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What’s All This, Then?

“If you want a happy ending, that depends, of course, on where you stop your story.”

Orson Welles
director, actor and producer


Honestly, this blog is supposed to be funny, but sometimes it’s hard to get there.

I am a cancer survivor. You cannot imagine how good it feels to write that. This blog was established to help me document my journey, process my experiences and, ultimately, inch away from thinking of myself as a cancer patient and towards being a mindful, peaceful and accepting (that’s a tough one!) creature on this Earth. Be warned, some of my posts are self-indulgent and unnecessarily wordy; I have much respect for anyone willing to slog through them.

Right now, this blog is anonymous: I need to stumble through my feelings, complain when I feel like it and be blunt when necessary — and I need a safe space to do it without fear of judgmental glances. While my goal is to keep this light-hearted, I realize that I have the pleasure of being a survivor and chuckling about my cancer experience; there are many who are not granted that opportunity. Writing this blog is a privilege.

Cancer sucks. It’s an indiscriminate spectre that has haunted the lives of practically everyone at some point, whether relatives, friends or ourselves. For me, cancer cannot pass into faded memory quickly enough, but at the same time, I am infernally curious about the disease and how it has changed me.

So here are my facts:

In early 2017, I was diagnosed with triple-positive (estrogen+, progesterone+ and HER2+) breast cancer. The lump was 1.6cm in diameter, removed at the end of March, along with three sentinel lymph nodes that were revealed to be unaffected. Chemotherapy (Taxotere & carboplatin) started a month later and lasted the entire summer, 6 hefty courses, one every three weeks; adjuvant therapy (Herceptin, a monoclonal antibody) also started at this time, but went for 17 courses, ending in April 2018. Daily radiation treatment lasted six weeks through autumn of 2017. A 3-D mammogram in February 2018 showed nothing, in a good way. That marked my first year without the tumor.

I wish I’d been able to write in 2017, but my head wasn’t there. I was not processing, I was existing and enduring. After my final Herceptin infusion, my port was removed and I turned around to see what had happened. It took several months of writing before I tossed out my first post in September 2018, privately at first, and then, “Hello, world!”

It’s going to be a bumpy, unpolished ride. Bear with me.

Little Decisions Build Beautiful Things

This is the time of the year that many people make resolutions they hope will catapult their life into a new and positive direction.

So it’s also a good time to encourage people to slow down and consider what they hope to achieve and how they plan to get there.

And they’re off! The New Year fills us with energy to make big changes, but most of that impetus fizzles out as we realize that our plans are not sustainable.

The New Year’s buzz drives us to dream big and leap high, but with all that emotional energy expenditure, we run the risk of overwhelming ourselves, burning out quickly and falling far short of our lofty expectations. And that may make us feel worse about ourselves.

This year, take a step back and consider: it’s the small changes that you make on a daily basis that determine where you ultimately end up. Consider an ocean liner that turns very slowly. It makes little adjustments in its course, but depending on which adjustments it makes, it can end up in very different places.

The real name of the game is consistency. While the big goal may be the shining light you strive for, consistency paves the way. And mindfulness helps you get there.

Maintain awareness of the present so that you have perspective on what choices you’re making today and their effect on tomorrow.

Focus on what you can do today. Even this hour. Want to increase your activity level? Get up and take some steps right now. That doesn’t mean sprinting around the parking lot for 10 minutes. It means doing something you wouldn’t have done otherwise. Something that won’t give you side stitches and result in wanting to throw in the towel.

Make little decisions to change something. Make them doable. And then make them consistently.

Maintain your awareness, every day, of what you’re doing and why.

And when those changes have become comfortable, do a little more. Keep your eye on consistency, not quantity.

Establish positive little habits the way you’d spread the seeds for a lovely cottage garden. Because here’s the thing: this is not a race. This is your life. You don’t live your life a month at a time–you live it moment by moment. And that’s the way you make changes.

