have a core needle biopsy ONE WEEK later. I was instructed to come to the appointment with my own artificial ice pack, because, due to funding cuts, they could no longer provide that."
"The core needle biopsy was done with local anesthesia, just like in the USA. However, different from what I understand happens in most cases in US, they only took one tissue sample. Or -- actually, they went in with the needle piston twice to grab a sample, but the first time, the needle came up nearly empty. The doc that took the sample told the doc doing the echography (in front of me) that she thought she felt the tissue slip out of the needle as she was pulling out the probe. I'll tell you, also, that the doc that held the needle was making no attempt to hide the fact that she was sweating bullets and making a supreme effort to control her anxiety as she inserted the needle probe. This seemed to be because, since I have very small breasts, and the tumor was right against the muscle/rib wall, she felt she had very little maneuvering room and risked to do something very dangerous with the needle. She actually said to the other doc, right in front of me, 'We've never done one like this before!' Great. When she ended up having to go in for a second try, she was really over the top with nervousness! I was doing everything I could to project a feeling of calm to her.
"The rest of my diagnosis and pre-treatment period was an anxiogenic odyssey of information deprivation and WAITING. The picture I've included with this report, by the way, is me, washing away the stress of waiting in my favorite waterfall. I highly recommend an immersion in nature to help deal with waiting stress.
"Fourteen days after the biopsy sample was taken, I got called back in to learn the results. I was told it was definitely an invasive cancer. And it was about 1.2 cm large (and that the mammography and echography had suggested VERY strongly that it would most likely turn out to be cancer). But, the biopsy report really didn't give any more information than that. It said simply 'solid invasive carcinoma' (and that the exam for e-cadherin was in progress and would be communicated later).
"Echography doctor escorted me to a room upstairs where she said I would meet an Oncologist. Met a nice lady, who immediately set up for me an appointment with a breast surgeon for the next day. I figured that lady was MY Oncologist. It turns out she was just a doc that worked in the 'prevention' department, and her job is to be an interface that helps set up the patient's appointment with the next doctor they need to see. She also told me that I needed to immediately go to an office across town to complete my 'ticket exemption' procedure. So, newly informed that I had breast cancer of some ambiguously described type, and having no idea if I was dealing with something that had a good probability of being very serious or more easily treated, I made my way to the very busy health service office, where I sat and sat and sat (for over three hours!) in an over-crowded noisy room for my turn to fill out documents and get handed a little blue piece of paper that said I was exempt from paying the ticket for medical costs relating to my cancer for the next five years. Fortunately, I got called in before the office closed and sent everyone left waiting home! (Yes, in a normal country, they could have taken care of all of that by computer. But this is Italy.) Sitting and waiting, I was to later discover, has a big role in healthcare in Italy.
"So I eventually got to go home, with my limited diagnosis, still not knowing if my cancer is ductal or lobular or something else (and having no information about its grade, estrogen-receptors or HER-2 proteins), and I started to do some mad 'internetting' trying to figure out if there actually was some cancer category called 'solid', or if that simply meant they didn't yet know what the heck it is. The only reference I found to a tumor called 'solid' was a rare subtype of the lobular cancer that had a very bad prognosis compared to other lobular and ductal cancers. Anxiety went up. And I waited in the hope that real info would arrive.
