Breast Cancer: Are we overreacting?

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Margery “Margie” Gould Rath

There are about 3 million women living with breast cancer in the US today and 40,000 of them will die this year, according to the National Cancer Institute. Roughly 1 in 4 women who have breast cancer have Ductal carcinoma in situ(DCIS). DCIS, also known as early stage breast cancer, is a type of breast cancer that forms in the milk-producing parts of the breast. Nearly all of them will undergo intensive surgery to remove the cancerous lumps(or the whole breast), followed by radiation. But these women die at the same rate as those who don’t do anything. So what is the point of punishing your body with major surgeries,  toxic drugs and then radiation, only to have the same chances of survival if you had continued to live as though nothing happened? Should some cancers just be left alone? How valuable is the extra time gained if your quality of life is much worse?

The first Breast Cancer Walk took place in 1984 as an initiative spearheaded by cancer survivor Margery “Margie” Gould Rath. Back then it was called the “move-along-a-thon” andattracted an enthusiastic crowd of 200 people. Last year’s walk galvanized 1.3 million participants that raised a cumulative $64 million. These fundraising dollars given to the American Cancer Society are spent providing educational and supportive services to breast cancer patients free of charge, as well as supporting research that will inform the way that breast cancer is treated. While the $685 million that have been raised since 1993 has gone a long way toward informing the standard of care for breast cancer, it’s not clear that we’ve found the answers we’ve been looking for. This year’s walks will surely bring in similar levels of support and the NYC walk, talking place this weekend, will round out the season.

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Thanks to efforts lead by the American Cancer Society, its partner organizations and its many activist groups, mammograms have become a standard practice in this country. This has increased detection and allowed for early intervention in a disease that can be aggressive and completely devastating. However there is now an ongoing debate as to whether we jumped on the early intervention wagon too soon. It is important to catch cancer early, but does that mean we have to act on it just as quickly?

TIME Magazine recently published an article that got me thinking. When it comes to breast cancer, are we doing too much, and is it even making a difference? Cancer is a terrifying and complex disease. The aggressiveness of a cancer is not only determined by the size of a tumor or how much it has spread, but also by how quickly it continues to grow. This may be where we’ve jumped the gun with treating early stage breast cancer. Early detection may not have to be followed up with a thunderstorm of a response. Right now we see early stage cancer and immediately pull out all of our biggest guns but we may be better off going tit for tat with breast cancer. Some doctors think it may be better to monitor the tumors and only act when it’s absolutely necessary. Precautions shouldn’t be the most aggressive form of care.TIme_Cover_12Oct2015

It is becoming clear that some cancers don’t progress as quickly as we initially thought and we need a new strategy. I hope to address some of the questions I’ve raised in my next few posts as I use breast cancer awareness month as an opportunity to talk about the trade-offs that come with managing a life-threatening disease. I will unpack a few major papers that came out in the last few months that go against everything we’ve been doing lately in the fight against breast cancer. It is as good a time as ever to be aware of how far we’ve come in breast cancer and if we should continue down a path of intensive care, for what seems like little benefit. Maybe we shouldn’t be fighting against cancer, but searching for a way to live with it.

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