Be like the big ship whose many little changes, made consistently, take it to fantastic places.

Any decision that positively affects you remains yours to keep, like a little jewel in a box. Did you go for a walk among trees after lunch instead of hanging out in your office perusing social media? No one can take that experience away from you. Tomorrow, if you have a meeting after lunch and must stay at your desk, the positive effect of that walk will still have taken place.

It’s like a little brick that you can use to build a palace. You collect one each time you’re consistent with a behavior. Play the long game.

And when you remain mindful of your behavior every day, you can also step back and see where you, the human ocean liner, are headed. This makes it easier to correct your course. A short diversion does not need to take you in an unwanted direction. One small correction and you’re back on track.

And that thing that you might have called a “failure” in past years and just given up because you’d figure you’d “blown it anyway”? It would be a temporary side trip. Because you are mindful of where you are and where you’re going.

And that’s how you know you’re going to get there.

Happy New Year!

Gratitude: It’s Not Just for Big Things

A number of years ago, when my kids were still very small, we lived in an area with brutal winters. That meant sub-freezing temperatures for weeks at a time. Money was tight so we had to keep the thermostat in the 50s overnight and in the low 60s during the day. To make matters worse, our bedroom was in a part of the house that the radiator pipes wouldn’t warm properly, so it was always cold there at that time of the year.

Gratitude for a cup of tea and a quiet moment to write – that is enough.

And by “cold” I mean, the bedsheets would be literally frigid when it was time for bed. So much so, that my joints would ache and I’d be miserable until my body heat could warm them up.

This continued for a year or two until I found an electric mattress pad. The first night that I crawled under the sheets with the heat turned on, I thought I’d won the lottery.

There were so many negative parts to the years we lived there, but going to bed with warmed sheets overwhelmed me with gratitude for the simple pleasure of removing the pain of the cold.

The reason that I’m telling you this is that it’s so obvious to be grateful for the stark changes in our situation. It’s a no-brainer.

But there is no need to wait for something like that. There are simple things that we take for granted that it would be so easy to be grateful for.

Turn your attention to little pleasures and acknowledge their importance in your life. Take some time to sit and bring them to your awareness. Feel into how they lighten your existence. Maybe thinking about them makes you smile. Or maybe the fact that something is simply working properly can be enough to help us realize how fortunate we are to have it at all.

Whatever it is, open up and invite gratitude in.

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Maybe generating gratitude during bad times is exactly what we need.

Those of us who have recently gotten a cancer diagnosis may feel a touch bitter about this concept. Understandably, it may be easier to be grateful when you’re not dealing with a serious disease. And no one would blame you for having a hard time generating a mood of gratitude.

But perhaps that’s exactly when you should look for things that elicit a sense of gratefulness, no matter how small. It may be one of the most important things you can do to maintain a sense of well-being in a difficult time.

Making Mondays Bearable

As 2022 approaches and we face the prospect of having another twelve months speed by us again, I’ve found it useful to sit down and take stock of where I was last January, what changed over the past year, and with what attitude I will enter into the next 12 months.

One thing that has caused a great deal of anxiety for me has been work, even with having one of the greatest bosses in the world and a flexible work situation.

My work situation is quite positive, but anxiety has left me with emotional claustrophobia.

Why? Because my job has also been associated with some of the most wrenching anxiety that I have ever experienced, including being diagnosed with cancer.

What’s resulted is that even in a supportive and stimulating environment (although not my passion, admittedly), I’ve felt trapped, like an animal trying to scratch my way out of my cage.

This past year, I came up with a tactic to at least partially relieve this feeling.

Now, I actually look forward to Mondays, because I’ve set up a beautiful association for the first day of the workweek with something very indulgent.

First, I work from home on Monday. This softens the dread that I’ve historically felt on Sunday nights, knowing that the weekend is over. The transition to the office is gentler.

Second, with some changes in my kids’ school schedules (one in college living at home and the other in high school), I start my workday an hour later. This has given the entire family reprieve from the stress of waking very early and starting the week sleep-deprived.

