Weighing In on Breast Cancer

Or at least on the raging debate that has occurred this week.  Warning notice:  I’m about to express some opinions.  Some of those opinions will be supported by “facts” (I place quotes around “facts”, because facts can never be separated from our perception of them–that must be the philosophy student in me rearing its ugly head), but I will not be posting any links for you to check where I got my “facts”.  If you don’t believe me, look it up yourself.  As I am fond of saying, this is a blog, not a term paper.  You won’t find any op. cits. here.  Additional warning:  You can dispute the “facts” all you want unless it concerns my personal body, which you don’t have enough information about to dispute. 

That doesn’t mean you won’t get some links.  To begin with, Thursday’s op-ed column in the NY Times by Gail Collins, always one of my favorites, who pretty much pokes fun at the hysteria the “new” recommendations concerning mammograms has engendered.  “New”, as in, returning to previous recommendations, with now even more evidence to support them.  But the hysteria involves “rationing” and “death panels”.  God, you people (and you know who you are) make me tired.  I suggested to my most rabidly conservative friend that he read her column, and he did, and sent me a message afterwards that I would describe as a diatribe, if I weren’t trying to be kinder and gentler.  In his defense, his mother and many other people he knows have had breast cancer, so it is a very emotional issue for him.  Yeah, well, me too.  In her column, Gail mentions that she had breast cancer herself.  I think she should be cut a little slack for that.  But never underestimate the power of fear, and men fear for their wives, their mothers, their daughters, their sisters, and their friends, and fear is never subject to logic.  It would be foolish to think that only women are affected by breast cancer, and I’m not talking about the fact that men get breast cancer too, which they do.  I’m talking about it affecting the men who love the women who get it.  And if you are the person who has cancer, you feel very much that the situation is out of your control.  As the friend or family member of a person with cancer, you are that much more out of control.  It’s like helpless, then helpless once removed.  That’s why you find people with cancer comforting those around them;  it’s actually worse for you. 

Now we move to the “facts”.  Most breast cancers are extremely slow growing.  It takes years for a tumor to be large enough to be visible on a mammogram.  So two years is not an unreasonable interval. 

Most women develop breast cancer after age 50. 

The value of self-exams has been questioned for forever.  I understand in theory that if you know your own body, you’re better able to detect changes.  Nothing wrong with that.  The problem is that most women don’t know what they’re looking for.  Many women have “lumpy” breasts (sorry to get so technical).  It’s called fibrocystic disease, which is benign (although I’ve recently learned that a history of it is now considered a risk factor for breast cancer), so even if you were to detect a new lump, your response might be “whatever”. 

Mammograms are far better than self-exams, except they aren’t very good.  Collins notes that having just had a clear mammogram, she then found a lump on her own.  In this case, self-exam worked.  The most sensible thing I heard all week was a quote by someone from the Susan B. Komen Foundation who said that this was at least a good debate, since it sheds light on the fact that mammograms are a poor test.  CT scans are much better, but they cost ten times what a mammogram does.  Now there is the debate we should be having:  about why we aren’t doing the best testing available.  Mammograms are crude, and reading them is subject to varying levels of competence by the radiologist.  Of course, so are CT scans. 

Now we get to the part about cutting me some slack too.  In my own case, the tumor was detected by CT scan–a scan I had for an entirely different reason.  Afterwards, I had a mammogram and an ultrasound, but it’s important to note that the mammogram I had was “diagnostic” as opposed to “screening”.  Screening mammograms, which are of the type women have every year, are very general, and I think of them as tests that something has to jump off the screen for the radiologist to recognize.  Between the screening mammogram and the breast exam by a doctor, you hope you will pick up something, operative word here being hope.  Not guaranteed.  Diagnostic mammograms are a lot more detailed (and a lot less fun).  After the CT scan I had, I had that diagnostic mammogram and that’s what I have every year now.  And the results of that first diagnostic were, yeah, there’s something there…not sure what it is….

I will never know for sure whether a screening mammogram would have picked up the tumor first, before I had the CT.  But I seriously doubt it.  My personal advice is, if you can afford it, have a CT scan.  (You have to do that anyway if you have breast implants, I recently learned!)

Finally, for a bit more factual information.  This op-ed article appeared in today’s NY Times and it’s entitled Addicted to Mammograms.  The author explains rather well the history of breast cancer treatment and recommendations, and really, it would apply to most cancers. 

If you’ve read this blog for any length of time, you know that I have a friend who is dying of breast cancer that metastasized to bone.  In distress, I once asked our (mutual) radiation oncologist, if you know where breast cancer is likely to metastasize, why don’t you test for it?  To make a long answer short, the answer was, “It wouldn’t do any good.”  Our methods of detection are primitive, and methods of treatment are worse.   

But I have to tell you, it positively insults me to the core to have politicians trying to tell me that the government wants to kill me.  It’s almost too ignorant to dignify with a comment.  If you care so much, give some money to the NIH for cancer research.  Oh wait, that’s a government agency (Government bad, Tarzan good.)  Okay then, give it to the American Cancer Society.  But your grandstanding is definitely not working for me.