Medicine and the C-word

Isabel Bishop. Two Girls (1935), California Digital Library

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Since October is Breast Cancer Awareness Month, it seems to me that some information on the topic of breast cancer, published in Time Magazine, bears consideration. At base the article--Why Doctors Are Rethinking Breast-Cancer Treatment--presents evidence that DCIS, classified as Stage 0 of breast cancer, is often over-treated. The article also contains some compelling arguments and I recommend buying a hard-copy of the issue (October 12, 2015). Time online has 2 additional articles: Choosing to Wait: A New Approach to Breast Cancer at Its Earliest Stages and A Major Shift in Breast Cancer Understanding.

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There were a couple of points made about our perception of cancer and the resistance to change rooted in medicine's standard of care that particularly struck me.

One,

Cancer has a language problem–not just in the way we speak about it, as a war that drafts soldiers who never signed up for it, who do battle and win, or do battle and lose. There’s also the problem of the word itself. A 57-year-old woman with low-grade DCIS that will almost certainly never become invasive hears the same word as the 34-year-old woman who has metastatic malignancies that will kill her. That’s confusing to patients conditioned to treat every cancer diagnosis as an emergency, in a world that still reacts to cancer as though it’s the beginning of the end and in a culture where we don’t talk about death until we have to.

And two,

“I hear people say that medicine is so important that we can’t be too quick to change, and I would say the opposite: Because it’s so important, we need to innovate,” says Dr. Laura Esserman, a surgeon and the director of the Carol Franc Buck Breast Care Center at UCSF. “If we were doing so well and no one was dying, I would agree we don’t need to change. But patients don’t like the treatment options, and physicians don’t like the outcomes.”
Esserman and Hwang, now chief of breast surgery at Duke University and Duke Cancer Institute in North Carolina, are leading a number of studies that they hope will fill in some of the knowledge gaps that make change such an uphill battle. DCIS now accounts for about 20% to 25% of breast cancers diagnosed through screening. Before routine screening, which went wide in the mid-1980s, it was 3%.

The treatment proposed is called "active surveillance," a term often used for prostate cancer.

Again, read the articles for a more complete picture.

-- Marge