Chemotherapy given before surgery to remove cancer is called neoadjuvant treatment. An oncologist might recommend this based of the size of the tumor -- it being very large. The idea is to shrink the tumor and then have surgery to remove the cancer.

Having chemotherapy administered while the tumor is still there can show what drugs are working and what drugs have no effect on the tumor. Chemotherapy when started immediately, not after surgery with healing time needed, gives the patient systematic treatment right away. This could be beneficial and is why physicians might recommend this form of treatment. The truth is they don't know if it is better or not.

Of course, every case of breast cancer is different. We all need to make tough decisions regarding our treatment plan. The facts are that currently there is no evidence that survival is improved with neoadjuvant verses adjuvant (after surgery) chemotherapy in women with locally advanced breast cancer.

The clinical trials that are done help physicians understand what treatments are more effective. Results from a Phase II clinical trial was published in the Journal of Clinical Oncology. It stated that neoadjuvant treatment with Taxotere, Navelbine, and Herceptin resulted in a complete disappearance of detectable cancer in 39 percent of women with locally advanced HER2 positive breast cancer.

The study showed that after two years followup, on the thirty one women with locally advanced breast cancer involved in the study, the overall survival was 97 percent and cancer free survival was 84 percent.

So, the message here is that, even though the study group was small, the results showed a good response to this treatment plan.

My gut hasn't always guided me through life's most difficult decisions and dilemmas. It wasn't until I felt a lump in my breast more than two years ago that my gut kicked into gear and told me something very important.

"It's cancer," my insides told me one week before the surgeon who did my biopsy called.

"It's cancer," the surgeon said. I didn't tell him, but I thought it: "I know."

I also knew prior to surgery that my cancer had not spread to my lymph nodes. My gut told me this too. It also told me the chemotherapy drug Taxol was not right for me -- since my cancer had not spread -- despite the urging of one oncologist that I accept this treatment. I would have gone on gut instinct alone in my rejection of this medication but another doctor weighed in and agreed with my gut, so I had solid backing on this decision.

Many have dismissed hunches like these and have written off those who believe in them as screwballs, says writer Chip Brown in the March 2007 issue of The Oprah Magazine. But as Brown shares after peering into the world of gut instinct, there are 100 million nerve cells in the gut. They run on autopilot, regulate digestion, play a critical role in the body's immune system, and control mood-altering neurotransmitters identical to those in the brain.

The gut is essentially a second brain. It was a "gut feeling" that led Fred Smith, founder of Federal Express, to begin exploring the possibilities of overnight delivery and Howard Schultz, founder of Starbucks, to begin mass marketing coffee. Wall Street professionals make millions on their gut feelings, sportscasters make startling predictions based on gut guidance, and entrepreneurs launch thriving businesses because of the inklings that rumble in their tummies.

You may or may not be a gut thinker yourself. But I've stumbled upon a gut exercise -- thanks to psychotherapist Nancy Napier --and I'd like for you to consider it the next time you find yourself stuck at a crossroads, unsure of where to turn. You never know, the direction you seek may be swirling around in your midsection, just waiting for a call to action.

Think about this:

You are wavering between two choices. Find yourself a quiet, serene place where there will be no disruptions. Now sit down. Take a moment to settle and focus on the issue you want to explore. Then choose one side. Think about this side and notice what happens in your gut. Do you feel a tightening and gripping or a softening and warming? Are the sensations pleasant or uncomfortable? Notice your thoughts. Are they positive or negative? Give yourself some time to feel your gut and your mind responding.

Now shift to the other side. Think about the previous questions, and try to chart what your body gut is saying.

While you may not get a gut answer at first, if you come back with the question several times, you'll likely hear just what your gut wants you to know.

Wyeth officials say their hormone replacement therapy Prempro is not the cause of one Ohio woman's breast cancer. But two jury decisions prove otherwise.

The first jury, in October, awarded Jennie Nelson and her husband $1.5 million in compensatory damages, validating Nelson's claim that her breast cancer -- resulting in a double mastectomy, chemotherapy, and radiation -- was caused by the Prempro she took for six years. When this verdict was thrown out due to a mistrial, a retrial began.

The retrial concluded yesterday -- with a Philadelphia jury awarding the Nelsons this time with $3 million.

"Both times this case has been heard on terms established by Wyeth and still the juries have clearly found that Prempro causes breast cancer," says Nelson's attorney Tobias Millrood, adding that Wyeth puts sales ahead of patient safety.

Wyeth respectfully disagrees and argues that it acted responsibly in the promotion of its hormone replacement products and in disclosing with doctors and patients all therapy-associated health risks.

Millions of women have used Wyeth's hormone replacement therapies to control the effects of menopause, and the company, sanctioned in January to pay $1 million to an Arkansas breast cancer survivor, now faces more than 5,000 lawsuits of this same nature.

Despite a large-scale study revealing drugs like Prempro increase the risk of breast cancer if used for five years or more, the drug still remains on the market. And Wyeth is so sure their drug is not at fault for causing Nelson's breast cancer that they plan to appeal yesterday's verdict.

I know just how Jon Lester feels as he survives the cancer that took him out of the game of baseball and threw him into the arms of the medical system.

