Indolence

“Indolent” is an adjective meaning lazy. Doctors use this to describe conditions that “cause little or no pain,” as in the use described in this recent New York Times article. I find the medical profession’s use of this term to be perversely hilarious.

As someone who’s made it (making it) through multiple cancers, and has personally discussed “indolent” growths with several docs, I know there is plenty of pain that comes with potentially cancerous, yet indolent, growths. It’s just pain of the emotional variety.

I’m not saying that I disagree with the less aggressive approach favored by Dr. Laura Esserman as outlined in the New York Times article above. There is growing evidence that DCIS patients would be just as well off in the long term by foregoing any treatment (surgery and/or radiation) as they would if they went through treatment. One might fairly ask, then: given those options, what sort of crazy person would choose surgery and radiation?

Well, it turns out a lot of people would.

At this point I should remind everyone that I didn’t have true DCIS, which is “pre-cancerous” or Stage 0. Rather, I had DCIS with microinvasions, which means that the cancer had begun to spread outside of my ducts, invading nearby tissues. These invasions, even though they were “micro,” bumped me up to a Stage 1 diagnosis, placing me outside of the group of indolent lesions discussed in the NYT article.As one of the docs quoted in this article notes, it is this chance of finding invasive cancer that makes it so hard to draw a clear line regarding the approach to DCIS:

“But no one has these tools now to know whether or not it’s safe [to only do surveillance rather than treatment], and the biggest factor is we know that when we do surgery on D.C.I.S., about 10 percent of the time, commingled with the D.C.I.S. is invasive cancer.” – Dr. Elisa Port, Chief of Breast Surgery at Mount Sinai Hospital

“She added: ‘When we talk about watching and waiting with D.C.I.S., the question is, ‘How do we know it’s just D.C.I.S.?’ The answer is that we don’t.’”

Don’t get me wrong: I admire what Dr. Esserman is trying to do. She seems to be a gifted researcher who is dedicated to figuring out how to improve treatment for breast cancer patients. After all, even She Hulk can have too much radiation. I’m someone who doesn’t take medicine for colds and waits a ridiculously long time to even take OTC medications for headaches. I strongly believe that the healthcare industry has traded convenience and risk-avoidance for thoughtful preventive care.

But when you are the person with the potentially – but not assuredly – indolent growth…well, it becomes a much more difficult choice to decline treatment. I’m actually a little relieved that I had stage 1 breast cancer rather than true DCIS, because it would have been a very difficult decision to determine how to proceed. As it is, I am looking at a 96-98% cure rate and I can feel confident that I made the right choices with regard to my care.

Alas, indolence is in the eye of the beholder.

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Indolence