"My surgeon appointment was for the very next morning. So things seemed now to be speeding along just fine, and I was pleased with that. My surgery was to be done at a University Clinic (as opposed to the general hospital). The place I was sent to for appointment was a noisy crowded waiting room/vending machine room, with many different cubicle offices coming off of it, and various nurses calling out numbers in a disorganized way. I discovered that many other people had appointments with the breast surgeon for the same time as mine, and we were supposed to take a number and be seen first come, first serve. And then I discovered that the surgeon that I was specifically sent to see didn't work that morning. But, the nurse kindly arranged for me (and another person who was supposed to see the same surgeon) to meet the surgeon in the ward (where the in-patients stay) in the afternoon. I was given only a vague time range, and told to show up and wait for him to have time to see me. I showed up and was escorted to a patient lunch room. Long wait, but the surgeon eventually saw me, took a quick look at the minimal biopsy report, a quicker look at me, and informed me that I'd get a quadrantectomy surgery plus radiation, and described what the surgery would be like. (Unlike in America, I was not offered an option of choosing breast conservation surgery versus mastectomy. I have since, after my surgery, learned that some people here are given that option, I'm not sure if that depends on the surgeon or on the nature and placement of the tumor and your body -- not that they knew anything about my tumor before surgery time other than the size, number, and location). My surgeon was clearly very big on breast conservation surgery, and I guessed that all Italian surgeons were, since the breast conservation surgery technique was originally proposed and validated by an Italian team of doctor-researchers. My surgeon made a point of telling me that, although they were in a general surgery department, they were in the process of building a special breast pathology surgery sub-unit. And he talked to me at length about all the scientific meetings he'd attended in America, admitting that he was doing that in large part to show me that they were up to date on current techniques and approaches. Surgeon, by the way, strongly emphasized that the surgery I was going to get, a quadrantectomy (aka segmental mastectomy), was a totally different surgery than a 'lumpectomy'. Here, on Breastcancer.org, in our profile section, we are given the possibility to describe our surgery type as only 'lumpectomy' or 'mastectomy'. I get the impression that it is desired here that we classify all breast conserving surgeries as 'lumpectomies', so this is how I have classified mine. It might be nice if a description of the quadrantectomy surgery is added to the breast cancer site, and if in our profiles, we are asked to specify our surgeries using the more general term 'breast conserving surgery' or mastectomy.
"Things continued to hop along with surprising speed. Here in Italy, a number of tests, checking for possible metastases, are done before you get to surgery. Before every test, I had to go first to the surgery department to pick up my clinical record, and then bring that with me to the place of the exam, often in another building. I had to bring the clinical record back to surgery department after exam. I was set up to get blood work the next day. This included tumor markers, CBC (complete blood count), chemical blood exams for organ function (most especially those indicating liver and bone issues), as well as checks to make sure we didn't have HIV or Hepatitis, which would require special precautions by the surgeons. A few days after that, I was scheduled to have a chest X-ray to check for signs of lung metastases. Nothing was said to me about the results, other than that they would be communicated directly to the surgery department. A few days after that, I had an EKG to make sure I was OK to have surgery. Before doing the exam, the nurse told me she was going to pick up my chest X-ray exam because they needed to see that. They eventually called me in, and asked me if I was a smoker. They seemed very surprised when I told them I was not (and knowing they had seen my chest X-ray, this, and the fact that they seemed to be treating me with such kind reverence, made me more than a bit nervous). At end of exam, nurse handed me my clinical record, and giving me what seemed to me to be a knowing look in the eyes, told me that the referral of the EKG, but also of the chest X-ray, was inserted in the back of the clinical record file. I stopped on the staircase to look at it. Chest X-ray NORMAL! Whew! I saw that my blood test results were in there too, and since I wondered if perhaps I really wasn't supposed to be looking at those results on my own, I ducked into a bathroom to take a look. Heart jumped a bit when I saw ALP level was elevated to 218 (reference value 40 - 150). All other liver values were normal (and I knew that with liver issues, the ALP would usually be at a much higher level). Could I possibly have BONE METS???? (I later investigated and learned that ALP can go up also for trivial reasons like vitamin D deficiency and maybe for one of the drugs I am taking. But the level of elevation was a level that some other Breastcancer.org members reported as being sufficient to alarm their doctors that bone mets could be a possibility.) I bring my clinical record back to the surgery department, and the nurse there informs me that I now have a mammary scintigraphy scan scheduled for the next day and a bone scintigraphy scan scheduled for a few days after that. Bone scintigraphy had never been mentioned to me before as a test I was supposed to do before surgery. I jumped to conclusion that they added the test after seeing my elevated ALP level. (It turns out that was not true. In Italy, bone and mammary scintigraphy are done on all breast cancer patients before surgery).
