Something is wrong. To be a good steward of the life you are given, you will do whatever it takes to keep it far from being at stake. But what would you do when at one point as you strive to be well and healthy again, you are faced with two unlikely treatments? Both choices claim to bring your body back to a healthy condition, BUT on one condition: it has to suck the life out of you first!

That’s how it felt like when my doctors said I have to still undergo both radiation and anti-hormonal treatments following my successful chemotherapy and surgery. “You’ve done well. The chemo worked. The surgery worked,” says my surgeon whom I’ve met a week after my lumpectomy operation on March 1. If that’s the case, so what are these two treatments for?

The six sessions of chemotherapy that I went through for fours months was able to reduce the size of my tumor from 2.7 cm to 1 cm. The surgery following the chemo cleared out that 1 cm leftover tumor in my left breast, including one sentinel lymph node. This node is the first lymph node that cancer cells are most likely to spread from a primary tumor to the rest of the body. (The more lymph nodes involved, the more serious the cancer.) Thank goodness, the doctors found only one suspicious node in my left underarm and that was taken out, tested and found clear of cancerous cells!

Does it all mean I am cancer-free now?

Experts say that if you have survived for five years, then you’re considered cancer-free. As for my surgeon, she assured me that there’s no more tumor left in my left breast. What it is now is a matter of when and whether the cancer returns back or not.

Cancer recurrence is, therefore, the main reason why my doctors highly recommend radiotherapy and anti-hormonal therapy as my next steps. Both are for prevention purposes and are seen in studies to have helped reduce the chance of cancer coming back by 50%!

I fully understand the benefit of these two treatments, but are they really for me?

If results of my surgery have shown residues of cancer left in my breast, then I wouldn’t really mind going through all the recommended radiation and anti-hormonal treatments. Praise God, it’s no longer the case. I’ve already been through the toughest part, which is the chemotherapy, so undergoing radiotherapy and the anti-hormonal medications per se is not what bothers me most.

What concerns me a lot is this:

How necessary is it to undergo two prevention treatments and their associated risks and side effects when Big C is already out of the way?

Does the claimed benefit of radiation and anti-hormonal treatments outweigh the risks and side-effects?

To help myself find answers, I need to do my homework. As a responsible patient, I find it important to weigh my options carefully before making a decision. So I kept reading more studies published on medical journals. But the more I understand where I am at, the tougher the dilemma becomes!

Matthew 7:7 says, “Ask and you shall receive. Seek and you shall find. Knock and the door shall be opened to you.” I must say prayer is really powerful! This dilemma gave me such a difficult time that I spent weeks praying for an answer, asking God to please help me understand, give me wisdom, guide me in my decision making, and clearly lead me to the right next step.

“I cast all my cares upon You. I lay all of my burdens down at Your feet… and anytime that I don’t know what to do, I will cast all my cares upon You,” are the words I kept singing all week. For not so long, every information I need to know, every place I have to go, and every people (family, friends, doctors) I have to meet just came in at the right time and place!

My fight against the unknown

So when I told my radiologist, oncologist, and case manager that I have doubts about taking the recommended treatments (especially radiotherapy), I was called in for a second consultation meeting. I am soooo thankful to my radiologist for taking her time to sit down with me for more than an hour and patiently explain the pros and cons with numbers and charts. Because of this, I have realized that my next round of fight against Big C is really all about chances! It’s fighting the unknown.

10-year risk of breast tumor recurrence calculated based on my particular case: with both chemotherapy & anti-hormonal treatment

10-year risk of breast tumor recurrence calculated based on my particular case: with chemotherapy & without anti-hormonal treatment

As the representative chart shows, if I don’t undergo both radiation and anti-hormonal therapies following my chemo and surgery, the calculated chance of my cancer coming back is nearly 35%. With both therapies, the cancer recurrence is estimated to decrease down to 8%. If I opt for only the radiotherapy, my calculated chance of getting back the cancer is reduced to 10%. With only the anti-hormonal medication, cancer recurrence is down to a calculated 25%!

The calculated chances are based on two factors: my age (i.e. still young :-)) and the type of cancer I had (i.e. aggressive). My doctor emphasized that above-mentioned percentages are meant for representations and reference points only. It may or may not be exactly the case.

Nothing is indeed certain. If the cancer decides to come back, it will come back (regardless of how high or low the calculated chances are). The good news is that there’s also a zero chance the cancer will not come back. But who could really tell? Even with the best information available and the best team of medical experts, no one can really predict the future.

Radiation and anti-hormonal therapies VS me

During radiation therapy, high energy X-rays are used to kill the cancer cells. It works by damaging the DNA of the cells and stop it from growing. In my case, the affected area is my left breast, so radiation beams will be targeted directly to the left area of my chest, where there also sits the heart and the upper part of the lung.

This is the type or radiotherapy recommended for me, the external beam radiotherapy.