It also gives me to time to enjoy a cup or two of decaf in the morning.

Third, when the rest of the family leaves for school and work, I have 45 minutes before my own workday starts. I set up my rower for a 30-minute row, facing the tv/computer monitor in the living room…

Great exercise + fun videos = an amazing start to Monday!

…and put on a half-hour YouTube video of something I really enjoy that I might not have time to watch otherwise. For me now? It’s an episode of “BuzzFeed Unsolved–Supernatural”. Pure 100% indulgent entertainment.

Because it’s a timed row, when the 30 minutes are over, I stop. No pressure to hit a certain speed or distance. No matter what, it ends up being a decent workout because I enjoy the exercise.

That leaves 15 minutes before I start work. Chemo left me with short hair that allows for a five-minute shower.

By the time my workday begins, I am completely refreshed and the day’s workout is done. I feel like I’ve been given a huge treat–almost like I’m cheating, but I know I’m not. That 30 minutes of physical activity tied with watching a fun video re-sets my attitude and I’m ready to take on the week.

I love Mondays!

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Can you create your own positive association with the toughest day of the week or anything else that causes you grief?

No More Sticky Fingers!

Running late with this post as I’m furiously cleaning our apartment in advance of the Christmas holiday!

I noticed a few mornings ago that when I made a fist and then straightened the fingers of my right hand, the joints didn’t stick at all.

It took over 300 days…but I’m happy to celebrate the end of the side effects!

While this may seem like an odd thing to celebrate, it marked a milestone for me. This was the last side effect attributable to letrozole that I had been experiencing, and it was finally gone. Letrozole is an aromatase inhibitor that blocks production of estrogen and is used as endocrine therapy for breast cancer patients who have estrogen receptor-positive tumors. I’d been on it for about 14 months after switching to it from tamoxifen.

For reference, as of today, I am at Day 307 since stopping the medication, so it’s taken quite a while for this joint side effect to subside. Yes, there are other things still plaguing me, such as memory issues, low libido and difficulty maintaining muscle (even with strength training), but those are more difficult to separate out from the garden-variety effects of menopause.

The sticking fingers began in August 2020 (about 8 months after starting letrozole) and were getting progressively worse. By March 2021, when I called it quits with the endocrine therapy, a number of finger joints were sticking and painful, particularly in the morning.

At that point, I was having trouble getting up off the floor, as I was having issues with joints throughout my entire body. The medication was affecting various aspects of my life, making it difficult to exercise and, as I like to put it, lowering the quality of my existence. Following discussions with my oncologist, we both agreed that my risk of breast cancer recurrence was low enough to stop the meds.

It’s been quite a journey to get to the point where I am now.

Shaking this last side effect of letrozole reminded me how far on this cancer journey I’ve traveled. There have been so many ups and downs, friends made and friends lost to the disease, that it was easy to forget that nothing in life is permanent. Time passes and situations change, sometimes for better, sometimes for worse.

The concept of “CANCER” used to terrify me, and after I was diagnosed, I hit a low so deep I thought I’d never be able to crawl out of it.

Gradually, as my experience with the disease played itself out, I came to accept the uncertainty about the future. As the end of 2021 draws near, I inch closer to the 5-year survival mark. The fact that I can straighten my fingers in the morning without any pain or sticking is a perfect example of how while I cannot know what the future will bring, I can deal with the “now”. And this “now” is not so bad.

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Best wishes to everyone for a very Joyous Holiday Season and much promise for 2022!

The Snow Globe: A Mindful Visualization

Since it’s winter in the US and we’re starting to get the first blankets of white around the country, I thought it’d be fun to use snow as a visualization.

While it doesn’t snow where I live now, I grew up in New England and remember the peacefulness of calm, snowy nights when I stood out on the second floor balcony in the midst of snowfall, listening to the gentle “pat-pat” of snowflakes as they landed on the ground.