"The mammary scintigraphy proved to be a surprisingly traumatic exam. I had read on some internet sites that the exam is performed with the patient lying face down on a table that allows scanner access to the breasts. Other websites described the patient in a sitting position. Instead, my exam was in two parts. The first part was done lying on my back. That was nice and relaxing, and I took a nap. The second part was awful. I was standing, with my breast clamped in (like in a mammogram exam). But it was much much more physically trying than a mammogram. Because my breasts are quite small (and my backbone and rib structure a bit deformed), it was very difficult for me to put myself in a position that allowed my breast to stay sufficiently deeply in the breast clamp. And I was required to hold the position for a very, very, very long time. As a result of keeping my body in a contorted position, and pushing hard with my legs. and pulling with my arms so that my breast would stay in the clamp, I had terrible, terrible cramps in my legs and back. But that wasn't the worst of it. The scanner "camera" was positioned in a such way on the machine that some part of my head was inevitably in between the scanner and my breast. The technician kept telling me to turn my head; more, more, more!!! It seemed my head was never turned enough, and the very long process became very painful and exhausting. When they finally changed and scanned the second breast, and I was having the same problem, the technician suggested that I try lifting my chin way up instead of turning my head to the side. That seemed like a good idea to me -- until I woke up on the floor with the technicians standing over me, and I realized I had fainted and collapsed. (I had forgotten that lifting my head up like that tends to limit of the blood supply to my brain.... Fortunately, my tiny breast apparently popped easily out of the clamp, because I wasn't left with any bruise.). The technicians decided that even though I hadn't completely finished the exam on that breast (the side with no known tumor), that the exam was far enough along towards being complete that they felt I could trust the result, and they didn't want to torture me by making me repeat the whole thing. I do not know if other small-breasted women who do not have my slight skeletal deformity would have the same difficulties I had. But I did hear from others tested in my facility that most women found the position difficult and very uncomfortable to maintain, and several felt dizzy afterwards. The breast scan technicians felt sorry for me and actually told me the results of that exam, even though it was against the rules. Only breast cancer detected was the one we already knew about.
"The bone scan exam was a few days later. The exam itself was relaxing -- lying down on my back. But the technicians were button lipped about the result, saying it would be referred directly to the surgery department. Got back to the department and was told I didn't have another appointment for 13 days. So no chance until then to peek at my scan results or talk to anyone about it. I asked the nurse if I would ever get to talk to a doc about any of my testing results and she just said 'of course'.
"(All this time I had just been assuming that whenever the e-cadherin result of my biopsy exam would arrive, I would either be notified to come in to pick it up, or else it would be automatically forwarded to my surgeon (since the echographer who had taken the sample had referred me to the oncologist, who had, in turn, referred me to the surgeon). Since I didn't have any other information, I decided to call the doc that I thought was my oncologist to ask if the e-cadherin result had come in. She told me she knew nothing about it, hadn't thought about it, and I had to go get it myself. I went to the echography doc that had taken the sample to ask if she had any info. She had a copy of the report that she could give me. But she also told me that the report had arrived long ago, and she had immediately forwarded it to that oncologist that she had referred me to. OK -- that doc is NOT MY oncologist, I have no oncologist, and I finally understood that. E-cadherin result was positive. Good. That meant it's just an ordinary Invasive Ductile Carcinoma. Anxiety went down a small notch.
"Next exam was abdominal echography. Normally they only do an 'upper' echography, looking mainly at the liver. But, since I hadn't done any kind of physical exam in 22 years, I asked nurse if they could possibly look at a bit more, and they agreed to do both upper and lower abdominal echography. Echography doc was very nice and actually wrote up the report right away and handed it directly to me! All OK on that one!
