Things just aren't that easy

Dr. MacCormick wanted to be as cautious as possible with my case, which I am thankful for. He told me that if I was 40 years old he would be patting me on the back and sending me on my way, but where I am so young it causes some nervousness. He said this is because I have so many years left to live and also because it is less common for people my age do develop breast cancer, so it then makes them wonder why. I think a lot of this unrest is due to the lack of research done on younger people with cancer. I really think it is important to start pushing for more research in this area because I am becoming living proof that it is needed. We need to start learning the risk factors in young people, the behaviours of these cancers, and how best to treat young adults who are diagnosed with cancer. We also need to start coming up with ways to address issues that young people in particular with cancer face--namely, infertility caused from chemotherapy.

Because Dr. MacCormick was respectable enough to admit this, he called a colleague of his in Halifax to ask his opinion of my case. He explained everything about me and said: "If this were your patient, what would you do?" The second oncologist replied that he would prescribe Tamoxifen (hormone therapy) for 5 years and nothing else. Thus, Dr. MacC.'s decision was confirmed. I again became excited at this wonderful news.

Here is the turning point: Just as Dr. MacCormick was about to talk to me about Tamoxifen, a nurse came in at this very convenient time with a piece of paper. It almost seemed staged. The second piece of paper turned out to be a pathology report done by a second pathologist in Halifax, N.S. Did I mention that Dr. MacC is thorough and likes second opinions? Before I came in he sent for a second opinion of the pathology to be sure that everything was as it appeared. But ... it wasn't!!!!!!!!

The second pathologist saw my tumor as a Grade 2 tumor, rather than Grade 1, as the first pathologist had suggested. This meant that in her opinion, the cancer was stuck somewhere between slowly growing and not aggressive, and quickly growing and aggressive-- a "moderately differentiated" cancer.

Just my luck. This is like dangling candy in front of a child's face and then telling her she can't have it. Dr. Mac Cormick looked puzzled for a moment, but quickly composed himself: "If you were fourty, even with a grade 2 cancer with the reports I just reviewed, I would send you on your way with Tamoxifen. But, again ... your age plays a factor here. We want to be as a sure as possible here. Really, Melanie, I am not about to put you on chemotherapy and risk your heart and bone health and all the other major risks of this drug unless it will benefit you significantly." He continued: "For now, I would like to stay with my original decision and prescribe you Tamoxifen for 5 years. In the meantime, I will contact a lady named Kathleen Pritchard in Toronto who is known to be one of the world's leading breast cancer oncologists. I will ask her opinion of your case. If she believes that with a grade 2 tumor you should have chemotherapy, then I just may recommend that option to you."

He then called and left a detailed message on Dr. Pritchard's voicemail (which he allowed me to hear), went into the details of Tamoxifen with me (which I'll explain later), and directed me to meet with the nurse after the appointment for the chest xray, blood work, and pregnancy test (because Tamoxifen is harmful to unborn babies).

"Apprehension, uncertainty, waiting, expectation, fear of surprise, do a patient more harm than any exertion." --Florence Nightengale