Tuesday, July 21, 2009


I'm all done with chemotherapy, to which I responded well. The next question is, should I have radiation? This is a controversial question for the type of cancer I had (primary mediastinal diffuse large B-cell lymphoma). My oncologist recommended getting a second opinion; he sent me to a lymphoma specialist he works with, Dr. Brian Link in Iowa City.

Dr. Link explained that radiation reduces the risk for relapse by 5-10%, a figure that agreed with my own research. The question is, are the risks of radiation worth that benefit? My tumor was under my breastbone. The major risks of radiation in this location are heart disease and, for women, especially young women, breast cancer.

I have no family history of heart disease or of breast cancer; I also have no risk factors for either disease. Dr. Link explains that he worries most about radiation-induced breast cancer in women in their young twenties and in teenagers. Since I am in my late twenties, he's more comfortable with my level of risk. Because my baseline risk for heart disease and breast cancer are relatively low, he believes the benefits of radiation outweigh the increased risks for those conditions.

Dr. Link also told me that he had colleagues - lymphoma specialists at other institutions - that did not believe radiation should be given in cases like mine. The research data is just not there to support a firm opinion in either direction.

With no good data to guide me, though, it seems prudent to follow the advice of my doctors. Today, I met with my radiation oncologist. He was pretty thorough about explaining all the short-term side effects of radiation treatment.

He said many women getting radiation to the chest worry about breast cancer, but this seemed to only be an issue for teenage women. I mentioned the studies I'd seen of women treated 30-40 years ago that experienced significantly higher rates of breast cancer. I'm aware that treatment in the past 8-12 years has used lower doses of radiation applied to smaller areas of the body. But the long-term affects of radiation don't appear for 15-20 years, so there's no data on how effective the newer treatments are at reducing such risks. "Yes," he replied, "there's no data showing current treatments increase the risk for breast cancer."

The radiation oncologist didn't even mention the risk of heart disease. I guess it's a psychological defense mechanism: he doesn't want to believe he's harming his patients. Oh, well. I need him to be good at giving me radiation, not at deciding whether to use it in the first place.

I will have my setup visit Thursday, and then I'll have treatments every day (Monday through Friday) for five weeks. I've enjoyed the past several weeks of no treatment, and it's disappointing to once again have frequent visits to the hospital. Still, I think these weeks will go by quickly.

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