She's the guru on breast cancer, the woman who writes the continually updated breast cancer bible. She's Dr. Susan Love, author of Dr. Susan Love's Breast Book, and in the May/June 2007 issue of MAMM magazine, she shares some of her latest thoughts.

On milk ducts

Dr. Love says all breast cancer begins in the milk ducts. If we want to get rid of breast cancer, she says, we need to understand where it starts. Until recently, we weren't able to do that. Now, doctors can numb the nipple, thread a catheter into a milk duct and sample the fluid, cells, carcinogens, and hormones. By looking at the location where cancer develops, there's the potential to find out how it started and how to prevent it. In March, Dr. Love's Research Foundation sponsored a conference on this topic.

On MRI

Dr. Love is not a big fan of MRI. It's overly sensitive and finds everything -- most of which is not cancer, she says. MRI leads women on wild goose chases so Dr. Love likes to reserve this test for women at high-risk.

Yesterday, I saw my oncologist for one of my every-three-month follow-up visits. As always, I went armed with my list of questions -- which is really my list of worries -- and one by one, I rattled them off. On a little sticky note, I had written:

• Lymph node
  
• Digital mammogram
  
• Next MRI
  
• Heart
  
• Colonoscopy

And this is what my doctor had to say about my concerns of the day:

Just recently, European researchers announced that MRI scans offer a new way to detect breast cancer in its earliest form. They can even prevent cancer among high-risk women.

Better than standard mammograms, MRI can detect a nonmalignant tumor called ductal carcinoma in-situ, or DCIS. Once found, the lesion can be surgically removed before it becomes cancerous.

Think about this: It is believed that almost all breast cancer starts out as DCIS. And this: if MRI were the gold standard breast cancer screening tool, we might be able to prevent a lot more breast cancer cases than we do now. It seems researchers agree.

Magnetic resonance imaging, or MRI, may offer an alternative to conventional colonoscopy, according to a new study.

MRI does not require the insertion of a long tube in the rectum and with the use of a special technique called fecal tagging, patients do not have to undergo bowel cleansing as in conventional colonoscopy. An advantage of conventional colonoscopy over MRI is that polyps that are detected can be removed or biopsied during the procedure.

The study found that MRI can accurately detect polyps that have potential to become cancerous, but is not as good as detecting small polyps. According to the lead author on the study, Dr. Christiane A. Kuehle, MRI colonography was good at detecting polyps greater than 5 millimeters in diameter, but nearly always missed smaller polyps.

The researchers believe that conventional colonoscopy will remain the screening method of choice for colon cancer.

David Foster was diagnosed with Advanced Renal Cell Carcinoma in April 2005. Translation: stage four kidney cancer and the sixth deadliest form of cancer. Not a great disease to acquire. Also not the end of the world. Just ask David who is busy working as a National Strategic Advisor in Augusta, Georgia, headlining within the independent magazine community, hanging out with dog Gracie, and documenting his journey in a blog he calls David Foster's Kicking Kidney Cancer's Arse.

He's no wimp, this guy. Just read his June 23 post, titled May kill me, but it ain't gonna beat me. He didn't let that hard-nosed kid Jerry whip him when he was eight -- he smacked him so hard in the lunchroom, Jerry was left stumbling and bleeding -- and he won't let cancer bully him either. Still, David admits: he is sick. He explains it all in a post he calls Mr. Foster, are you really sick?

David got an e-mail one day. It read, Mr. Foster, are you really sick? I read your blog and you don't sound sick.

Magnetic resonance imaging (MRI) showed in a study presented at the 2007 annual meeting of the American Society of Clinical Oncology to be better at detecting ductal carcinoma in situ (DCIS) than mammograms. MRI's were also shown to be very good at detecting high grade DCIS.

Women are recommended by the American Cancer Society to get an annual mammogram after the age of 40, do clinical breast exams starting in your 20's and if you are in a high risk group to receive annual screening with a breast MRI.

In a study among almost 6,000 women who were screened with both MRI and mammography, MRI detected 92 percent of DCIS cases where mammography only detected 56 percent of cases diagnosed.

As I worked my way to the check-out cubicle at my oncology office yesterday, I carried with me the small stack of paperwork my doctor had handed me. There was a sheet denoting all my charges -- of course. There were orders for a mammogram and MRI. There was a summary of sorts about my visit. I handed each of these papers to the woman eagerly awaiting receipt of my money -- but before I let them leave my hands, I noticed a check mark on one of the papers. It was located right next to words: No cancer present, in remission. There were other words -- like cancer recurrence -- where my check mark could have landed. But it didn't. I ended up just where I want it be, just where I want it to stay.

A simple check mark brightened my day. It's not that I thought my cancer had returned. It's just that my every-three-month check-ups open the door for this possibility. I go to these appointments for a reason -- to identify cancer's current role in my life -- and so there's always a chance something will be discovered. But not today.

