A Personal Cancer Struggle -- In the Public Eye

Since arriving in the office this morning and learning of Elizabeth Edwards' breast cancer recurrence, I have been trying to piece together the story of what happened and what the impact may be on Sen. John Edwards' presidential campaign.

I have been fascinated (if that is the correct word) at the guessing games that have been going on both about her health and his campaign.

Now that I have had a chance to see the news conference, it is clear that all this speculation about the senator suspending his campaign was way off the mark.

I do believe it's important from a medical point of view to bring a sense of rational discussion to the situation surrounding Mrs. Edwards' disease and her potential treatment. I have learned from experience that trying to guess about a particular person's situation is a dangerous game, and frequently incorrect.

One also learns to respect the privacy of celebrities when it comes to their health. Should they wish to share information, fine. But when they don't, it is equally important to take note of that decision and act accordingly.

The Edwards' were very open today about what is transpiring in their lives. There is still much that is unknown, and much that is unknowable.

What is clear, both from their comments and the comments of her physician, is that they have apparently provided us with all the information that they know, and perhaps even more than some of us would have expected.

What We Know Now

Let's take a look at what we do know.

Elizabeth Edwards is 57 years old. She had breast cancer diagnosed in 2004 during the presidential campaign. I have heard that she had chemotherapy and radiation therapy for her cancer, but we don't know the actual type of chemotherapy that she received nor do we know the characteristics of her breast cancer.

I do not know if Mrs. Edwards received any additional adjuvant therapy beyond the primary treatment course.

At today's news conference, as it was initially presented, Mrs. Edwards indicated that she developed pain on her left side after an apparent rib fracture following a hug from her husband (some hug!). That in turn led to a bone scan, which showed a lesion on the right side, which was subsequently biopsied.

I have been told that her doctor has now said that there may be other lesions present, so we really don't know the extent of the disease at this time. What we can say is that it has recurred, and at the least has metastasized to the one area of bone.

And, more important, we don't know yet what treatment will be prescribed.

What the doctors are going to do (in fact, are already doing) is perform a number of studies to get an idea of where the disease has spread. They have already taken a biopsy, and they are going to do additional tests on that biopsy to get a sense of the characteristics of the recurrent disease.

Once that analysis is done, they will make recommendations regarding therapy. However, based on the comments by Mrs. Edwards, it would appear that the treatment would have only modest side effects. That suggests a treatment other than intensive chemotherapy.

But with these comments I find myself falling into the same speculative trap that I warned about.

Decisions about treating recurrent breast cancer are complex, and it takes time to complete the studies, obtain the results of the biopsies, and analyze the tissue.

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