Monday, October 01, 2007

Breast Cancer Awareness Month

Since it is the first day of October, this is the start of Breast Cancer Awareness month. If you're looking for a good resource of information, the American Cancer Society has a lot of good stuff. I encourage you to check it out.

I was also reading this article from the Chicago Tribune this morning which reviews a new survey stating that there is still a lot of misunderstanding out there as far as the facts about breast cancer.
One "stunning" example, she said, is that people still believe heredity is the cause of most breast cancer cases, although in reality only 5 percent to 10 percent of breast cancer is caused by genetic mutations that can be inherited.

The survey, being released Monday, the first day of Breast Cancer Awareness Month, also found that 7 out of 10 women believe eating enough fruits and vegetables can help prevent breast cancer. In reality, there's no good evidence that this is true.

Most women (and nearly two-thirds of those age 18 to 24) believe breast cancer can be prevented. In reality, there are only a few things women can do to reduce, but not eliminate, the risk of developing the disease, such as not drinking alcohol and not taking hormones. The biggest risk factors are being female and getting older.
Unfortunately, the end of this article is a political commercial for a website. They also state that they are going to make this an issue in the US presidential election. So, again, the press taking advantage of cancer patients to push their political agenda. It's really unfortunately and frustrating how these people make pawns of cancer patients for their own political purposes.


Your Mother said...

I believed some of those myths. The media gives so much attention to genetic engineering's role in identifying certain risk factors, it's really easy to think, "it's all genetic!"

I remember reading once that a study had found that women who "ate more broccoli" had lower rates of breast cancer! Even I know better than to believe a study like that (confounding factors, anyone?). But it just stuck in my mind.

Sandy at Junkfood Science talks about this in her article myth busters. The human brain tends to believe what it hears first, or what it hears most often--even if it learns later that it isn't true! That's so fascinating.

Eric, AKA The Pragmatic Caregiver said...

Cancer sucks. Breast cancer sucks more, because it's frequently disfiguring and directly attacks what makes some women feel like a woman. The treatments are brutal (not quite as bad as they used to be, but no spa treatment) and acutely defeminizing.

I think it's realistic to say that breast cancer sucks a whole lot.

On top of the rest of the suck, women with breast cancer become *pariahs*. In my state, women who have had anything other than DCIS who are treated with the standard of care (surgery, chemo, hormonal therapy for the next five years) can't get individual insurance for *at least* the next fifteen years.

Fifteen years living in fear that you don't lose your job (or your partner doesn't lose theirs). Fifteen years wondering if you'll max out a lifetime cap.

I don't think of women living with breast cancer as diseased pariahs, and I don't think they should have to choose jobs or spouses based on being insurable. But that's their reality today. My mom can't change jobs to some cool little company that doesn't offer health benefits. She can't start her own gig. She is living well with breast cancer in spite of a pretty grueling battle with recurrence, but she can't follow her dreams in *large part* because she can't find health care coverage.

Until she turns 65.

When the system becomes universal.

Three years is a long time to wait for a woman who has survived metastatic breast cancer.

So yeah, this *IS* a political issue.

Cancer affects young women disproportionately. Most men with cancer are older at diagnosis, many already retired.

But when smart, capable, educated working women, balancing home and family are hamstrung by the political realities of healthcare finance in the United States, that's a whole 'nother ballgame, and I encourage people to get pissed about it and make it a political issue.


Anonymous said...

I think the real problem here is that a lot of organizations have a political agenda, and the message has become very muddled.

To give one example: the American Cancer Society continually pushes the benefit of fruits, vegetables and lifestyle "choice" as a cancer preventative. There is no real evidence that any of this will actually prevent cancer, but who's going to question the ACS? I think the media often just reflects the general noise that's going on in society at large.

Eric, Eric, Eric: Where shall I start? Get your head out of the sand. *All* cancer sucks.

You want to talk about pariahs? Talk to me, a woman who had a hematological cancer in her 30s. I was stunned to discover that unless I was an old person or unless I was a female with breast cancer or a "women's" cancer, I was invisible.

You want to talk about defeminization? Let me tell you about my hair loss, about the premature menopause, about the nice big scar on my neck from the biopsy. You don't have to lose a breast to feel defeminized; the side effects of tx and the dehumanizing nature of the medical world take care of that all by themselves, thankyouverymuch.

Good thing I already had life insurance, because no one will ever write me a policy again. It's a real struggle for me to continue working full time, but you know what? I don't have a freakin' choice. What I really need is to cut back to part time but I have to hang onto my health insurance, because if I lose it, I will be unable to buy a policy on my own at any price, and I still have decades to go before I qualify for Medicare.

