The word awareness is like nails on a chalkboard. Even in areas of the world, or communities in this country that are not in this pink stranglehold, I submit that what we need is **education** not awareness.
Let's discuss facts, let's discuss science, let's discuss evidence, let's discuss research direction. And let's put some things in their proper perspective. Some of what we are being sold may have been relevant decades ago, but we are long beyond the days of women going to sleep on an operating table not knowing if they would awaken intact or missing a breast.
The media bandwagon? Shrill. Soundbites. Early detection saves lives. Early detection is the key to the whole thing. NOT. It's a myth that is going to be sold and resold and bantered all over the place. Shame on them for doing the same thing every single year. Shame on them for not setting the record straight. They have the platform, they have the audience and they have the ability to change the conversation. It's easier to recycle the same old feel good story. Find it, remove it and wear that pink badge with pride.
There's nothing wrong with that scenario. Indeed, it's wonderful. What's wrong is the lack of balance, the ongoing insistence that this IS the story.
Early detection is a tool. It's just one tool and it's woefully inadequate in the grand scheme of things. Women must get their mammograms. Yes (or maybe in some cases a sonogram or an MRI might be the best tool for the job). I think it's imperative that we do not lose the message. Screening is important. The thing we must remember? Early detection is just that. Early detection. It's not a guarantee of anything.
One of the first places I recall reading about early detection and its shortcomings was in this NY Times piece which dates back to October of 2011. It raised many eyebrows. I wasn't sure how I felt about it then. I'm fairly certain I may have been insulted. It's logical. The earlier a problem is identified, the earlier the problem may be addressed and ultimately, the quicker the problem may be resolved. That logic, however, presumes to be dealing with something where logic might apply. Cancer is not logical. There are no rules.
I know how I feel about it now. It all makes sense. Some lives will be saved by early detection and some won't. There will be over treatment because of better imaging leading to even earlier detection. We are barking up the wrong damn tree. It's not about seeing what's there, it's about understanding what we are seeing. Until we can stop the nonsense of making imaging more sensitive and get into the cellular makeup of what we are finding, yes, we will over-treat.
Unfortunately, (I'm not going to quote statistics but I do know it's greater than 50%) more cases of DCIS will never cause a problem than those which would go on to become invasive, but until we know how to differentiate, asking someone with a diagnosis of DCIS to watch and wait before acting takes an exceptional personality type. I'm not the watch and wait type so I do know which side I would fall upon should I have had a DCIS diagnosis.
Solutions create problems. This mammography solution has created countless other problems. Thanks to decades of focus on early detection, we've been completely distracted from the reality of what we should be doing. Saving lives.
I urge you to read the NY Times article. And I'd like to encourage you to take three minutes to watch this video. Diagnosed at Stage Zero, this is Theresa's Dream:
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A very sad truth about early detection. Thank you, AM.
ReplyDeleteI have never been on the pink ribbon band wagon, I think awareness is just that- I'm aware. 'I broke a fingernail. I'm aware and I bite at it and pick at it all day but it does no good until I can get the clippers and a file.' Then I am no longer just aware, I am actively taking care of it.
ReplyDeleteI have to say my experience has been one of what ifs and why nots. My mother pulled the neck of her shirt down far enough for me to see one day and said, "feel this and tell me what you think." I didn't have to feel it, I could SEE it. She had been watching it grow for months.
So what if Daddy wasn't in a wheelchair and Mama thought she was the only one who could take care of him? Would she have went to the doctor sooner? If she had would we have the same outcome?
Why did she not go, why would somebody so finicky for the care of another feel a lump in her breast day after day and not do anything about it until it was literally visibly to other people?
So my take on early detection is a little different, I don't know what difference it would have made but I never will know.
As far as this airbrushed vomitrotious pink carnival they put on every October to sell products, get publicity, and make money- that needs to stop. Mama liked her little pink ribbons though, in some strange way they made her feel better. So I'm conflicted and wrote this to get some of it out- http://www.notquitewonderwoman.com/breast-cancer-awareness-month-october/
early detection remains the first step in saving lives
DeleteEarly detection remains the first step in saving many lives, but sadly, early detection will do nothing to help the 30% of early detected cancers that go on to metastasize to a distant site. My mom's cancer's, one primary in each breast at 20 year intervals, were both "early stage" cancers. Today, she is in treatment for metastatic disease to her bones. It happens and it's a fact that no one seems to want to discuss when we talk about early detection. The video I've embedded is of a woman who was diagnosed at Stage Zero. She passed away less than one year ago. Yes, it happens.
ReplyDeleteThis is my nightmare situation. I was diagnosed initially in 2012 with DCIS in my left breast, it was not detected on the mamogram or visible on the ultra sound. Only the doctor at the breast screen clinic could understand my concern and he ordered a biopsy this biopsy resulted in the initial diagnosis, he then required an MRI because he needed to see what we were dealing with. The first MRI was inconclusive so I was sent for another one. This one showed invasive stage 2 cancer in the right breast. The DCIS in the left was 7.5cm in diameter and the invasive was 9mm so much smaller. I opted to have a bilateral masectomy because I didn't want to be lopsided and I could not stand the thought of the DCIS becoming invasive. I also had 32 lymph nodes removed and two were positive to cancer. I had regular checks from the time I turned 40, my best friend had passed away from breast cancer in 2011 so I knew a lot but my own cancer has given me a true perspective. I have had chemo, radiation and I am on tamoxifen for five years. My greatest fear is that it will come back, it is always in the darkest deepest recesses of my mind. Early detection helps some people and I believe it helped me. However it is entirely dependent on the type of cancer the grade of cancer and the individual. I hope with all the hype around pink we can raise money to find a cure for all cancers and to stop the onset of future cancers. We needed greater understanding of cancer across all fields Going pink allows people to feel they are making a difference, they are supportive and that in itself is a good thing. I have made many pink sister friends and my own pre-cancer circle has decreased because some people can not deal with the realities it entails and that is fine to. Thank you for sharing theresa's story. She has and will continue to, make a difference. Best wishes and long life to you all. Sue Kitching
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