No cancer present, in remission. These are five of the most beautiful words ever written about me.

Elizabeth Edwards, wife of Democratic presidential candidate John Edwards, has had many routine medical follow-ups since her 2004 breast cancer diagnosis. And all of them -- until just a few days ago -- resulted in what is generally termed a clean bill of health.

The term doesn't always come with a sense of relief for those of us surviving breast cancer -- or any cancer for that matter -- because it only really defines what our bodies are telling us at one specific moment. There are no magic blood tests, no special body scans, no conclusive ways of determining whether or not cancerous cells have gone astray and will one day surface again.

I asked my oncologist after my first six-month follow-up how he would know if my cancer returns. He told me it's really up to me to determine whether it comes back. It's up to me to get mammograms and ultrasounds and MRIs. It's up to me to report any symptoms and suspicions. It's up to me to track my general well-being so that it will be clear when something feels not-so-right. If I have a persistent cough or headaches that won't subside, my doctor will take action with X-rays and scans and tests. But as long as I feel fine and nothing troubling presents itself, then I remain in the clean-bill-of-health club.

Edwards no longer has a clean bill of health. But she is determined to use her newest diagnosis -- stage four metastatic cancer of the bones, considered treatable but not curable -- to work toward the best health she can acquire for as long as she can hold onto it. And that is about as good as any of us can do.

The doctor who read my mammogram and ultrasound results today is the same doctor who detected in my recent MRI something of unknown significance. Today, the unknown remains. But the significance is not so significant.

This doctor saw an unusual pattern of tissue in my right breast when she viewed my Friday MRI results, some sort of enhancement she didn't see in the left breast or on the MRI I had a year ago. But today's mammogram looked good and today's ultrasound did too. So I guess if three different imaging tests don't turn up anything truly suspicious and there doesn't appear to be anything to biopsy, then all is well. For now.

All that must be determined now is when I will report back for more screening to chart the state of the dense breast tissue that keeps me on my toes.

Another bullet dodged. Another day in the life of a worried breast cancer girl.

A doctor found something suspicious when she read the results of the breast MRI I had on Friday. What she found is of unknown significance. This means something caught her attention. She just isn't sure what it is.

This doctor does know that whatever it is inside my right breast appears to be a low-risk something. But still, there's a concern looming in the air -- for her and for me.

I spoke with my oncologist about this concern, and he told me anything suspicious must be pursued by further testing. I'm thankful for that. He also said he expects that nothing actually significant will come of this. But if it does, it will have been caught early.

On Friday, I will report for further testing -- a mammogram and an ultrasound -- and then I will learn more about this unknown something that inhabits my breast, this something that takes me back more than two whole years when another something turned out to be what I feared more than anything. Breast cancer.

While sitting in the lobby of my hospital's MRI center on Friday -- time for the annual breast MRI -- I found myself a bit irritated by an appointment mix-up that kept me waiting much too long for a procedure that in and of itself is no real treat.

As I waited to bare my breasts and dangle them through square cut-outs on an MRI table, I flipped through a few ancient magazines -- why are lobby offerings so old? -- and as is usually the case when I read just about any publication, out jumped some cancer news.

So maybe the wait was worth it. Without it, I wouldn't have found this enlightening bit of information, this thought for today.

Now I warn you -- this item I am about to share comes from an October 2005 issue of Parenting magazine, so it's a bit outdated. But it still holds some truth. And if you remember nothing else from this message, I hope you'll take to heart this one lesson -- women tend to overestimate their chances of developing breast cancer.

Think about this:

• 46%: What women estimate is their lifetime risk of getting breast cancer
• 13%: Their actual risk

My blood looked good. My weight is normal. My temperature was 98.2. My blood pressure was perfect. And the physical exam conducted by my oncologist revealed that for another three-month stretch, I have survived cancer.

There are other exams ahead in the next few months -- a breast MRI, a mammogram, an ultrasound, a follow-up with my radiation oncologist -- but mostly, my life revolves around the every-three-month visit with my medical oncologist. He's the one who plotted the course of my treatment, responds to my physical and emotional ups and downs, and checks my every piece and part. He is the one who will declare my remission in five years, if warranted. He is the one who told me today I am doing very well.

And for the next three months, I will assume I am just that -- very well. And my hope is that on May 21, when I depart his office once again, I am able to report that not one thing has changed.

Cancer-related fear once consumed my mind. Now it sits lodged in the back of my brain and only presents itself on rare occasions.

I handle my fears so much better now than when cancer was new and fresh and raw. My fears hardly ever cause me real anxiety, they don't cripple my mental functioning anymore, and more than ever, they serve to focus my efforts in life. When fear strikes, it's usually a wake-up call of sorts, a reminder to leave no stone unturned, a summons to keep on living.

