CAST ADRIFT

Since my treatment ended in October, I have felt cast adrift. I haven't blogged because I have had nothing to say that didn’t seem pessimistic or worse. Even the recent articles about recommended later and fewer mammograms didn’t anger me enough to respond.

What has angered me is the added recommendation that doctors stop teaching women how to do self exams on their breasts. Really?! What could be more benign than that? At first I thought it was a mistake; but no, it’s part of the recommendation. The underlying purpose is simple. If women examine themselves, they will find lumps. Most of these lumps are made up of benign tissue--lumpy breasts, fibrous breasts or just plain random deposits of tissue that is different from the surrounding tissue. All of these can lead to tests and procedures and, of course, anxiety. The tests can be expensive and the anxiety is “bad” for women. Therefore, it would be better if all these false alarms could be avoided. Of course that would also mean that early detection would be avoided as well.

The question then becomes, does early detection really make a difference? A recent article in the Fall, 2009, issue of Cure Magazine questions the value of routine screenings. The article compared cancer to an asteroid hurtling toward earth. If the asteroid can’t be stopped, does it really help to know three months or three years in advance that it is on the way? The end result is the same. On the other hand, if there is a way to destroy the asteroid before it arrives, the earlier it is detected the better. The point of the article is that all too often detection and treatment does not add significant time to the patient’s life expectancy and frequently reduces the quality of the time remaining. Findings indicate that this is particularly true for prostate cancer. Men can live for a number of years with this slow gowing cancer while the treatment can significatly impair their general health. This may be the case with other types of cancer as well.

However, the fact that it might rarely make a difference in the final outcome doesn’t matter to those “exceptions” who are still alive years after diagnosis and treatment. Most of them are convinced that they would be dead if they had not discovered and treated their cancers.

I am certainly convinced that my bout with uterine cancer in 1996 would have killed me if I had not had surgery, chemo and radiation. How can we ever be sure though? If this Triple Negative breast cancer is going to ultimately be the death of me and my treatment was all for nothing, maybe I would prefer to have the six months back and go on a cruise instead. How can we dare to make such choices and leave our loved ones wondering if we abandoned them without putting up a fight? For me, that's the toughest question of all.

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