First -- The "Better" News

Okay, so there isn't a whole lot of "good" news when you've been diagnosed with cancer, but everything is relative, and the info I've received over the last two days has injected us with some much-needed hopefulness.

First, I had a pre-op mammogram today (my first ever, and what a bizarre thing a mammo is, too). Results were all clear on both sides: no masses, no calcifications. ("Calcification" is the build-up of calcium in the breast tissue and may indicate early signs of cancerous growth. They are usually small specks, like grains of sand, and can't be detected by clinical exam. But I don't have any, so we don't have to worry!)

Second, and even more thrilling, was my Tuesday pre-op appointment with my surgeon, Dr. Tartter. The meeting was initially scheduled to be my post-op appt, back before we knew that I would need more surgery. Dr. Tartter has been on vacation since the week after my first lumpectomy, and even though I've made fast friends with Wendy, the Physician's Assistant, this was my first time speaking with Dr. Tartter since the diagnosis. I was terrified that he would give me even more bad news, that maybe Wendy had tried to go easy on me. On the contrary, Dr. Tartter was very encouraging in his reading and explaining of the pathology report. Here are the highlights:

• Whereas the path report states that I have 3 positive margins (that is, cancer cells at or near the edges of the mass that was removed), Dr. Tartter explained that I actually only have one small area that is close. A tumor, when removed, is marked as if it is a cube or box: with 6 flat sides coming together at right angles. Of course, in reality it can be shaped very differently, with rounded edges, uneven sides and angles, and so forth. My positive margins happened to be at the "intersection" of 3 of those flat sides - like on the point of a cube. So, technically, it is 3 margins, but in practical terms, there is only one spot where the doctor will go back for a bit more tissue.
  
• My positive margins were the best kind of positive, which is to say "not very." A "clean" or "negative" margin is generally considered to be one with 2 mm of normal breast tissue between the cancer cells and the outside edge of the mass. My margin was between 1 and 2 mm - what they sometimes call a "dirty" margin. Dr. Tartter said that he normally would not even go back for one such margin, but since we need to do the sentinel node biopsy anway, he'll take out more tissue there as "insurance" (his word).
• Dr. Tartter said I should disregard studies that conclude that younger women diagnosed with breast cancer have a lower survival rate and/or a worse prognosis than older women with the same disease. He recently published a paper on that topic, parsing the literature, and concluded that the difference is not statistically significant.
  

In conclusion, YAY! The best news we've heard so far. At the end of our appointment, I asked Dr. Tartter if all this meant that we shouldn't be panicking as much as we have been, and he answered, "I don't think you should be panicking at all." I really felt, for the first time since receiving this diagnosis last week and despite my bravado about "focusing on what I can control, going one step at a time, thinking about the most positive outcome, and blah, blah, blah," like I'm going to beat this thing - I'm going to live.