When we’re at our busiest, life can feel like a blur.

I draw on those memories when I think of snow globes. Yes, they’ve often been associated with chintzy souvenirs, but there’s really something quite magical about that little underwater world.

They are also quite beautiful representations of the process of settling down.

Shake a snow globe and watch the glitter spin furiously about, swirling like mad with little sense of a pattern. Those are the thoughts of a busy pre-occupied mind, overwhelmed with responsibities and expectations. For some of us this may be what our current life is like. Or perhaps we’re going through a particularly stressful time and feel as though we’re unable to slow down and catch our breath.

Perhaps we ourselves are adding to the chaos by unintentionally shaking things even more, allowing our monkey minds to run with stressful thoughts. With so much “noise” we can’t see through the water. Everything is a blur. We have a hard time collecting our thoughts.

When we stop shaking the globe and put it down…it will continue to swirl for a while and we may feel like we’re getting “nowhere” by trying to relax. But if we trust in ourselves, trust in impermanence–nothing lasts forever–slowly things will start calming down. The agitation will diminish.

Just as the “snow” will begin to settle down, so too will our busy thoughts and our busy lives. The glitter will float through the water more slowly, and the view will become clearer. A few more breaths, a few more moments of patience. The currents inside the globe lose momentum and the snow will gently blanket the bottom until, eventually, everything is still.

No sign of the tempest that once took place. Just silent peace and quiet breaths.

Until the moment the globe is shaken again.

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The trick, of course, is to learn how to find peace as the glitter water swirls madly about. Once we can do that, the storm may rage, but we will enjoy bliss.

Targeted Therapy? Yes, Please!

You cannot say that there is a “good” cancer to have. Because the only thing that would make the cancer that you have “good” is not having it in the first place.

But if that’s not the case, the next best thing is having a cancer with characteristics that serve as targets for drugs, enabling the use of “targeted therapy”. As described by the American Cancer Society, “Targeted therapy is a type of cancer treatment that uses drugs designed to ‘target’ cancer cells without affecting normal cells. …Targeted drugs can block or turn off signals that make cancer cells grow, or can signal the cancer cells to destroy themselves.”

Cancer treatment often means chemotherapy, but there are some targeted therapies available that are highly effective.

When talking about breast cancer, currently there are several targets possible: estrogen receptor, progesterone receptor and human epidermal growth factor receptor 2 (or HER2 [also HER-2/neu or ErbB2]). These three are the ones that your oncologist will use to characterize your tumor.

The estrogen and progesterone receptor positive (ER+ and PR+, respectively) tumors are the most common ones. According to WebMD, about 80% of breast cancer tumors are ER+ and 65% are PR+, and these tumors are treated with hormone therapy, generally tamoxifen and aromatase inhibitors (depending on the patient’s menopausal status).

HER2+ is an interesting case. HER2+ tumors contain extra copies of the gene that makes the HER2, which is thought to make cancer cells grow faster. Historically, the prognosis for HER2+ tumors has been worse than for HER2- tumors, with a greater chance of recurrence and metastasis.

At least, that was the case before the development of targeted drugs specifically for HER2, such as trastuzumab (Herceptin), pertuzumab (Perjeta) and others. These drugs don’t come without risks and are known for being potentially cardiotoxic, but they are very effective.

This is the irony. Triple-positive breast cancer went from being one of the more aggressive breast cancers to being almost “curable”. All due to targets.

This is also what makes triple-negative breast cancer (TNBC) more complex. Without specific targets to aim for, treatment of TNBC relies on aggressive chemotherapy, which can be quite effective. But without targeted therapies, TNBC still has the highest rate of recurrence and worst prognosis of all breast cancers. Researchers are furiously searching for new ways to characterize TNBC tumors for this very reason.

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We are all looking forward to the day when we can say there is a definitive cure for cancer.

