When I first looked at my pathology report more than 18 months ago, it made little sense. Terms like Bloom Richardson Score and margins and Her2Neu were as foreign to me as the breast cancer that somehow invaded my body. So I read it over and over again and was eventually able to identify the basic meaning hidden within the four pages that detailed my disease. As it turned out, this report was my map. It led me in various directions for various treatments. It contained some roadblocks. It was sometimes confusing. And sometimes I got lost. There were some good and not-so-good stops along the way. And in the end, I reached my final destination -- in the land survival. And this is where I hope to stay. For a long time.

My map is not necessary anymore -- although I still look back at it. I've found that it makes more sense now that time has passed. I can interpret it more objectively, with more perspective and less emotion and fear. I am still learning about the disease that was removed from my breast. And I am realizing there was a lot I never really knew -- like these seven subjects -- when breast cancer was new and fresh and debilitating.

• My tumor was 1.1 centimeter is size. I had no spread to lymph nodes. My cancer was called stage 1. This was the easiest material to digest. But it still meant that cancer faced me, and it was enough to scare me. Now I realize that these three characteristics are pretty good. My tumor was fairly small. It did not spread. It was found at the earliest stage. Not bad -- except that I was 34 at the time. One doctor told me, "A good tumor in a young woman is still a bad tumor." But with the passage of time, even this frightening statement is something I can take in stride.

• I knew I had invasive ductal carcinoma -- yet that meant nothing to me. It was only a name, a title. Now I know that about 86 percent of breast cancers start in the ducts and about 70 percent of breast cancer cases are just like mine. I've learned that the word invasive -- while a bit scary -- only means that the cancer has grown out of the duct where it started and into the surrounding tissue. And I know now that it's not the type of cancer that determines prognosis -- it's the size. And my tumor was fairly small.
  

• I have learned that cancer cells may look aggressive -- mine did -- but that they may just appear that way. There's no way to predict if they will actually act aggressively. Well-differentiated cells are closest to normal, poorly-differentiated cells are most wild-looking, and moderately-differentiated cells are in between. Most women have either moderately or poorly-differentiated cells but can still survive well.

• It took me a long time to figure out the Bloom-Richardson Score that was listed on my pathology report as grade 2 (score 7). This is a commonly-used scoring system based on certain features of the cell. A score in the range of 3-5 is grade one. Range 6-7 is grade two. And range 8-9 is grade three. Grade three is the highest and supposedly the most aggressive -- but the features are all very subjective, and one comparison of pathologists' scores on the same cancer showed they agreed only 75 percent of the time.

• My report told me that my margins were clear. This means there was no cancer found at the margins of the tissue that was removed. Sometimes when a tumor is removed in more than one piece, it's hard to tell if the margins are clear. And pathologists can only do representative samples -- to do all of them would require thousands of slides. So margins are clear is just an estimated guess -- it's just an attempt at predicting whether or not cancer still remains in the patient's breast.

• Estrogen and progesterone receptor tests reveal how the tumor is behaving. Mine were both negative -- so my tumor was not fueled by hormones. In general, tumors that are hormone sensitive are slower growing and carry with them a better prognosis. Premenopausal women -- like me -- tend to be negative on both counts while postmenopausal women tend to be positive. Some women may be negative on one and positive on the other. And those who find themselves in the positive category respond to hormone blocking treatments. I do not.

• Another measurement looks for overexpression -- too many copies -- of Her2Neu which is one of the dominant oncogenes that contribute to cancer. One-third of invasive cancers have this tendency. Mine did. And this road on my map led me to treatment with Herceptin -- which at the time of my diagnosis was still a questionable drug. Now it seems to be the possible wonder drug for women like me who are Her2Neu positive.

What I've learned most by looking back at what first overwhelmed me is that there are no real definites with breast cancer. There are estimations and guesses and opinions -- but there is no one indication of how anyone will fare with this disease. Which can be a good thing -- because it opens the door for hope. It allows us to set aside statistics and predictions and to live fully without worry about the scary numbers that appear on a pathology report. So maybe one doctor's opinion is that "a good tumor in a young woman is still a bad tumor." But there is always room for exception. There is always room for hope. So I am letting go of my pathology report for now. I'm packing it away in my box of breast cancer stuff. And I'm hanging on to hope.