Although so much less threatening than they once were, my fears still exist. And I like to review them once in awhile, lose myself in a little emotional housekeeping, tidy up some of the mess cancer made. I always feel better when things are in order -- fears included.

• I fear a breast cancer recurrence, the return of a tumor that rises to the surface of my skin and presents itself again underneath my fingertips -- or in my worst-case scenario is lost among dense breast tissue, undetected by self-exam, and caught too late by some combination of mammogram, ultrasound, and MRI.

• I fear more than anything another cancer -- something entirely different from breast cancer, something buried in my body and not as responsive as breast cancer to treatment. I am prepared for a second visit from breast cancer because I know how to proceed, know I will succumb to treatment that is familiar, know I will remove both breasts in the most radical of life-saving approaches. But cancer in my lungs, brain, bones, blood, ovaries is out of my realm. And these cancers -- among many others -- really scare me.
  

• I fear that my mom and my sister -- my first-degree female relatives -- will one day follow in my breast cancer footsteps. I once thought family history trickled down from above, from older family members. Now I know the disease can start with anyone. I am the anyone in my family. I am the reason my mom and sister are closely watched and monitored and tested. I am the one that put the fear of cancer into their hearts and minds -- and into mine.
  

• I fear having another baby. I fear the return of cancer during pregnancy, leaving me with difficult choices regarding my health and my baby's health. I fear cancer returning after a baby is born, leaving me with one more child and more treatment to manage. I fear another cancer would lead to a decreased chance of survival and another baby would leave my husband feeling stranded should I die too soon. And I fear having a baby girl who would inherit the very real chance of developing breast cancer at some time during her life.
  

• I fear not having another baby. I fear the regret I may feel one day, perhaps 50 years from now when I am healthy and cancer-free and without the child I longed for. I fear I am being overly cautious, too tentative, a bit selfish. A fellow cancer survivor once wrote me, "I learned that my family continues, even if I do not. I also learned that they are at least as tough as I am so will cope with the genes I pass to them and their own cancer battles if needed. Finally, I learned they look out for each other just as I looked out for them. No matter what your future, you will never regret giving another child a place in your family." I fear this man may be right.
  

• I fear dying at a young age. I fear leaving my children before they are grown. I fear leaving my husband a single parent, my mom someone who has lost a child, and my sister an only child. I have been told over and over again that my chances of survival are great, fantastic even. I have a 93 percent chance of not dying from breast cancer. This does seem great -- until I take into account that this percentage is good for only five years. My five years will expire when I am 39 years old. What happens then, I am not sure. The only thing I am sure about is that five years is not enough time. I want more, need more, demand more. Yet I fear my days may be numbered.
  

These are the fears that keep me focused. And while they are sometimes not-so-pleasant, I am in no hurry to resolve any of them. I am thankful really to have these fears swirling in my head -- because it means I am alive. And for me, being alive with fears is better than not being alive at all.

It was his father's death from stomach cancer -- and the cold, impersonal, clinical manner in which his father was treated leading up to his death -- that inspired Dr. Jeremy Geffen to become the kind of oncologist he wished had been available for his father -- "someone who could look into the mind, heart, and spirit of a human being as intently as he could gaze at an MRI scan or pathology report; someone who provided love, support, wisdom, and hope."

For the 20 years that have followed his father's death, Geffen's inspiration has led him in exactly this direction. He credits education and a strong network of mentors for preparing him for the path less traveled, for allowing him to achieve his vision for comprehensive, integrative medical care.

Geffen founded the Geffen Cancer Center and Research Institute in 1994, and directed it until 2003. It was one of the first cancer centers in the United States created specifically to provide complete, holistic care for people with cancer and their loved ones.

After working closely with cancer patients over the years, Geffen observed that every single question and concern encountered on the journey through cancer falls precisely into one of seven different yet interrelated domains.

Geffen wrote down these domains -- he calls them the Seven Levels of Healing -- and began sharing them with his patients and staff who remarked that the levels perfectly mirrored their own experiences. And so Geffen kept them fresh in his mind and over the course of time developed them into a formal program that became the foundation for the standard of care offered to his patients and their loved ones.

Geffen's book -- that brings life to the Seven Levels of Healing -- is called The Journey Through Cancer: Healing and Transforming the Whole Person. It is a result of his own personal journey that began the day his father left a dreaded string of words on his answering machine. "Oh, Jeremy. I think I've got a little problem. I had an endoscopy today and the doctor said I have a tumor in my stomach. Unfortunately, it's malignant. Maybe you could give me a call."

Geffen was in medical school when his father recorded these words. Now he is an accomplished oncologist, author, public speaker. He is the father of the Seven Levels of Healing -- soon to be revealed right here on The Cancer Blog.

To read previous post on the same topic, visit:
Sunday Seven: Seven Levels of Healing on Cancer Journey

Stay tuned for:
The Journey Through Cancer: What Is The Purpose of Medicine?