Some patients you never forget. One woman told me she had a breast cancer on one breast removed. But her surgeon refused to remove the remaining breast. I told her then that her doctor may be right. There was little research or clinical data to help in determining if this was a prudent decision. Her surgeon had said, “I can never sleep again if I keep worrying whether or not the cancer will occur in the other breast.” After repeated medical appointments with her, it became evident the continuing anxiety would affect her overall health. So, was I wrong or right 50 years later?
Dr. Steven Narod of Women’s College Hospital in Toronto is also a professor of obstetrics and gynecology at the University of Toronto. He and his colleagues, using U.S. data, have reached a conclusion. They say that there is no advantage in having the other breast removed by either a lumpectomy or a mastectomy. In other words, there is no increase in the survival rate.
This study was reported in the Journal of the American Medical Association and involved 661,000 women who had cancer in one breast. What happened to those women who decided to keep their other breast? The chance of cancer occurring in it was seven percent over a period of 20 years.
But there was one other fact. Women who had a gene variant such as BRAC1 or BRAC2 had increased risk of recurrence. For the 1 in 500 American women who have this gene variant, both breasts should be removed. Nonetheless, it is a difficult fact to accept that removing both breasts is not a sure way to remove the risk of a recurrence of breast cancer in the future.
Why does this dilemma continue and why can’t early diagnosis by routine mammograms solve this puzzle? Afterall, they say over and over that mammography of the breast detects cancer. But does it?
This column has explained the details, initially many years ago, and again from time to time. But somehow the nuances seem to be lost in what one commonly hears about mammography. Cancers of the breast do not appear all of a sudden. Early malignancies begin as cellular particles that are totally unseen by present day mammography. According to the experts, cancer cannot be diagnosed until the growth reaches a certain size. How long this takes is debatable. But experts report that it generally takes several years. This is when mammography becomes very valuable. But by this time the cancer has had a chance to spread to the other breast or elsewhere in the body.
What a major difference to the Pap’s test to diagnose cervical malignancy. This test cannot only diagnose cancer cells using high powered microscopes, but it can also diagnose precancerous cells long before they change into cancer cells that can kill.
It is important to repeat that mammography is a “lump diagnosis” and that the Pap’s test is a “microscopic cellular diagnosis”. In other words, it’s the difference between night and day.
What we need is a cellular diagnosis of breast cancer to save more lives. But to date, it doesn’t exist, and women will continue to die of this malignancy.
Saying mammography diagnoses early cancer malignancy is stretching the truth. This has given false hope to women for years.
Some women with breast cancer will still want to have a double mastectomy. From this study it does not appear to increase the survival rate. But one wonders how the data would look if it factored in mental health considerations and other measures of wellbeing.
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