With my radiation burn healing up nicely, I had my worst-part-is-over appointment with my oncologist late last week and talked through the pros and cons of two options for the next phase of my cancer treatment: hormone therapy. 1. Ten years on Tamoxifen, the drug that most women my age and with my type of breast cancer take (a daily pill) to block the body's uptake of estrogen.

2. Three years of aromatase inhibitors (also a daily pill), plus periodic injections that would would essentially turn off my body's estrogen spigot. Traditionally, only post-menopausal women take the aromatase inhibitors route, because the drugs don't work if you're still ovulating. But recent studies have shown that after inducing early menopause, aromatase inhibitors can work better than Tamoxifen — especially for women like me, with cancer that metastasized to nearby lymph nodes. So, option 2, it is! Both forms of hormone therapy come with some gnarly side-effects. With aromatase inhibitors, the biggies are joint and muscle pain and an elevated risk of osteoporosis. I'm going to be diligent about taking calcium and vitamin D supplements, in addition to eating healthy and doing lots of good weight-bearing exercise, both good for the bones (mind, body and soul, too, of course).

After a month, if I'm tolerating the aromatase inhibitors well, I'll continue getting the ovary shut-down injections every four months and might also get a supplemental treatment to lower my risk of osteoporosis. If I do, get this: Studies have shown it may decrease the risk of breast cancer. Go figure!

If aromatase inhibitors really kick my ass, I can switch to Tamoxifen.

In the weeks since I celebrated the end of radiation, many of you have asked if there's some sort of scan or test I'll get to declare my cancer fight an official victory. The answer is no. While CT and PET scans can pick up signs of breast cancer recurrence a few months before there's any palpable tumor regrowth, those scans don't do anything to increase survival rates.

So aside from hormone therapy, my next step is a mammogram of my right breast in six months. In the meantime, I'll closely monitor my ex-breast; most recurring tumors are pretty easy to spot because they crop up close to the skin. I'll see my oncologist again in three months, with periodic phone check-ins with him and my primary care doc as needed.

Am I anxious about this next phase? You betchya.

I'm trying my best to feel grateful that because my cancer was estrogen-sensitive, I can get this additional treatment to increase my odds of kicking it for good. It's as important for my survival as chemo was.

So here I go ... again.

UPDATE: Since I first wrote this, guidelines for aromatase inhibitors have changed. I'll be on them for the next 10 years, not just three.

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