"Ducked into a bathroom again to see if by chance my bone scintography result had been put in my clinical record file. Found it. No focal bone uptake, but they did note diffuse elevated uptake in the lumbar spine area that they suggested should be investigated in the future. I'm left wondering if, even though the uptake was not focal, and even though I know that diffuse spinal labeling could be a sign of arthritis or a grinding of my vertebrae (that might be expected considering my slight spinal deformity), if this little something not normal on my bone scintigraphy exam, when considered together with the elevated ALP level, isn't anyway a cause for at least increased attention to the bone met possibility, and perhaps some additional exam. I ask the nurse in the surgery department again if I would get to meet with some doctor to discuss my exam results anytime soon. She gives me an irritated look and tells me that there's no rush because the surgery schedule for the next 10 days has been made, and I'm NOT on it. (As if there would be no other reason for a doc to tell me my metastases exam results.) We are now arriving very close to August. August is a very particular time in Italy. Everything slows down almost to a halt, as everyone goes on vacation. I start to worry that this might further delay my surgery.
"Twelve days later I NOTICE A SECOND, rather small, LUMP IN MY BREAST. In the same breast, but a different quadrant than the original tumor. I'm almost happy to find it, because I guess this can finally win me a visit with the surgeon and I can get some answers about my real situation. It does. I get a surgeon appointment for the next day. Surgeon says 'maybe you already had it before' (as if that made it less important??). I told him perhaps that was true, but I just thought it was wise to bring it to the attention of a doctor. He got more serious and tells me he'll make an appointment for me to have another breast echography. Then he informs me that he is about to go on vacation for three weeks, but that he hopes, for my sake that maybe one of his colleagues will be able to do my surgery before he returns. I start to ask him my other questions, starting out with wondering if it is normal that I do not have an oncologist at this point, and am being seen only by the surgery department. He assures me that that is normal because 'Your tumor is only in your breast -- it has not spread to other parts of the body' Great to hear him actually say that -- but then I say, 'So you've LOOKED at the results of my exam and have concluded that I do not have metastases? Because NOBODY has talked to me about those results, although I have peeked at them and there are things that concerned me'. He then admits to me NO, HE HAS NOT EVEN LOOKED AT THOSE EXAM RESULTS, BECAUSE, AFTER ALL, MY SURGERY ISN'T SCHEDULED ANY TIME SOON. But he does at that point promise me that he will look at them the next day. I don't hear from him again, except for reasons relating to scheduling the echography exam.
"Echographer tells me that the second lump is an enlarged intramammary lymph node. I ask if enlarged means cancer cells or is just a reaction to the known tumor, and she says, 'Ah -- that's the question we'd all like to know the answer to'. But she does tell me that it looks macroscopically normal from the echography, and that probably the surgeon would take it out anyway when he operates me.
"Don't hear anything more from anyone for 17 days, when I get a phone call from the nurse telling me to report to the hospital the next morning (8 AM) for my sentinel node mapping. YAY! It was now two months and 10 days since my core needle biopsy was taken (and three months, five days since my mammogram that showed a very highly likely cancerous abnormality) and I was FINALLY going to get that thing OUT and analyzed and docs could start to think of what my treatment plan should be.
"During all of this waiting time, I felt like I'd had a good and correct attitude. I realize now that that wasn't completely true. My way of being 'positive' was to say I'm OK with any possible outcome, and my focus will be on living as well as is possible with whatever reality brings. The tough part was waiting for reality to arrive to give me at least an idea of what direction it was going to go. But I realize now that I spent an inordinate and unhealthy amount of time imagining and feeling that the outcome would be metastatic cancer, and experiencing how it felt to be calm and accepting of that idea. I compulsively read through the signature lines on the BCO forums, with my eyes catching and focusing and fixating only on those that had small tumors and discovered immediately or with time to be stage IV or a high stage III. I lurked on the bone mets groups. I felt one of them. (I told people that I was just being realistic, and if in the end the outcome was good, it would be a pleasant surprise. I didn't tell them that I really, really expected to not have that surprise.) While I think that it was right (for my personality) not to tell myself a Disneyland sugar story that everything is certainly going to turn out just fine, when I really had no information at all to base it on, I realize now that I went way overboard, living these three months in a distorted way. I don't think I increased my illness by being 'negative' -- I wasn't negative. But I think that if I had to do that obsessive imagining of outcomes and feeling OK with it, I should have tried honestly imagining myself with a positive outcome too. If possible, in closer to the proper proportions of the general statistics of outcomes of a 1.2 cm tumor."
