Follow Research or Follow Tradition?

At 67 and nearly eight years after being diagnosed with BC of the single site, stage1, DCIS variety, I’ve made the decision to eliminate one mammogram every other year from my life. With my oncologist’s approval, my plan is to have an MRI one year and one mammogram the following year instead of one MRI and one mammogram each year. My decision was based on all of the studies I’ve mentioned in previous blogs in combination with new information, my age and the type of cancer.

Breast cancer is big business and mammography is one of the most profitable cancer tests in history. The US still favors yearly mammograms from 40 onward, while in the UK, it is once every three years for those 50-70. Considering that the new 3-D tomosynthesis scans give you (according to computations by my radiation oncologist) the equivalent of about 10 round trip airplane trips to the West Coast. The older mammograms expose you to slightly less radiation but come with the added distress of increased compression, and the oftentimes the requirement for more scans because of poorer images. I realize that my decision is not for everyone. I’d just simply prefer to skip every other year.

Many countries are beginning to question the logic of their breast screening programs. A US task force now suggests that women should receive screening starting at 50, not 40. The 2012-13 British (Marmot Study) and Canadian (Canadian National Breast Screening Study: randomized screening trial) studies have been influential in questioning the logic and usefulness of constant breast cancer screening. Example - for every 200 women screened, 1 will be saved from breast cancer, and 3 women will be diagnosed with cancer that would not have harmed them if left untreated. New Scientist magazine, Unwitting Women in Cancer Scan Trial, Clare Wilson, 11/12/14.

OK. Who wants to be either one of the three, or one of the 197 that received years of radiation for no reason? It seems to me that making this choice is like rolling the statistical dice with the odds on our side. Yet we are trained to believe that if you take every precaution you’ll never get sick – be it cancer or a cold, and that simply isn’t true. Science and the human body don’t always work in harmony. We know a lot more than we once did about BC, but we certainly don’t know the whole picture. Fact remains, that mammography may be one of the better low cost tests currently available for women. But it’s been proven that mammography is definitely not the best or even the safest screening test.

Even the new Cure magazine has an article on “The DCIS Dilemma”, Charlotte Huff, Fall 2014. The medical world is still up in the air as to whether or not DCIS is cancer or a condition the might not cause any damage, might be controlled by the immune system, or might actually turn cancerous. As a result, “some women decide to use the surgical equivalent of a sledgehammer on a not-quite-cancerous lesion – getting a double mastectomy.” Most women follow my opted route, not that I’m saying I made the correct choice: lumpectomy, radiation, and 5 years of taking estrogen receptor blockers. I can attest that taking those drugs have their own horrific side effects. The only reason I capitulated was because my mother and sister both had the same type of cancer – which the doctors now believe was from some sort of exposure because none of us had any genetic tracers. One thing all doctors agree on is that very few patients die from DCIS.

DCIS is detected only by mammograms. It is seldom found as a palpable lump. This is one case where being older is better. According to the article, “One difficulty in advising patients is that relatively little is understood about the natural course of DCIS and how frequently it progresses to invasive cancer if left alone and closely monitored.”

I mentioned several blogs ago that a good friend of mine who is 34 was diagnosed with DCIS this year. She opted for surgery and radiation but said “No” to tamoxifen because of the long and short term side effects. She is also questioning the frequency of having mammograms going forward. Ultimately, we must forge our own paths in life which is easier to understand when you are selecting a major in college or whether to take a job offer, but rolling the dice with one’s health is not a decision is for the faint of heart or those who refuse to research their health problem. If you don’t do either, you run the risk of choosing unwisely. I must admit that for the most part I did what was suggested by a trusted surgeon. Everything else I questioned but to this day I wonder if my research fell short because I was in shock and afraid.

Interesting aside on LCIS

Also covered in this issue of Cure is an article on LCIS which is lobular carcinoma in situ. LCIS is considered a marker of elevated risk for invasive cancer…not at the moment but potentially in the future. LCIS doesn’t show up on mammograms. It’s usually found during a biopsy for other reasons. It isn’t cancer and doesn’t necessarily develop into cancer. It seems to be a marker of future invasive breast cancer. Those most likely diagnosed with LCIS have a family history of breast cancer, took hormone replacement therapy or are women in their 40’s… strange, because it appears to effect women just prior to or after menopause.

Does that mean you must have surgery? Apparently if it’s in one place, probably not say the articles I’ve read, but if it’s scattered throughout the breast, probably so. It all depends on the doctor’s evaluation of the site plus the patient’s particular age, health status, family history, etc. The general treatment at the moment is taking estrogen receptor blockers such as tamoxifen or raloxifene. Surgery is also an option but only if you are at high risk of breast cancer because of a very strong family history.

Interesting book on the cost of burying our traumatic experiences

OK, count me as obsessed with New Scientist this week but I’ve ordered a book based on their review: The Body Keeps the Score: Brain, mind, and body in the healing of trauma, Bessel van der Kolk, published by Viking books. One line caught my attention: “Excess stress can predispose us to everything from diabetes to heart disease, maybe even cancer.” According to the review, the book speaks to all kinds of trauma/stress and its effects on the human psyche and body. But did you ever consider what it might do to your children in the short term or later in life: “If your parents’ faces never lit up when they looked at you, it’s hard to know what it feels like to be loved or cherished. Neglect creates mental maps used by children and their adult selves, to survive.”

I can identify with that statement as it relates to my mother. Small wonder why after the added stress surrounding her death, I was diagnosed with BC. Could it have been that my autoimmune system gave up at that point because no matter how hard I tried to experience that look, once she was gone so was the hope to enjoy acceptance? Our bodies are such interdependent networks that it stands to reason stress, especially long term, deep stress, can cause serious illnesses.