But what brought on this post? I was searching on the internet for breast cancer info on HER2+ tumors and came across a provocative headline from MedicineNet.com that read, “Can HER2-Positive Breast Cancer Be Cured?” The answer to this, I assumed, would be “no” because we’re not at the point where we can say that we’re definitively “curing” breast cancer.

In addition, I’d been conditioned by my oncologist to think of cancer in terms of years of survival rather than cure.

But according to this MedicineNet article, “With recent advances in medicine, it is considered that HER2-positive breast cancer is curable.” A bold statement indeed. And one that I hope we will be making more and more.

For an article from the American Cancer Society describing available targeted therapies for breast cancer, go here.

Losing My Voice and Finding Calm

About a week ago, I lost my voice. This doesn’t happen often (some in my family might say it doesn’t happen often enough) as I tend not to get demonstrably sick beyond a runny nose.

Oh yeah, and cancer, but that’s beside the point.

Quiet is contagious.

I was coordinating a lectureship that was to take place on a Monday and Tuesday (luckly, I was not the speaker, just the one making arrangements), and on the previous Friday evening my voice disappeared. I could only manage a whisper as the event approached.

And I noticed something funny. As my voice became quieter, so did the voices of my family members. When one of us is not speaking loudly, others don’t have to either. Everyone is heard. Like magic!

As we all lowered the volume, I found myself less anxious about work. As I became quieter, it felt as though the world slowed down a bit too. Things felt a bit calmer.

This made me wonder how much I was adding to needless noise clutter at home…and how much I was responsible for driving the hectic state.

Sometimes we need to be reminded that we have more control over our mental state than we may realize.

It also reminded me that even when things felt “out of control”, that was just an illusion. They were most definitely within my control. I could turn down the rush of anxiety. I just had to remain aware of what was happening and that I had a choice in the matter.

Now, none of this is a miraculous revelation. I’ve known this since before I started meditating. But knowing something is not the same as putting it into practice. And sometimes to put it into practice, you have to realize that even though you “knew” it, you didn’t truly believe that you could do it.

I need that reminder now and then. That’s the gift mindfulness has given me. And even then, I still might need a nudge.

And the lectureship? It came and went, a little hiccup here and there, but under the circumstances everything worked out well. No voice required. And more importantly, no anxiety required.

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I’m not going to pretend that it’s easy to switch off anxiety. If I knew how to do that I would be living a carefree and very wealthy life. But just being aware that we have a crumb more control than we thought we did…brings us one step closer to a little more peace in our lives.

Working Out to Avoid Freaking Out

It’s hard to imagine a cancer diagnosis that doesn’t provoke some level of anxiety.

When I was told that I had breast cancer, it didn’t take long before I got a prescription for Xanax because my anxiety was going through the roof — I clearly couldn’t handle everything I was feeling. It wasn’t until my radiation oncologist suggested that I try meditation that my view of the best way to handle my anxious feelings changed, and eventually I dropped the Xanax altogether.

But one thing that I kept on doing was exercising, at least as much as I could manage on a given day. So after reading a recent study about exercise, I had to wonder how much worse my experience might have been if I hadn’t kept to my workouts.

Henriksson et al. (2022, Journal of Affective Disorders; see link below) found that engaging in moderate or strenuous exercise was very effective in relieving the symptoms of anxiety. What I found so interesting was that half of the study participants had actually lived with anxiety for at least a decade, and they still got relief!

The subjects in the exercise groups did a combination of both strength and cardio training.

The subjects in the experimental groups were assigned to one of two groups: low-to-moderate intensity group exercise or high intensity group exercise. The exercise was timed circuit training that combined both cardiovascular and strength moves and subjects maintained heartrates at levels appropriate for their assigned intensity levels. At the end of the 12-week program, everyone’s anxiety had significantly decreased, as compared to a control group that was not participating in group exercise.

What is striking is that there was a tendency for the improvement to follow the level of intensity; the harder the subjects exercised, the more anxiety relief they experienced. Talk about motivation!