Pre-surgery, Surgery and Hospital Recovery
"In Italy, a breast conserving quadrantectomy is inpatient surgery: Check into hospital the day before surgery. If all goes well, and no drains need to be placed, you get released the day after surgery. When drains are placed, you are kept in the hospital longer, I think I heard that it's until you are producing less that 20 mls of fluid a day.
"I was not offered any kind of anesthetic cream for the sentinel node mapping injection. Fortunately, I do not have sensitive breasts and I felt no pain. When I told technicians that some women find the injection to be very painful, they just laughed and told me it wasn't so.
"Based on what I have seen in other Italian hospitals, I was expecting that my hospital room would have 6 beds per room, with perhaps extra people stuffed in on cots, a single dirty bathroom for the whole ward down the hall. Instead, I was very pleasantly surprised!! In this University clinic, I had a double room, with a very clean bathroom right inside the room, that EVEN HAD TOILET PAPER!! The ward was one hall that had females on one side and males across the hall. Lunch room had a TV and a refrigerator. A luxury place!!!!! Only thing not good was that the alarm bell to call the nurses didn't ring in the nurses' office. It made a loud screechy, squawky, giant birdlike noise right outside the room.
"Unfortunately, my first night in the hospital was miserable for a totally stupid reason. The tension of those months of waiting (and the additional pressure unintentionally added by my American relatives that just couldn't understand or tolerate the waiting time) had taken it's toll, although I had convinced myself that I was handling it all almost well. On the night before going in, I was wired and excited and didn't sleep a wink. By afternoon of pre-surgery day, I had a miserable headache and requested from nurses a headache medication that never arrived. By evening, my headache was beyond the point of no return, and late at night, when, upon my begging, they finally gave me a Tylenol, it just triggered vomiting. After the third vomit, when knew that I just couldn't continue to disturb my poor roommate like that, I went to search for a nurse to ask if it would be possible for them to give me something to stop the vomiting. Nurses' room was dark -- seemed unoccupied. But after knocking on the door, I discovered that the two night duty nurses were inside, asleep. (The nurses' room had beds, so perhaps that was allowed??) Nurses yelled at me brutally for knocking on their door and scaring them, waking them up, and ordered me to go back to bed and to call them USING THE ALARM if I vomited again. I did. (Squawky alarm made my headache much worse, of course, and my main reason for wanting the anti-emetic was to be able to STOP disturbing the sleep of all the patients.) Nurses come and say they'll bring me an anti-emetic, but don't bring it until several hours later when it is almost morning. They then hook me up to an IV that is permanently attached to the bed, so on the next inevitable vomit, I'm stuck, and my roommate follows me the bathroom, holding my IV bottle in the air. We ask the nurses for a portable IV holder, and I'm told that they don't have any and ordered to get back into bed. They tell me they'll bring me an extra sheet to vomit in from bed. (They don't.)
"Advice: Get a good nights sleep before going into hospital!!!! And bringing a headache medicine (but asking permission to take it first) wouldn't be a bad idea.
"I'm first on the morning list for surgery!! I see my surgeon just before they put me under, for the first time since the day I pointed out my new lump to him. After asking me if I remember him, he tells me that he'll only take that enlarged intramammary lymph node out if he happens to be able to see it anyway from the cut he makes to remove tumor and sentinel nodes. He's not going to make a separate cut to get it, because he's sure it's just a normal reactive lymph node. He doesn't see it and doesn't remove it. (By the way, my roommate was actually in the hospital for her second surgery. This time they were doing a lymph node resection. At the time of her mastectomy, the surgeon saw with his eyes some lymph nodes [that were not her sentinel nodes] that looked a bit funny, so he took them out to send for analysis. Turns out, that while her sentinel nodes were negative, those other nodes, that were near her tumor, had cancer cells.)
