Metastatic breast cancer, for the vast majority of patients, has turned into a chronic disease. It’s rare in our practice to see a superaggressive type of presentation. Maybe three or four percent of my patients have disease that you just cannot get into remission. They mostly fall into the new classification of basaloid tumors — the triple negative tumors — and no matter how you treat those patients, they progress right through it.

But for the average patient with metastatic breast cancer, we can get them into remission very easily with either hormonal therapy or chemotherapy, and patients often live many, many years. We all have women in our practices who are now out 10, 12, 14 years or more with metastatic disease that is controlled and living reasonably normal lives most of the time. Many of these patients have never been hospitalized, even for complications of therapy.

— Charles Vogel, MD

(Received by email on May 15, 2006)

I think your CDs on breast, lung and colon cancer are terrific, but I would offer one comment about what I hear being said more and more (and not just on your CDs) in terms of changing cancer into a chronic disease.

I am not sure what anyone’s definition of a chronic disease is, but to the lay person (and to most nononcologists) a chronic disease is one you live with for many years (ie, decades, such as with diabetes or COPD), with perhaps even a normal life expectancy or a somewhat shortened life, though you are always dealing with issues from the disease.

That is clearly not what we are achieving when, for example, we control liver metastases from colon cancer for three or four years. And it is especially not a chronic disease when we tell a 38-year-old woman with metastatic breast cancer that we will make her disease a chronic one because she won’t die from it until she is at least 45 or possibly even 50.

I have a concern that we are misleading our patients (plus families and other healthcare professionals, including other oncologists) when we say we have converted metastatic breast cancer to a chronic disease.

While we have made substantial strides in recent years in treating a variety of metastatic cancers, we really should not be promoting this rather utopian concept of cancer as a chronic disease, at least not until more profound and dramatic improvements in disease control are achieved. Once again, however, many thanks for providing to us a terrific forum on critical issues involving our most common cancers.

— Tony Coscia, MD
Norwalk, Connecticut

I have an excellent quality of life interspersed by periods of sheer terror that I try to keep very short and very far between. Obviously you appreciate life a lot more in this situation.

Each day is very precious, and you are very happy to be out and about and able to do things you never thought you were going to be able to do again. The scary times usually last for several days, generally triggered by checkups and body scans, which for sure are harrowing experiences.

— 60-year-old woman with metastatic breast cancer
to the liver on high-dose estrogen therapy

I love life. I get out. I’m alive and I do things. I feel good. I’ve got energy. This situation has completely changed my life. Before this, I just kind of lived. Now, I live for a reason: To do better things and have more compassion for people. I want to help more.

I’m very involved with the Lord, and His will is my will. If tomorrow it’s time for me to go, I have no problem with that, and I’m very aware that that can happen to me. God brought Dr Vogel to me, and he’s just been wonderful. I know I’m in the best hands, and when it’s time to go, I’m ready.

I never cried over this. I never felt sorry for myself. I just thanked God it wasn’t one of my children. I’m very lucky. I’m very blessed.

— 72-year-old woman with soft-tissue metastases on capecitabine

You can’t explain this to someone who hasn’t gone through it. My family has watched me live with this for eight years. Do they really understand? No. And I don’t expect them to because you have to live it to understand it.

It’s maybe not a great saying, but I live like I’m on my way out and not on my way in. A girlfriend of mine who just passed away used to say, “These are my senior years now.” She was 40 years old. She’s right. These are my senior years now also, and I am on my way out. Anything can happen at any given time. I’m lucky. The treatment is working. Is it going to work forever? Probably not. But it’s working now, so I enjoy everything now.

If I could bottle what I have learned and teach it to other people, this world would be a better place.

— 44-year-old woman who has been treated with trastuzumab
for metastatic breast cancer since 1998