My own experience echoes this, but in a subtractive sense. At times of intense stress, my anxiety skyrockets when I’m prevented from engaging in my regular workouts. This may happen, for example, when I’m dealing with an unreasonable workload that ties me to my desk and preempts my exercise sessions.

I used to wonder why I felt so much worse when I was getting more work done. This study answers that question for me.

Couple these results with what we’ve learned about the beneficial effects of exercise in decreasing the risk of recurrence of breast cancer and it is incredible why physicians don’t write exercise prescriptions for their patients, and why personal trainer sessions are not covered by health insurance.

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There are several things that I feel are important to underscore here if you’re interested in trying this out yourself.

The social aspect of the exercise sessions may have also played a role in alleviating the anxiety that the study participants had initially complained of, and there was the added benefit of a pre-planned, supervised program.

First, this was a group session. That means that there was also social support involved as no one was exercising alone. The subjects were supervised by a physiotherapist; they didn’t have to come up with their own program, as it had been created for them.

Also, the exercise included both cardio and strength exercises and included warm-up, cool-down and stretching, so it covered all the bases, so to speak. And the subjects got fitter as the study progressed, so there was also a sense of self-efficacy at work here.

Does this mean that the exercise didn’t matter? Not at all! The emotional benefits of exercise have been documented in previous studies. If you consider the mind-body as a single system, as your physical fitness improves, your mental health will generally follow.

If you’d like to see the original article, it is available free online:
Malin Henriksson, Alexander Wall, Jenny Nyberg, Martin Adiels, Karin Lundin, Ylva Bergh, Robert Eggertsen, Louise Danielsson, H. Georg Kuhn, Maria Westerlund, N. David Åberg, Margda Waern, Maria Åberg. Effects of exercise on symptoms of anxiety in primary care patients: A randomized controlled trialJournal of Affective Disorders, 2022; 297: 26 DOI: 10.1016/j.jad.2021.10.006

For a reader-friendly version, see the write-up in Science Daily:
University of Gothenburg. “Anxiety effectively treated with exercise.” ScienceDaily. ScienceDaily, 9 November 2021. www.sciencedaily.com/releases/2021/11/211109095348.htm

The Voice of Reason: Why I Love Guided Meditations

If you’ve read my posts, you’re aware that I really like guided meditations. There are a number of mindfulness apps that I use everyday, and if it’s not a meditation, it may just be ambient noise that I have in the background that helps keep me grounded.

The fact is that guided meditations have been a game-changer for me. During those times when I am trying to fall back to sleep and shake off anxiousness, having someone else’s voice in my head makes a huge difference.

When I’m groggy, I’m vulnerable. My thoughts can run away with me and take me to places that will keep me awake.

What do I mean by that? I’ve found that I’m a very visual person and for better or worse, I have a vivid imagination (this seems to be the case for many anxious people). During the day, it’s much easier for me to ground myself with the techniques that I often write about here — and it’s even better if I can find a quiet corner to do so. But nighttime is different. Sometimes I wake up stressed and clearing my head of all the noise feels like a Sisyphean task.

When I am groggy, I am vulnerable. But I certainly don’t want to do anything to make me more alert since my goal is to fall back to sleep, not to practice improving my concentration. That is the perfect time allow someone else to guide me in meditation.

The guidance does this: it allows me to focus on someone else’s voice. That’s enough. I do not want to have to exert effort beyond that required to listen.

The exact topic of the meditation is far less important than the delivery. A gentle voice at a low volume draws my attention just enough that it keeps my anxious “Monkey Mind” occupied and quiet.

The Monkey Mind running loose is a good way to visualize what your thoughts might be doing inside your head, swinging from branch to branch, chattering, jumping and constantly changing directions. It can be a jumbled mess in there. The meditation helps sort it out.

I have tried this on a number of occasions and have been very impressed with how effective a guided meditation is in dulling the clarity of what my mind has cooked up and clings to. It provides space between my worries and my self. And then I drift off to sleep.

