Well, the girls are going through another round of assessment before surgery. When we last met with Dr. Beatty last Monday, he seemed frustrated with the lack of complete information he’d gotten from my MRI, diagnostic mammogram, and ultrasound. On Tuesday morning, he left me a message sounding mildly excited about a suggestion he’d received at case conference earlier in the morning. Yes, my breasts have been presented at a case conference, which means that my cancer is no longer boring. The case conference was attended by a number of physicians who work with breast cancer, surgeons, radiologists, radiation oncologist, medical oncologists, etc.
I called him back and he told me that one of the recommendations was that I do a positron emissions mammogram (PEM). If this sounds a little like a PET scan, that is not an accident since PET stands for positron emissions tomography. I’m sure my physician would correct me but I’m going to say it’s basically a PET scan of my breasts. The main advantage of this technology is that the clinical trials (it is in stage III clinical trials, which is the last stage by which a drug or technique is tested and if the results are positive, becomes part of standard medical practice), have shown evidence that it is particularly suited to pre-menopausal women, with dense breast tissue, and hormone responsive tumors. Sound like anyone you know?
My understanding is that the other imaging techniques have taken “pictures” of the structure of the tissue and the form of the cells. PEM actually takes a picture of differences in the rate of glucose metabolism (rate by which sugar is broken down and converted to energy) across the breast tissue. Since cancer cells metabolize more quickly than noncancerous cells, they can be “spotted” in the picture because they are shown in a different color (or shade of black/white/gray). This is my understanding and it is somewhat tenuous. My grasp of nuclear medicine and cellular biology are kind of limited.
So they can control my sugar intake during the procedure, I need to follow a strict diet for the 24 hours prior to the procedure-meat, nuts, cheese, butter, peanut butter, and non starchy vegetables. There’s stuff I think would probably be okay like black coffee but it’s not on the forbidden or okay list so I’m not going to chance it. Before the procedure, they will inject me with a solution of glucose and radioactive stuff. Then I sit quietly for an hour. Then they take pictures And as an extra bonus, I get to sit in a comfy chair for the entire procedure. Huzzah!
I know that one consequence of this is that they might find more stage 1 or stage 0 cancer that they didn’t know about before. My thought is that it is better to know about this so that we can do something about it. Fortunately, the specificity and sensitivity of the PEM is high. That means that the false positive and false negative rates are low while the true positive rate is high. Okay, that was not the clearest explanation about something in my area of expertise–measurement. But I’m in a hurry for another medical appointment so this will have to do for now.
So the big PEM day is next Monday. Wish me luck!
My Eyes Are Up Here 
That sounds GREAT! Especially the being completely dressed & no boobs getting squished part. Is it topography or tomography? I thought PETscans were tomography.
You are correct that it is tomography and it’s “positron” instead of “positronic.” (I make a lot of errors on my blog and I usually go back and correct them later after I’ve learned more or after my mind has cleared and I remember how to spell again. However, I just looked again and it’s misspelled on a number of websites including a hospital website where they spell it two ways on the same page. Oops!) After talking to the scheduler yesterday, it sounds like they are going to put me in a PET scan machine instead of a PEM only machine. I am guessing this based on her last question, “Are you claustrophobic?” A mild bummer because I will need to do the enclosed space thing. I survived the MRI, though. It was less time but disconcertingly noisy, squeaky, and vibrating. The directions say I can listen to an mp3 player but “no reading”. So it must be more open than an MRI machine if someone thinks they could fit a book in there. Actually what the brochure said is that I could not read while I was “waiting” and did not specify whether this was the hour of waiting after the injection or the hour of waiting for them to finish the scanning. But not being able to read after the injection does not sound logical. Anyhoo, I’ll find out on Monday morning. I’m going with the flow as best I can.
I am so glad they presented you at their case conference…many brilliant minds working all together for a better treatment plan!! Yes! Yes! And to then have a diagnostic tool that will be used specifically for your cancer…yes very good news! So I will be cheering for you…Have a relaxing time in the machine and that will be a good time to practice your mindfulness based meditation techniques Yes? Hugs Karen
Thanks, Karen! I did tell Dr. Beatty that although I don’t like idea that being presented at case conference means that I don’t “boring cancer”, but that I very much appreciated his asking for additional consultation. You know, he is pretty senior and the head of breast surgery at Swedish. He was also a professor for many years and used to be the Executive Director of the National Cancer Institute in Canada. People in those positions can give in to the temptation of being too sure of themselves but he has been honest, humble, and dedicated to doing everything he can to help me.