When we think about things, we often use frames to organize, and focus our experiences. Think about how a picture frame focuses the content of what’s inside. Or when we list things based on a valence – such as “positive” or “negative”. Those are examples of what people (mostly in the social sciences) call frames.

I’m taking a comparison of my mother’s breast cancer diagnosis and treatment experience compared to my own, and- highlighting the differences rather than the similarities – using “frames” to some extent.

My mother was diagnosed with breast cancer in 1986. How long she had her particular lump is hard to say – but she never had a mammogram, and by the time she went to the doctor with the lump, the surgeon expessed certainty that it was malignant. It was a cigar-shaped lump in her left breast. After surgery (she had a radical masectomy and lymph node resection), but no metastatic disease as far as we knew. Now I can’t remember if she was even scanned for metastatic disease. As post-menopausal, she was treated with tamoxifen. It was only after she died that I learned she also had 9/19 nodes positive. It should have been no surprise when pain in her hip lead to a diagnosis of bone mets. That was in early 1989. Several courses of chemotherapy and more radiation to various bone areas to ease the pain. For a while, things seemed to be ok, but then in mid-1990, bone mets lead to brain mets, spine compression and my mother died in early 1991 of liver failure.

I was diagnosed in 2010, a smaller tumor, and one that we knew was malignant from the start, but one that looked benign to the radiologist who did the biopsy. I had clear margins, no spread to lymph nodes and no evidence of metastases. I am also post-menopausal, but was recommended for chemotherapy because of the aggressive nature of my tumor. I had a lumpectomy, and I have completed 3/4 of my chemotherapy, I will receive radiation to the lumpectomy site, and I will take a newer generation drug, armidex, rather than tamoxifen.

Some weird things with time. I was diagnosed Dec 21, 2010 with breast cancer, the day we brought my mother home from the hospital to die 20 years earlier. My first trip to the oncologist was the same day my mother died. My diagnosis and treatment decisions have been bracketed by my mother’s death and it’s eerie. I’ve posted about this before. At first, all I could think about was that my story had to be the same as my mother’s with the same ending. Death. And at various times during chemotherapy, especially when I’m tired, I see my mother in myself. Especially in the eyes. However, as time goes on, I see more differences than similarities. The passage of time, differences in diagnoses and prognoses, and individual differences.

With the passage of 20 years comes more information and changes in treatments as a consequence.Twenty years ago, I would not be receiving chemotherapy as a postmenopausal woman without a metastasis. But now, I am, because too many women with node negative status and aggressive (Grade 3) tumors did end up with recurrences and metastasis. There are different ways to receive chemotherapy. Twenty years ago, the idea was to give the strongest dose possible. Now, there are dose dense methods – lower, more frequent infusions increase exposure to the drug, possibly capturing more cells at a vulnerable time. And although this doesn’t apply to me specifically, neoadjuvant therapies – shrinking tumors prior to surgery help to improve prognoses.

As for differences in treatment, I don’t remember now if there were screens in between. I know my mother had mammography yearly on her remaining breast, but I don’t recall other scans prior to finding the metastasis. I had clear margins, no positive nodes and my tumor was perhaps an inch around. I also had no evidence of metastatic disease from bone, lung and liver/abdominal scans. So a far better prognosis from the start. I will also have more frequent scans to follow up on any possible metastatic activity, and my left breast will have mammography every 6 months, my right every 12.

Our diagnoses and prognoses differ, too. I don’t know if my mother and I have the same type of tumor. Maybe so – but I don’t know that the same pathology/histology screening in 1986 was available. My mother’s surgeon described the tumor to me as cigar shaped, and he was sure it was malignant. I can’t remember the dimensions, I want to say about 2-3 inches, so 5-7 cm. The margins were clear, but 9 or 19 lymph nodes were affected. So it was no wonder that 2 1/2 years later, metastases were found. Maybe the mets were there already. My tumor resembled a benign fibroadenoma – in fact when the radiologist did the needle biposy, he assured me it was benign – I could, if I wanted just follow it. I had no problem saying no, biopsy now, for which I am quite thankful. Even my surgeon said that the exterior of the tumor resembled a fibroadenoma, but it was invasive ductal cancer, the most common type of breast cancer.

And I suppose we differ in our approach, and personality. I wish I knew then what I knew now (absent the technical advances) about being in the moment, and not trying to view this all as a war. I wish we knew more about the important of easing anxiety and depression from the outset. But it also has to do with individual differences and autonomy. Each of us has to choose the path we will take, given the information at hand. I’m also a much stronger person at 56 than I was at 36.

Focusing on the differences rather than the similarities doesn’t mean I love my mother any less, nor cherish her memory any less. But it does mean that I look at the experience in a more positive manner, something that should (I hope) help me deal with both the present and the past.