Friday was my second-opinion visit at Dana-Farber. It was also the birthday of my doula clients’ baby…scheduled for just the day I couldn’t be there for them. I was there to help them get started and there to rejoice afterwards, but my doula partner was there for the labor and birth. Everything went fabulously and everyone is happy, and only I am also very sad. But mostly happy.

The second-opinion appointment was very useful. Judy Garber, the oncologist I saw at DFCI, was really helpful and nice, gave us lots of balanced, nuanced information about chemotherapy options, and told us more about genetic testing and my personal chances of having the BRCA1 and BRCA2 mutations.

I feel like my field of view on chemo options has opened up a bit, which is good. She said either TCx4 or CMFx8 would be a good choice–both are equivalent as far as efficacy goes, and while CMF has many years of evidence behind it that TCx4 doesn’t have, TCx4 has one recent very positive study and people have been using it, including her, going on the hunch that the evidence will continue to be positive. The T (Taxotere aka docetaxel) has been shown to be very effective in late-stage breast cancer and also to work as well or better on ER-/PR- cancers as on ER+/PR+ ones.

Genetic mutations and testing: she confirmed that whether or not I have the mutations does not affect current treatment at all. She said someone with breast cancer has a 2% chance of having the mutations; someone with breast cancer under 35 has a 10% chance (that was me before); someone under 35 with Ashkenazi background (that’s me) has a 30% chance; and her guess is that if you add another tumor before 40 you are “not quite 50/50, but close.”

So that opens up a whole can of worms, which I am examining briefly and then pushing down into the can again until the genetic testing appointment (9/22) and the results.

She also said that as far as she knows, recurrence risk is not greater if this is a second cancer (which is not what that one study of contralateral breast cancer concluded). I like her idea better.