by Janet Tingey

Tuesday, July 28th, 2009 2:45 p.m.

“Y’know,” my young, gorgeous surgeon said, as she cupped my breast in her hand, “I don’t think your breasts are all that small.”

What?! This was the most amazing thing I’d ever heard in my life.

My breast inferiority complex started at home. My mom and sister had much bigger boobs. My dad, inappropriately, liked to point that out, and tell me I looked like a boy. Cue: body issues, enter stage right.

I never found bras that fit. I’d go into the store, try to find the smallest versions of an A cup, and sneak furtively into the dressing room with a dozen or so to try on. I can tell you which brands are generous in their interpretation of A cup (Bali), and which might actually fit me (Maidenform occasionally.) Once a dressing room attendant tried to help me. She looked at me in the bra I’d decided would do, and said, “Oh, honey, no, when it puckers and folds over on top, that’s not a good fit.” A good fit was not found that day.

I was in bed with a guy. He said he loved large breasted women. I was puzzled. I asked, “Do you think my breasts are large?” What did I know? Maybe everyone else he’d dated was a Lilliputian. He replied, “You have great legs.” Oh. Nope, he’d dated other women with real breasts. That was the last time I saw him.

On July 20th, 2009, I got a phone call at 11:13 a.m. telling me that I had an invasive ductal carcinoma. Three hours later, my husband and I sat in the office of Martha, the Wonder Nurse, my Breast Advocate, who carefully explained the pathology and my treatment options. She asked, gently, “What’s your cup size?”

“Er, it’s easiest to describe as Minus A,” I replied.

“Yes, I thought you might be rather small breasted. Sometimes, a lumpectomy isn’t an option for small breasted women because there’s isn’t much left over,” Martha explained. “It can be better to go to a mastectomy in that case, because then you don’t have to do radiation therapy.”

That was the question my surgeon answered: Was my breast so small as to not be worth the bother of trying to save, given that saving it would mean a more arduous treatment? I was prepared to sign up for the bilateral mastectomy–heck, lop them both off. Nobody would notice.

The first thing I learned from breast cancer: My breasts aren’t all that small.

I opted for the lumpectomy with radiation option. The jury was out on whether or not I’d need chemo. Every doctor who looked at the initial pathology report said I probably wouldn’t need it. After surgery, I met with my medical oncologist. She said that my pathology was unclear: nobody could give me a definitive answer whether or not chemo would help more than it would hurt. There are some very nasty side effects involved in chemo, it’s better to not do it if you don’t have to.

My med onc encouraged me to sign up for the TailorX study, a huge study being run by the National Cancer Institute, to determine the benefits of chemo in cases like mine.

In order to participate, I agreed to one more test, an oncotype test. This test looks at the expression of certain genes in the DNA and gives a score as its result. If the score is less than 11, no chemo is needed. If the score is greater than 25, chemo provides an obvious benefit. A score between 11 and 25 is the study’s sweet spot. For women who score in that range, the benefit of chemo is unknown. Women in the study who fall in that range are randomized to either receive, or not receive, chemo, through the luck of the draw.

My med onc encouraged me to participate so that the cost of the test (three grand) would be covered. And, she pointed out, why not leave the decision to chance, given that nobody knows the answer.

I said, okay, and signed a bazillion disclaimers that let them keep tissue samples of me forever and share medical info and all that. I don’t really care. I just knew I was having a heck of a time figuring out if I should or should not have chemo, so: why not.

The oncotype score came back. I scored: 24, and I’d randomized to not have chemo. HOLY SHIT!!! Suddenly, I wanted chemo. I wanted it more than anything. My husband said, “Sometimes, when you get the answer you don’t expect, you figure out the answer you really wanted.”

I called every doctor I ever knew and asked their opinion. I hit up residents on the elevator: “Hey, if you had an oncotype score of 24, would you go for chemo? Or would you skip it?”

The second thing I learned from breast cancer: I wanted to kick it in the ass. Really, really hard. That reality contained a corollary lesson. I did, in fact, want to live. (The jury had been out on that one.)

Most of the doctors said they’d skip the chemo. The side effects can be devastating. One doctor abstained from giving me an opinion, saying she was not well informed enough to give one. The best opinion I got came from Martha, the Wonder Nurse. She explained it thus:

"Suppose you don’t get chemo. Then, ten years from now, if you have a relapse, you’ll bash yourself, telling yourself that you should have had chemo back then. But really, no doctor in the world will be able to say definitively that you’ve relapsed because you didn’t have chemo, and that you would not have relapsed if you’d had it. They just won’t know."

The third thing I learned from breast cancer: When doctor’s say, “I don’t know” that the breadth and depth of what they don’t know is mind boggling. They mean it when they say “I don’t know.” I let the study roll the dice for me, and went the no chemo route.

In addition to the support I’ve received from bitchyourselfthin.com, I also got support from an online group on Ravelry, Knitters with Breast Cancer. Through that group, I met (online) an amazing woman named Treena. She’d been diagnosed with Inflammatory Breast Cancer while pregnant. She went through treatment, had a mastectomy, and was still able to nurse her daughter with her remaining breast. A few months after I met her, her cancer relapsed. She died. Her daughter was two at the time of her mother’s death.

The fourth thing I learned from breast cancer: I am not immortal. One might think I’d have learned this earlier in the process, but no. In fact, I’m still not sure I fully believe it. I’ve landed in a weird place, where I’ve survived the first round of treatment and am “cancer-free." I think I won’t die of cancer. Treena reminds me that this is a fatal disease.

I am now on a drug therapy that will go on for quite some time. The drug, an aromitase inhibitor, prevents output from my adrenal system from turning into estrogen. The tumor was estrogen positive, which means that estrogen binds to the cancer cells and helps them grow. I am now leading the estrogen-free lifestyle.

There are some down sides to the estrogen-free lifestyle. Any one of us gals who has been through menopause will report on the increased difficulty of losing weight. When living totally estrogen-free, one gets additional bonuses, such as bone density loss, joint pain, and waking up to hands and feet cramped into arthritic, crab-claw stiffness that can take anywhere from a few minutes to a few hours to wear off.

I have gained about seven pounds while on this medication. The docs won’t list weight gain as a Real Side Effect, they’ll only say it seems to happen to some women on the medication. My theory is that they won’t list it as an actual side effect because there are so many women who would rather be dead than fat.

In September, I started training to run a 5K race with two friends. I am being exceptionally careful, fearful of damaging my more-delicate joints. I have good shoes, I only run on a track. I fully anticipated that running would get me over the estrogen-free weight-loss stall. It has not.

The other day, I stood in front of the bathroom mirror–post-shower, before getting dressed. I took a good look at myself. And thought: okay. I can live with this. I may never lose another pound, but I’ve never stopped being who I am because of what I weigh.

The last thing I’ve learned from breast cancer: I am better fat than dead.

 Writer Janet Tingey is co-founder of bitchyourselfthin.