Don't you *ever* talk again about how "breast cancer sucks more." I am sorry about your mother, I truly am, and I hope she does OK.

But this is not a damn contest for who has it worse. We're all in the same boat here. The last thing we need is to be pitting one type of cancer against another.

And BTW, young men get cancer too. Let me tell you about the 40-something guy I know who relapsed after his second bone marrow transplant and committed suicide on Easter Sunday. In fact, young adults with cancer - defined as ages 20-40 - have the *worst* outcomes of any age group. *Despite* the strides that have been made in overall survival for children and for older adults with cancer.

I do agree with you on one thing, though: This does need to be a political issue.

Eric, AKA The Pragmatic Caregiver said...

Actually, I'm just going on the numbers from the Washington State Health Insurance Plan....

It's the scoring sheet - any set of numbers over 375 is what disqualifies you from individual insurance in the state of Washington.

Looking at page 2, hematologic malignancies score a maximum of 250 points after three years. Monocytic/lymphocytic types, 145 after three years.

Also, I admit I'm unfamiliar with the standard of care for hematological cancers, but I don't think most of them involve daily therapy for a period of years after diagnosis like the standard of care in breast cancer.

So, sorry, but women with breast cancer, rightly or wrongly, are flatly ineligible for coverage for 15 years from diagnosis, round figures. In our state, in the absence of co-morbidities, that's not the case for the following cancers:

Esophageal (other than distant)
Gallbladder (other than distant)
Hodgkin's Lymphoma
Nasal Sinus
Skin, including Melanoma
Thyroid, Other Than Distant

I'm not denying that cancer in general is horrific. (In fact, my mom's a survivor of another form as well). What makes this a political issue is the disproportionate nature of thin-slicing by insurance companies due, in part, to the nature of breast cancer treatment, where survivors are under active treatment for years to prevent recurrence, with agents that continually work to deny the cancer cells estrogen.

I don't deny that the outcomes for young adults are bad. I've lost friends - in part because of lack of access to affordable coverage (and admittedy, in part, due to "I'm young and indestructible" syndrome - why pay premiums for something you'll never use?).

The political reality is that survivors of other forms of cancer with *less* advantageous 10-year survival rates are being treated differently than women with breast cancer in my state. That *is* more of a suck. It's because they're women. It's because they have breast cancer. Sure, I'm partisan about this. But that basic injustice, that a cancer with *better* outcomes gets treated worse, smacks of really ugly misogyny.


Anonymous said...

I thought the Chicago Tribune article was actually very good and very factual. It raised some important points that don't often get heard and make a good effort to distinguish between myth and fact.

I don't really see that this article was taking advantage of cancer patients for political purposes.

What the story actually contained was a link to the breast cancer caucus Web site. I thought this was appropriate, given the fact that the woman being interviewed was speaking about this new caucus (advocacy coalition would probably be a better description) and urging readers to question their political candidates about funding and policy regarding breast cancer.

As I saw it, the article was simply reporting on what the source said. And then linking to the advocacy group's Web site, so readers could seek out more information if they wish.

I guess I just saw it as informative and a way of enlisting more involvement from the public. Nothing political or commercial about it. My $0.02.

None said...

It's true there is no magic bullet to prevent cancer, but certainly eating a diet rich in antioxidants has been shown to be at least a factor in prevention. Sometimes we do our patients a diservice by talking something up so much it sounds like a foolproof plan - a la eating fruit will prevent cancer - but I think that's a safer bet than saying, "Well, there's no proven way to prevent it so eat whatever you want". There is empirical data that says that high fat and protein diets can contribute to cancer, as well as inactivity, genes and smoking, of course, but we can at least move them in the right direction in terms of helping the body fight cancer as best it can.

And truly being healthy - exercising, eating a nutricious diet - helps the body endure treatments and recover easier if cancer does develop.

Hope said...

Thank you Dr. A. for putting it so succinctly:

"In reality, there are only a few things women can do to reduce, but not eliminate, the risk of developing the disease, such as not drinking alcohol and not taking hormones. The biggest risk factors are being female and getting older."

I do not cease to be amazed that even some of the medical people that I come into contact with seem to think that a woman can eliminate her chances of getting breast cancer by a healthy lifestyle or prevent a recurrance by losing weight. They scoff when I point out that my oncologist has never suggested either.

As far as empirical evidence...don't make me laugh. What one study states unabashedly, another will refute. The only thing that seems to be agreed upon is that the biggest risk factor for breast cancer is being a woman over the age of 40.

Lioness and Eric, please take off the gloves and kiss and make up. You are both right, cancer sucks. Nobody should have to endure it and then be caught in the trap of being punished for having had it.