My cancer is taking a test this week. It’s the Breast Cancer Index test (BCI for short), a test that predicts the likelihood that my cancer will metastasize (spread) to another part of my body other than the breast, and give me cancer in that part of my body.
There are a lot of weird and scary and cool things about this test. But the first thing that came to my mind when my doctor recommended the test was: Wait, you mean my cancer still exists?!
In November it will be eight years since I was diagnosed with stage 2 estrogen and progesterone receptor positive breast cancer. Three tumors were removed from my right breast. I never asked what happened to those tumors. In fact, I thought more about what happened to my bloody placenta after my babies were born than I did about the three cancerous, potentially life-ending tumors that were removed from my body.
Imagine my surprise when I learned that they are still very much alive, housed in a lab somewhere, and are now being called upon to give information about the damage that they’ve done.
It’s weird to think that they’re still alive, separate from my body. I imagine them in a jar of fluid, looking like an ochre octopus, laughing maniacally at the damage that they’ve caused. Do they sit on a shelf next to someone else’s tumors? Do they make faces at each other through the glass?
Photo by Andy Barbour on Pexels.com
Because my cancer is hormone receptor positive, meaning that it feeds on estrogen, my current treatment involves anti-estrogen therapy. I’m on a shot and a pill (sounds like a good night at a bar, but it’s not) to keep my body from producing estrogen. These therapies put me into menopause before I turned forty and have given me early osteopenia. I also blame them for my prediabetes, which is more common in women who have low estrogen.
The first purpose of the BCI test is to predict the risk of recurrence in years 5-10 post-diagnosis. And I feel as nervous for this result as I did when I took the SATs. I’m going to way oversimplify the medical jargon here, so read up on the BCI if you are considering it. The result of the test will be a percentage that predicts the possible return of my cancer.
Now, I’ve been living pretty worry-free for about seven years not knowing the actual number that describes my chances of my cancer metastasizing. But now, regardless of what the number is, it’s like the line in Dumb and Dumber: “So you’re telling me there’s a chance.”
When I walked into my oncologist’s office a month ago, I thought she was going to tell me that I could stop my aromatase inhibitor medication and Lupron injections. I thought I was going to get to see if my periods come back. (A few more years of being young!) But then, record scratch: she introduced me to the BCI. “There’s this test that can help predict if you would benefit from staying on the shot and pill combo for a few more years.” It’s the story of my breast cancer experience: as soon as you think you know what’s going to happen next, there’s a pivot. A change. A new test. A new drug. A new piece of information. In this case, a new purpose for an old tumor.
The second purpose of the BCI is to determine whether a patient would benefit from additional anti-estrogen therapy. In my case, the shot and pill cocktail. The result actually tells you YES or NO. It’s kind of like a pregnancy test, though there’s no peeing on a stick with this one.
It’s not exactly like a pregnancy test though. With a pregnancy test, a “no” means 100% no baby. But a “no” on the BCI doesn’t mean that your risk of recurrence is zero. It just means that you won’t benefit from additional medication. It’s a determination of, “Well, we’ve done all we can here.” It does usually mean that there’s a very small risk of recurrence, like 3%. But when you’ve lost the cancer lottery once, anything seems possible.
It’s scary to think of not being on any kind of medication or therapy for cancer. It’s like driving without a seatbelt. You’re constantly worried that you might go through the windshield.
There are specific requirements for who can benefit from the BCI, and in fact, its benefit for women like me who are on ovarian suppression (thanks to a shot) plus aromatase inhibitors (the pill) is murkier. Sometimes, more information is more terrifying.
Still, I’m eager to discuss the result with my oncologist, and to do a little more reading beforehand so that I can ask thoughtful questions. A lot of the trepidation comes from the delivery: It’s a lot scarier to be told that there’s a 5% chance you’re going to go through the windshield than that there’s a 95% chance you’re not going through the windshield. I’m going to try and keep both in my head when I get the results.
If you’re eligible for this test, I’d encourage you to read up on it and be very clear about what it is that it’s testing and what the results mean. The testing center is very easy to talk with, and has an extremely forgiving financial assistance policy. So if your insurance won’t foot the bill, definitely look into the financial assistance.
I’ll report on my scores in a future post. In the meantime, have you taken the BCI? What did you learn?