The athlete and cancer

I am a 55 year old women nationally ranked competetive swimmer diagnosed with a 1.6cm medullary invasive cancer(histologic score 8 - grade III) of the right breast, ER neg, PR neg, HER2Hercep test 0/neg, sentinel lymph nodes(3)neg.  Aside from the obvious goal of destroying the cancer, my ultimate goal is to get through all the treatments and emerge as whole and in tact as possible. By that I mean I want to continue to be able to perform at a national and world level of competition.  My Dr.'s seem so uninformed and unconcerned about how cancer treatment effects athletic performance.

I'd prefer a breast conservation over mastectomy but I am concerned about radiation to the lung and damage to the chest and back muscles.  Could you comment on treatment plans both in effectiveness and in the light of any permanent damage to any part of my body which would effect athletic performance.

I've seen 2 oncology Dr's.  One wants AC the other CMF.  Each is willing to do either chemo treatment.  Could you comment on each treatment plan both in effectiveness and in the light of any permanent damage to any part of my body which would effect future athletic performance.

I am very willing to sacrifice a more "user UNfriendly" treatment plan in order to continue to be competetive the rest of my life.  My Dr's have never treated an "athlete" and have not been helpful.  Where else can I turn for info.  I'd hate to take a treatment which would damage my heart or lung, even minimally, if another equally effective option were available.

Thanks so much for this wonderful site!

[CCF-RN,MSN-rf]

Dear Phillyfish:  There is no research to date on cancer in the athlete.  There are athletes who have had cancer and have gone on to excell in their sports.  Scott Hamilton and Lance Armstrong are two examples that come to mind.  Both had surgery and chemotherapy.  Lance may also have had radiation therapy. Both have published books about their experiences.  Mario Lemeiux is another athlete (hockey player) who was treated with chemotherapy (he probably had adriamycin - see below) and returned to his sport.

In terms of choosing therapy, both approaches have pros and cons.  From the point of view of survival, both are equivalent.  Lumpectomy with radiation has a higher incidence of local recurrence for obvious reasons - but survival is not impacted.

Mastectomy is a bigger surgery with a slightly longer recovery.  If there is no axillary node dissection (since the sentinel LN bx was done), the recovery would likely be a couple of weeks.  Lumpectomy is an easier surgery but would require radiation therapy.  This would occur after the chemotherapy (whatever chemo you choose).  There are risks to radiation therapy, including lung damage and heart damage.  These are minimal and technique dependent - but they are there nonetheless.  Radiation may also cause temporary skin irritation.  

With respect to chemotherapy, the industry standard is AC for women who can tolerate the regimen.  CMF is used primarily in an older, frailer population.  Either is acceptable but research demonstrates survival advantage with AC.  The risks of AC (the A -adriamycin) can include cardiac damage (more common in people with preexisting heart trouble).  The incidence is rare and most women tolerate this regimen without any evidence of cardiac compromise.  The heart is always tested prior to this regimen.  CMF also has toxicities - although they are considered more mild.  

Another consideration may be time.  Mastectomy and chemotherapy would be the quicker treatment total time.  Lumpectomy, chemotherapy and radiation will add about 6 weeks to the total treatment duration.

With any option, the risk of damage is small.  However, there are no guarantees.  Treating an athlete is not much different than treating another person except that the athlete is usually in better physical condition and tolerates treatment better physically.  The athlete is also used to challenges and often has an easier time coping especially when the sport can serve as a distraction.  Conversely, athletes have a tendency to get frustrated with the fatigue and will tend to over do it sometimes.  Whatever option you choose, odds are that you will be able to return to competitive swimming.

[valpal]

I continued to play competitive tennis throughout 4 AC treatments and 4 taxotere treatments.  I am not at your level but did compete at one of the highest non professional levels in tennis.  With mastectomy you may have more problems with your arm.  I am not sure how the lumpectomy/snb has affected your arm but luckily your nodes were negative therefore you don't have to do the axillary node dissection.  I would not be concerned at all about the radiation. They are trying to just radiate the breast tissue and in your situation they will most likely not need to radiate the axilla.  I just finished and had minimal side affects.
Also, I'll bet that you will tolerate the AC very well.  My heart had no damage.  It was strong to begin with.  Be sure to drink alot of water and try to not compete day 3-4 after each treatment.  Be sure to ask about the procrit shots to keep the red blood cells counts up.  
My oncologist did everything possible to help me keep as active as I was before  -  she was wonderful.  She strongly encouraged tennis and any other exercise that I wanted to do.  Also, with the ac you will lose your hair - probably a plus for you with
swimming!

[cow chaser]

I ride cutting horses and was deathly afraid that I would have no strength to hold on to my saddle horn while the cutting.. I decided to lean on my faith and started a over the conter IP6  My pet scan is clear... and negative  Praise God!!  my tumor was 5cm.. the doctors are baffled