Sometimes it's hard to believe I'm 5 years into this process - other times I can't even remember what life was like BC (before cancer).
For five years, starting 5/1/21, I have taken my estrogen blocking meds (letrozole) every single day. For five years it has worn away my bones, my hair, my youth, my skin, my private parts, and my physique. My body is almost unrecognizable 5 years later. But I religiously took that pill every damn day because my choice is to do everything I can to prevent cancer recurrence.
That was my personal choice, and one that I can comfortably live with knowing I did whatever I could. Sadly the biological crapshoot of cancer might pay no attention and it might have all been for nothing - but it did give me at least 5 years without a recurrence, and here we are.
The BCI (Breast Cancer Index) is a genomic profile of one's specific tumor, and it gives a binary yes/no answer to whether 7 vs 5 years of anti-endocrine therapy will be useful in recurrence prevention. The data seems clear that 10 years of therapy doesn't show much benefit in recurrence prevention compared to 7, but it does significantly increase the risks and side effects of therapy such as osteoporosis. So somewhere between 5 and 10 years seems to be the sweet spot, and the BCI helps patients decide whether to continue from years 5-10.
As you can see above, my answer was a definitive NO. Regardless of whether I take 2 more years of letrozole or not, my overall risk recurrence from years 5-10 is 4.7%. (Which means a 95.3% chance of NOT having recurrence, which is a number I like....) Given the severe hit to my bones this drug has caused, I am partially relieved to stop it. I don't think many of the other changes will reverse given menopause is permanent, but there's a chance some of my bone density will recover, and for that I would be incredibly grateful.
But I am not entirely excited about stopping this drug - it means I have nothing standing between me and cancer besides my own lifestyle choices, my body's own ability to fight recurrence and metastasis, and basically a leap of faith. When you know there might be cancer cells floating around, just waiting for the chance to rear their biological heads, not doing anything specific to fight it feels icky. It's motivating me to use everything in my own control to keep my body hostile to cancer recurrence, and will talk about my own integrative approach to recurrence prevention in a post soon. I know there are things I can do to prevent recurrence - and I know those might not make a difference.
But for now, I am at peace knowing I took the 5 years of anti-hormone therapy, and ultimately the side effects and crappiness of it were worth it for me, such that if I am faced with recurrence I don't have to wonder "what if I had done.....". I didn't do chemo or XRT - and I don't regret the chemo choice, but sometimes "what if I had done XRT" creeps into my mind when I'm fearing regional lymph node recurrence. But at the time, I decided the risks of XRT were not worth the benefit, and someday if I had to look back at that decision from a place of recurrence, I would be at peace with it.
There are no guarantees in life, and even fewer when it comes to cancer. We wish we could predict who would recur, who is low risk enough to avoid medication altogether, and who might spare themselves the side effects and misery of endocrine therapy if their cancer would just come storming back anyway. We can't know these things, so we make our individual decisions with the (hopefully) best evidence we have. 5 years of letrozole was the right path for me. With fear - and some joy - I cancelled my auto-ship from the pharmacy today, and will be pill free as of 5/1/26 after 5 long years. My bones took a significant hit from this therapy so the focus now is building them back - and keeping my body inhospitable to cancer using its own metabolism, without the safety net of that little yellow pill.
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