"After a surgery wake-up in the 'reanimation room', I was brought up to my hospital room. There I was given four liters of IV fluids to wash out the anesthetic, on top of whatever they'd given me during the surgery. Needless to say, this resulted in a very full bladder. We were told not to get up, not to even sit up during this time, and we spent the full day in the open-backed hospital gown. When needed, nurses (some of them male) placed a pee paddle under us and cleaned us afterwards. They actually hid our underwear so that we wouldn't put them back on!! Anesthetic caused both my roommate and I to vomit, and this time we were both given an extra sheet to vomit in.
"The day after surgery I was dismissed, around lunch time. Upon dismissal I needed to run quickly to the hospital pharmacy to get a small supply of drugs for post-surgery therapy. I was worried that I would not make it to hospital pharmacy in time because I knew that it closed at lunch time, did not reopen on Saturday afternoons, there is always a long slow line there, and it was late. Fortunately, I made it in time. Otherwise, it would have been very complicated, because the dismissing doctors did not give me a prescription for the drugs, general practitioners do not work Saturday afternoons, and one of the drugs (that normal pharmacies have only if they specially order it), I needed to take that afternoon because the nurses had neglected to give it to me that morning (heparin injection). I actually ended up going to the pharmacy and sitting and waiting in my pajama pants (after having been dressed in clothes and ready to go home since early morning) because when the nurses took the cannula out of my arm, it began spurting blood (that I noticed only after it had totally soaked my pants, and the bed and was making a puddle on the floor). Nurses were mainly concerned about cleaning up the puddle before it stained the floor. And then, as I was wondering how I would protect my car seat from the blood on my only pair of pants, the nurses asked me to not leave the hospital wearing them, because they worried I would make them look like butchers.... They were nice, though.
"I had three follow-up post surgery appointments. All involved showing up, taking a number, and waiting over two hours for my turn to be seen. On my third visit, I finally got my much awaited path report!!!!!! Clear margins. IDC, ER- and PR- positive, HER-2 negative, Ki-67 = 7%. A GREAT, VERY POSITIVE REPORT!!!!!
"In Italy, the Oncotype genomic testing is not typically done. It is not covered by the public health system. It is, in theory, possible to have it done anyway, by paying 3000 euros out of pocket, but doctors don't even mention the possibility to patients. My breast surgeon didn't seem to know what I was talking about when I asked him, and he felt it was certainly not necessary (but agreed that it was my oncologist that I needed to discuss the issue with). My very first oncologist meeting is scheduled for next week. I felt determined to make a case to my oncologist about doing the Oncotype test, but now, after thinking and reading more about the test and my specific results, I am starting to think that the extremely low Ki-67 proliferation index is probably, in itself, an indication that chemo would be useless, and the high ER- and PR-receptor percentages suggest a very good response to hormonal therapy. So -- I'll ask his opinion on the matter, but won't push for it if he says it's not needed.
"It's time I get it through my head that this thing is very, very most likely going to be easy on me after all!!!"
"I happen to be a Vegan, and have been for 14 years. (This didn't prevent me from getting breast cancer -- who knows if it helped limit the growth, or if all those pesticides on my veggies helped do me in!) There are not many vegans or vegetarians in Italy (at least not in the part of Italy where I live). But, when I arrived at the hospital, I was pleasantly surprised to see that my roommate was reading The China Study (documenting the health benefits of a strict vegetarian diet), and, although she does not ascribe to the Vegan philosophy and ethics, she has been trying to eat a vegan diet since she was diagnosed with breast cancer. She was much less happy to learn that I was a long time Vegan and got cancer anyway....
"Since I have not yet met with my Oncologist, I do not yet know if they typically make recommendations about diet and exercise.
"If BCO allows me to, I will update this post with descriptions of my radiation therapy and medical therapy treatment, once that happens."