Friday, October 4, 2013


It's October.  It's Breast Cancer EDUCATION Month.  I'm NOT trying to be a killjoy but I am going to stick to sharing as much as I can....

This post originally appeared on this blog just four months ago.  It bears repeating now, when breast cancer takes center stage.

What I've learned since I stepped I fell off the edge of life as I knew it to life after a breast cancer diagnosis.  Pay attention.  This stuff is important.  With the death of Jen Smith last Saturday and after attending the NY memorial service for Jen Vennes just days before, I'm raw with emotion and more determined than ever to make sure the facts rise like a phoenix from the pink ash that has covered the planet.

For your consideration, what was originally titled Metastatic Is Not A Type Of Cancer, now Just The Facts:

Fact:  Breast cancer is not one disease.

Fact:  There are many different types of breast cancer.  Ductal, the most common, accounts for approximately 80% of all breast cancers.

Fact:  The most common in the other 20% would be inflammatory, for which mammography is useless as there is no lump and is mostly "rash-like" and lobular which is also a bit tricky with imaging.  Lobular is the sneaky cancer.

Fact:  Now that research is on the molecular level, further subtypes can be defined based upon hormone receptors and specific proteins. ER/PR/HER neu status aren't really types of breast cancer but rather, a means of better understanding the characteristics of a cancer type.  Having the ability to identify these receptors allows for more targeted treatments.  Ductal cancer can be triple negative or HER positive.  Lobular cancer is tested for the same receptors. 

Fact:  Metastatic breast cancer is NOT a type of cancer.  It's a stage.  The last stage to be precise.

Fact:  DCIS is NOT a type of cancer either.  It's also a stage.  Technically, it's stage zero because it's still confined to the duct.  A more accurate stage would be "Stage ?" since there is no way of knowing which DCIS lesions will become invasive and which ones will go away without any intervention.

Fact:  Metastatic means the cancer has spread beyond the cancer site to another part of the body.  Thus, most or all cancers (lung, colon, prostate, melanoma etc etc etc) have the potential to become metastatic. If breast cancer spreads to the lung, it's NOT lung cancer.  It's still breast cancer that has now taken up residence in the lung.  If lung cancer spreads to the brain, it's NOT brain cancer.  It's still lung cancer that has now found a spot in the brain.

Fact That Bears Repeating:

Metastatic Breast Cancer is not a TYPE of cancer.

Any type of breast cancer with any molecular signature can metastasize.  Some breast cancers are more likely to metastasize because they are more aggressive.  In plenty of cases, a metastasis is a crapshoot.  Off the top of my head and in less than a millisecond, I can think of five people who developed what might be considered an unexpected metastasis.  If I allow myself a full minute, I'm sure I could come up with a list that is far too long.

And the reason for this chat?  We are taught, as advocates, that it's not about our type of breast cancer.  It's about the community at large.

Since any type or subtype of breast cancer can and does metastasize, those of us who are staunch advocates for those who have metastatic disease are not advocating for a particular group.  We are advocating for all.  Any one of us has the potential to develop a distant metastasis.

To be chastised or to be accused of selecting a particular group of patients over another is off the mark. Metastatic patients are patients whose disease fits into any type or category.  They can be ductal or lobular, inflammatory or triple negative. They can be HER2 positive.  Or not.

In other words, it's not a type of disease, nor is it a population of patients with uniform diagnoses.  Their disease fits into every nook and cranny.  It's just that their needs are far more urgent than the needs of the rest of us.

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1 comment:

  1. Excellent breakdown - and a good reminder to post for this month.


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