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New in Breast Cancer: What’s the point of the science if nobody believes it?

February 4, 2013

Boston Globe, today February 4th.  Health Monday, “the daily dose”.  Deborah Kotz, author.  “Why Mastectomies are on the rise”.

Apparently surgeons are seeing a surge in requests from breast cancer patients to have both breasts removed rather than removing just the malignant lump.  Ms Kotz says that “That’s despite findings from seven large clinical trials which showed that, for tumors that hadn’t spread beyond the breast, mastectomies didn’t provide additional benefits over more conservative surgery…”  She then cites a recent article in the journal “Cancer” that lumpectomy with radiation might actually be BETTER than mastectomy.  I can’t find that citation.  I’ve asked her to send me the reference.  I could do a whole literature search for you people at some other time, but the Globe is saying it so we’re going to go with it for now.

Here’s the kicker, and the reason for this post.  The director of breast surgical services at Dana-Farber and Brigham and Women’s cancer center, Dr. Mehra Golshan, gives the following quote:

“It’s a nice study but it’s hard to imagine that less surgery with radiation gives a better outcome.”

But, but, but…. Dr. Golshan, rest easy because YOU DON’T HAVE TO IMAGINE IT.  IT’S IN THE STUDY!  Otherwise, what’s the point of doing research???  It’s a nice study?  I’m sure the authors would be very grateful to hear you say that.  You, the director of one of the most famous cancer centers in the world.  Who are all us poor women going to listen to?

According to Ms Kotz, and I have heard this in other places also, there has been a sharp increase in the number of women diagnosed with stage 0 cancers, self-contained cells that are sometimes considered pre-cancer because doctors don’t know if they’ll ever grow to become a breast cancer.  Fine.  Better safe than sorry.  But people, women are getting both their breasts removed completely, possibly for a few cells that may or may not become cancerous, JUST IN CASE?

Well, that’s ok, because insurance covers the entire cost of mastectomy and reconstruction.  So these women can get breasts back. Well, sort of.  To do that, you have to undergo multiple surgical procedures.  One of these is a 12-15 hour marathon, which leaves you with a scar on your abdomen and a couple of lumps on your chest that then require revisions, nipple reconstruction, etc. etc.  Or you can do implants, but you have to have tissue expanders first, then the implants, then whatever maintenance those require.

Some women can’t live with the uncertainty.  Treatment sucks.  They don’t ever want to do that again.  I get it.  But that’s what research is for – to infuse a little rationality into what is admittedly a very emotional decision.  Let’s let the researchers help us.

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From → Healthcare

2 Comments
  1. The reference which indicates that women with breast-conserving therapy and radiation do better than those who had mastectomies is available as an abstract in this link. Important to understand that there were more than 110,000 patients examined, and also that these patients covered a very large period of time from 1990 to 2004. Thus, there is likely improvement in survival and disease-specific survivals in both these groups of late, with the addition of better imaging–finding breast cancer even sooner and improved therapies. This type of study should be considered quite reliable, and is not one of those “popular press” articles, too often badly interpreted.

    Those women who chose to have double mastectomies when there is a threat of breast cancer truly show a lack of confidence in our medical system and the advances that have been made. As cancer survivor of a Stage IV diagnosis, I am sensitive to the fear this instills, and impressed by the advances made in all cancer treatments these last 9 years–an era not covered in this test.

    http://onlinelibrary.wiley.com/doi/10.1002/cncr.27795/abstract

    • Thank you for that reference. I agree that the study is very reliable. I found out about it through the popular press, which is where most of my readers will go. I appreciate the comment about lack of confidence in the medical system. I hadn’t thought about it that way. Our physicians have to trust the scientists before the patients can trust us.

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