As I mentioned, the meditation doesn’t have to be anything specific. While body scans work particularly well, any calming meditation will do as long as its purpose is to relax the listener. Breathing cues can also be highly effective, as can novel ambient noise that pulls you away from your worries.

No need to overthink it. Just indulge in a lulling guided practice and get some rest.

Don’t Call It a Boob Job…

I remember telling people that I had breast cancer. Most tried to be as supportive as they could, some weren’t quite sure what to say. But regardless of how they reacted, there was a general expectation that breast cancer surgery meant that I had lost both breasts to the disease.

A few people went as far as trying to get me to “look on the bright side” that I had gotten a “nice rack” out of the deal. For the record, I had opted for a lumpectomy, otherwise known as breast-conserving surgery, which removes only the tumor and some surrounding healthy tissue to ensure that the entire diseased part is removed. There was no “nice pair” to be had.

So maybe this is a good place to clarify a few things.

A mastectomy is performed to remove all breast tissue, usually (but not always) along with nipples, areolae and lymph nodes, of one or both breasts. It’s done to treat breast cancer or, in the case of prophylactic mastectomy, prevent development of cancer in the breasts.

There are alternatives to reconstructive surgery that may be very meaningful to the breast cancer survivor, including creating something beautiful out of what she might otherwise consider an ugly experience.

Whether or not a woman chooses to have a mastectomy vs. a lumpectomy is a very personal decision and based on a number of physiological and even emotional considerations. No one should ever be judged for their decision regarding this.

Similarly, well-intentioned folks should not assume that breast cancer means a bouncing new set of perky breasts. Not everyone who gets a mastectomy will opt for reconstructive surgery. In fact, there are tattoo artists who specialize in using mastectomy scars and the newly-flat chest as a canvas to create meaningful and beautiful artwork.

It’s also important to note, total removal of the breast does not come without its downsides. Surgical complications are more likely with mastectomies, and because so much breast tissue and skin is removed, there may be loss of sensation in the chest area that in some cases is permanent.

A newly published study in JAMA Surgery (Dominici et al., 2021; note, the free PMC version of this article does not appear until Sept 2022) with a reader-friendly version appearing in the NCI blog Cancer Currents) compares quality-of-life scores between a variety of breast cancer surgery types, including lumpectomy, unilateral mastectomy (one breast) or bilateral mastectomy (both breasts). All subjects were young (under age 40 at time of diagnosis) cancer patients with early stage breast cancer who gave scores to their perceptions of items such as breast statisfaction following surgery and both psychosocial and sexual well-being. Having a bilateral mastectomy with radiation treatments resulted in the poorest quality-of-life scores out of all surgery options.

Important: while the sample size of this study was ample, with 560 subjects filling out the questionnaire, the women were predominantly white, married and financially stable. A more diverse subject pool might affect the scores and the study must be replicated with inclusivity in mind in order to extrapolate the findings to the general female population. It should also be noted that no surgical groups’ quality-of-life scores were particularly stellar – such is the way with cancer surgery – but those of bilateral mastectomy patients were worse.

All women, regardless of age, have the right to have their questions answered before making a decision about breast cancer surgery.

Given the notable difference between these scores, and the fact that all the different surgical options were open to these young women due to their early-stage tumor status, it stands to reason that women should be informed by their oncologists and surgeons of the possible outcomes of their decisions and second opinions should be encouraged.

That doesn’t mean that a bilateral mastectomy isn’t the right choice for a younger woman with early-stage breast cancer, only that she should be aware of the possibilities of complications and persistent quality of life issues. She should not be pressured in either direction because there is a lot to consider and it’s not an easy choice, nor does it come at an easy time in her life.

So please, don’t call it a free boob job.

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If you are contemplating a prophylactic mastectomy in the absence of a genetic predisposition (BRCA+) and have early-stage breast cancer, please read this article from breastcancer.org and discuss your options with your medical team.