It's not the baseball I can identify with. It's the little bit of cancer fear that never really goes away. And it's the will to return to the land of the living that Lester and I share.

"When you're laying in bed at night, when you're not doing anything, you think about it a little bit," he says. "As long as I keep busy, I'm all right. Every now and again I feel something and go, `OK, what was that?' but I try not to think about it too much."

Lately, Lester is thinking mostly about a return to Boston's pitching staff, less than six months after a cancer curve ball came right at him, threatening both his promising career and his life.

Lester, whose weight was down to 190 during chemotherapy, is back up to 212 -- five pounds less than his normal weight -- and his arms are powerful, his legs strong, his appearance healthy.

As a rookie last year, Lester became the first Red Sox left-hander to win his first five decisions. He was 7-2 with a 4.76 ERA when cancer came crashing into his world. Diagnosed with anaplastic large cell lymphoma in August, Lester received treatment at both the Dana Farber Cancer Institute in Boston and at his hometown Hutchinson Cancer Research Center in Seattle. His last chemotherapy dose was delivered on December 4. His last check-up was in January. And now, newly 23 and cancer-free, Lester is ready to play ball.

Lester is prepared for his coaching staff to hold him back. He says he can tell everyone until he's blue in the face that he's ready but he knows the staff has his best interests in mind. He trusts their professional opinions, and he'll accept a return to the minors if that's what is in store for him.

"I'm not as hard on myself as I was last year," he said. "It's just a matter of enjoying playing baseball and not necessarily the result. So (I'm) just trying to enjoy things and take it day by day and live my life the best I can."

As a resource of medical information, take into account that there are over 25,000 medical journals published worldwide. For most of us, it is an overwhelming volume of information.

Doctor Evidence is an independent user-friendly fee-based medical search service connecting patients and doctors to the latest in relevant information which can then lead to the formulation of informed decisions about medical treatments -- and avoid potentially deadly mistakes in misdiagnosis, treatment or surgery.

In 2000, Dr. Todd Feinman founded Doctor Evidence after undergoing unnecessary surgery for intestinal cancer. After surgery he was told that the test that led to surgery had been a false-positive. He did not have cancer.

According to Dr. Feinman, "Every year, hundreds of new therapies and diagnostic tests are introduced to treat the thousands of diseases that are afflicting millions of adults and children. Finding evidence about the most accurate diagnostic tests and effective treatments requires the proper resources. This includes specialized information technologies, subscriptions to medical databases, medical librarians, and much more that is not readily available to most doctors and patients."

Yesterday, Extra aired a feature about Dr. Feinman and the Doctor Evidence service. During the report, a patient who had been told he might have pancreatic cancer turned to the Doctor Evidence website only to find out that one of the high-niacin level medications he was taking was mimicking symptoms of pancreatitis or pancreatic cancer. You can view the video of the segment online here.

Doctor Evidence staff is comprised of doctors with expertise in evidence-based medicine, medical librarians with masters in library science, other professionals with expertise in healthcare, and information technology experts. To learn more, visit the Doctor Evidence website.

I have a new friend who is a new breast cancer survivor. She is surviving a new diagnosis, a recent lumpectomy, and the moments leading up to another surgery to further investigate the margins surrounding the tumor removed from her breast. She is surviving the first phase of her breast cancer journey. A phase full of uncertainty and fear and panic. A phase so new and so fresh and so raw, her mind is whirling. A phase that has her grasping for any bit of direction she can find as she navigates a terrifying, unfamiliar road.

My friend is a young wife and mother whose worries are consuming her. She e-mailed me today and asked if I ever have moments when I look at my young children and worry that cancer will take me from them while they are young. She asked if I have always been so sure I will be okay. And so I replied with this candid cancer confession.

I can't decide what to do about my port now that my breast cancer treatment is over. It's been an on-going internal battle. I don't know whether I should leave it in place -- tunneled underneath the skin on my collarbone where it is available and accessible should I ever need further infusions of cancer-fighting drugs -- or whether I should have it removed since there is no real purpose for it right now. There is the issue of superstition and safety -- leaving it right where it is allows for easy use if cancer returns and prevents another surgery to implant a new one. But there is also the issue of moving on -- and removing it because I don't need it, because I may never need it. One doctor told me recently that it should come out because if it remains in my body, I risk infection. And anything foreign in my body for an extended period of time is not completely safe. But a cancer survivor told me that she had hers removed immediately after treatment and had to get a new one because her cancer recurred three months later.

I am accustomed to wrestling matches like this one -- like my stand-off between treatment with Taxol or without Taxol, between anti-depressant or no anti-depressant, between vegan diets and traditional diets. Sometimes I can make a good call. Sometimes I just can't decide. Like right now.

I have been a cheerleader for the breast cancer drug Herceptin ever since I began receiving it. I had my initial worries -- about an allergic reaction that I knew caused death within 24 hours for a handful of women and about possible toxicity to the heart -- but after faring well through my first dose and having now successfully completed my one year obligation to the drug, with no allergic reaction or heart damage, I have come to believe the Herceptin might just be the gem of a drug that the media says it is. Yet now I've read an article that makes me question what I really know about Herceptin -- and the studies that surround it and the statistics that back it and the messages sent out over the lines of mass communication to every day, non-medical people like me.