I have a 30 minute commute to work every morning, and since I ran out of money to pay for XM radio, I've decided to start listening to NPR. In the last week they have broadcasted two separate stories claiming that early stage breast cancers should probably not be treated as radically as they have been lately. They claim overdiagnosis is causing too many women to undergo unnecessary surgery, chemotherapy and radiation, which would not change their survival or recurrence rates. They elude to a conspiracy of the healthcare industry making money off of naive patients. The first UCSF article even claimed that some early stage cancers probably would have resolved themselves over time (Alvarado, Ozanne, and Esserman, e41). At first listen I felt my face flush wondering if I had made the right choice.... did I go through suffering and misery and mutilate myself for no reason other than simply listening the good advice of Kaiser Permanente? I decided to google further and was once again assured that I did make the right choice. Recurrence is real. Breast cancer, if left untreated can decide to migrate into other vital organs and ultimately cause death. Upon reading these articles, I do see a valid point, that late stage cancers seem unaffected by breakthroughs in early detection, but that shouldn't have a weigh in on how early stage cancer is routinely treated. Patients should still be entitled to options. 10% this and 2% that doesn't say where Peggy Sue will end up in 10 years.
Today's NPR article quoted co-author of the new study, Monica Morrow as saying "I have seen young women who leave the office having signed up for lumpectomy," Morrow says, "and they call back the next day and say, 'Well, I was on the Internet or I was talking to my friends and they said I'm a young mother, don't I want to do everything I can to be there for my child? I think I want a double mastectomy.(Knox, 2012)" What sticks out to me in this quote was the reference to young women. Where are the factors indicating that young women who opt out of mastectomy have no recurrence? I can list 3 women in my circle of contacts who have opted for lumpectomy and have still had a recurrence. It seems way too early to make that call and point the drastic finger to "young women." Young women are the ones who can catch cancer early and stop it before it spreads. A study telling women to opt out of mastectomy and/or radiation unfortunately sends a message that they probably shouldn't worry about cancer too much at all. Even though they are two completely different statements, they are read between the lines the same way to someone who has not had to experience a biopsy or be read a path report. If I had never had cancer I would have come across these two studies and probably thought..... hey cool, even if the lump is small, these media releases tell me it's probably no big deal, right? WRONG. Early detection is key and making a treatment decision is up to the patient, the doctor, the family AND a second opinion! EVERY case is different and should never be classified for treatment based on early stage or tumor size etc.
OK, rant over.
http://www.asco.org/ASCOv2/Home/Education%20&%20Training/Educational%20Book/PDF%20Files/2012/zds00112000e40.PDF
http://www.npr.org/blogs/health/2012/11/28/166064484/more-women-choose-double-mastectomy-but-study-says-many-dont-need-it
Entries and experiences of a breast cancer survivor going through treatment, motherhood and life.
I cam across your blog and wanted to clarify something about this post. The Alvarado, Esserman and Ozanne article talking about over diagnosis is focussed on DCIS (ductal carcinoma in situ) and not specifically talking about invasive cancer and definitely not talking about triple negative invasive cancer. The incidence of DCIS has skyrocketed over the last 20 yrs with no decrease in the rate of invasive cancer. DCIS was assumed to be the absolute precursor to invasive cancer. What is thought is that we are identifying DCIS that is likely to never "progress" to an invasive cancer and therefore possibly to harm to women with excessive surgery and specifically radiation.
ReplyDeleteCompletely agree with you regarding decisions about breast cancer- every case is different and every patient is different. It needs to be recognized that it is a shared decision process and the patient is ultimate in charge of the final decision. It is the physicians' responsibility to help the patient with the information. Congratulations on 2 years!!!
Thanks so much, Valyisa. That is exactly the type of clarification I think should be a little more prominent in the studies so that the general message of the findings are not misheard by the otherwise uninformed. Fortunately, many people may not have had to deal with cancer in their lives, and so they may not be familiar with the important details that you mention. That is when the words "early stage" and "young women" in conjunction with over diagnosis, can send the wrong message. Hopefully listeners and readers still know that self-exams and early detection are important and not to disregard important signs to see their provider and be examined by a professional. Adding this important information to the end of these studies would further the efforts of prevention and awareness. That is where I feel the stories were lacking.
ReplyDeleteI sincerely appreciate the reply and your visit to my humble blog :)