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.
Sharing a Struggle With the Public
What does impress me is the openness and the honesty the Edwards family displayed today in talking with the media.
This is an intensely personal situation.
It is one that is experienced by thousands upon thousands of cancer patients every year in this country. It is not unlike what many folks have to go through in their daily lives.
The difference is that this woman's husband is running for president of the United States.
Mrs. Edwards looks well and feels well, and that in my professional opinion is a very important observation.
In fact, given current guidelines, we do not do routine bone scans to look for recurrence at the earliest possible moment. Instead, we usually let a woman's symptoms and sense of well-being guide us into looking for recurrent disease.
In Mrs. Edwards' circumstance, the lesion on the bone where the cancer was found was asymptomatic. Under usual circumstances, it may not have been found for some time.
The Edwards' have already crossed the biggest hurdle of this discussion, and that was the comment that her disease is treatable but not curable.
Future Remains Unclear
We do not know as I write this what the future holds for Mrs. Edwards. I have seen patients do very well under these circumstances, and I have seen patients not do as well.
What I do know is that I have had many patients with more serious and more extensive recurrent breast cancer who have done well for extended periods -- and that was before we had access to many of the more effective drugs and targeted therapies that are available today.
I will not provide a statistic as to Mrs. Edwards' prognosis. I believe that is inappropriate in this type of circumstance, for all the reasons I have mentioned above.
Each woman with breast cancer, at the time of recurrence, is an individual. The extent of their disease, the characteristics of their disease, their treatment options and many other considerations must be considered in making such a prediction.
You may see survival statistics quoted in various reports, and these statistics may be attributed to the American Cancer Society. However, those statistics refer to the stage of disease at the time of initial diagnosis, which for Mrs. Edwards was in 2004. They do not apply to recurrent breast cancer, which for Mrs. Edwards occurred in 2007.
I admire the Edwardses and their physician for being so forthcoming. Had they not been, I would not have provided as much commentary as I have here. They have made this task much easier, and more honest than it would have been otherwise.
We must remember that Mrs. Edwards is one woman -- like so many women -- who has a disease that may take one of many paths. The Edwards appear to understand that, as reflected in their statements, their experience and their demeanor. This is not the first time they have had to deal with serious personal life-altering issues.
Our hopes and prayers go out to Mrs. Edwards and her family, as they do to all the women and families who have faced this disease with similar strength, love and support.
What we saw on camera today was exemplary, but it is no less an example than the one experienced in many homes in this country every day.
This is one woman who represents many. We should never forget that as we follow Mrs. Edwards through the upcoming campaign and her personal battle to fight this disease.
Dr. Len Lichtenfeld is deputy chief medical officer for the American Cancer Society. You can view the full blog by clicking here.