So along the process of external beam radiotherapy, there’s a risk of radiation hitting my heart and lung. If that happens, I’m prone to heart- and lung-related diseases in the long-term. Even if the experts insist that the risk is very low, to me that’s still a concern. It’s still a risk, and I can’t afford being sick again– not with my lungs nor any part of my body and certainly not with the heart!

Undergoing radiotherapy in my case entails going to the hospital everyday for a straight 21 days for the recommended 21-fractions of radiotherapy. The thought is already exhausting, but I can do that. What I’m not sure, though, is whether I can handle more of the unwanted side effects such as skin damages, swelling of the breasts, pain on the chest area, tiny broken blood vessels, and thickening of tissues (fibrosis). Per doctor’s advice to always listen to your body, my body tells me it got more than enough already!

The type of cancer found in my breast is also the type that is dependent on the hormone, estrogen, for its growth and survival. It’s a hormone-sensitive breast cancer, so the more estrogen produced in my body, the higher is the risk of the cancer coming back. The most logical thing to do then is to lower the amount of estrogen and block its activity in the body. How is that possible? Through the use of an anti-hormonal medication called Selective Estrogen Receptor Modulators or SERMs. Which anti-estrogen drug? Tamoxifen.

Are you still with me? Just a bit more chat on science and health… (you can do this!)

Two of the main functions of estrogen in the body is to keep the bones strong and the cholesterol level low. Take them out from your system, and you are obviously at risk of weight gain and weak bones! What else do I not like about this treatment? I have to take one tablet of 20mg tamoxifen everyday for a period of 5-10 years!

You read that right… five to ten years. That is literally sucking the life out of me and anyone taking the same treatment!

Just imagine yourself having to live your next 5-10 years with the following side effects lurking around: hot flashes, nausea and vomiting, vaginal discharge, skin dryness, mood swings, hair thinning, changes in vision, and leg cramps. Add to that the reported increased risk of blood clots, growth of ovarian cysts, and changes in the lining of the uterus (leading to endometrial cancer)!

A patient’s right to decide

Having done my homework with intense consultations with God our Great Healer, my doctors, and my body, I am certainly convinced that the claimed benefit of both treatments (i.e. to reduce the chance of the cancer coming back by 50%) DOES NOT OUTWEIGH the associated risks and side effects. So when asked what my preferences are, I answered my radiologist and said it would be as follows: either (1) NO to both treatments, or (2) One of the two treatments, but not (3) YES to both treatments.

As you can see, my decision is contradictory to my doctors’ recommendation (i.e. YES to both treatments). Thankfully here in the Netherlands, a patient’s right to decide, including the right to choose or refuse treatment, is well respected and observed. Because I opted for either NO to both treatments or YES to one of the two, my case was then taken further to the multi-disciplinary meeting of different medical specialists at the hospital for experts’ discussion.

The verdict

The following day, my oncologist called to inform me about their experts’ verdict: It’s NO to radiotherapy! BUT I have to at least try the anti-hormonal medication.

Upon hearing ‘NO radiotherapy’, I was literally jumping for joy, dancing and singing out loud like crazy! To God be the glory! I felt triumphant, truly relieved, and very thankful that I no longer need to undergo radiotherapy. It felt like a heavy weight was lifted from my shoulder. My mind was at peace and right there at the moment, I know it is the right direction to go. ‘Thank you, Lord. Thank you, Jesus,” is all I can say all day.

I will heed my doctor’s advice to move on with the anti-estrogen medication. Besides, my oncologist confirmed that I could stop it when serious side effects persist and/or when planning for a second child. My next appointment with her is this coming June.

There are still many follow-up checks and tests that are scheduled for me in the coming months and years. But for now, I can say the most crucial part of this fight against Big C is over! With my hair growing back, I can also say my road to recovery is halfway complete. I see bright rays of hope, new beginnings and shifting priorities springing like the season before summer.

I can compare myself to this plant. It looks so ruined, about to fade and dry out, but as you can see its stem remains strong. See that definite sign of new life, new start?

Renewing vows and commitments

I believe my faith in the Living God has already healed me completely since Day 1 (the day I was told I have Stage 3 breast cancer). The torturous months of chemotherapy plus the surgery played a significant role in getting rid of this life-threatening illness.

Now that the tumor is gone, I am renewing my vows to be a good steward of my body and the life I am given. As my alternative to not taking the radiotherapy, I re-commit myself back to healthy lifestyle, substantiated by healthy eating habits, regular exercise, mindfulness, and quite times. By prayer and supplication, I would also strive to have a stress-free and energy-boosting everyday life!

It feels great to be no longer torn between two suckers of life. I still have the anti-hormonal therapy… oh wait! Actually, I also still have until April 25th to decide whether or not to take the radiotherapy (in case I change my mind). But I am happy for the answered prayer. It’s such a relief to clearly see where I am heading next! The risks and side effects of tamoxifen remains to be seen, but I won’t worry about that…