Surveillance

17Dec09

I read some message board posts recently saying that a woman should not get tested for a BRCA mutation if she is not considering preventive surgeries. Supposedly, this logic came from genetic counsellors. Although I understand that we have to consider the impact that anxiety can have on people’s quality of life, I still don’t quite understand this reasoning. Isn’t surveillance still an option? Can’t surveillance help BRCA carriers avoid a late stage breast cancer diagnosis? Even if breast cancer is inevitable for some of us, maybe some would still like the option of postponing life-altering surgeries.

Research hot off the press of the San Antonia Breast Cancer Symposium finds that MRI helps BRCA+ women find cancer earlier than mammography alone. It’s not fool-proof of course, 2% of women with MRI screening were still diagnosed with Stage II or above after 6 years. But that was significantly less than the 7.1% diagnosed in the mammography only group.

Ironic I read this on the same day that I found the National Breast Cancer Coalition (NBCC) website. It is a group that advocates political action to “stop breast cancer.” I was intrigued at first glance of the website, but then I read their “31 Myths of Breast Cancer.” The first three were as follows:

  • Myth #1: Monthly breast self exams save lives
  • Myth #2: Mammograms can only help and not harm you
  • Myth #3: MRI is better than mammography because it finds more cancer

What’s the take away message here? It seems as if the NBCC is claiming that self-exams, mammograms, and MRI are of no use for breast cancer detection. Instead, the claim these screening methods are harmful because they lead to unnecessary biopsies and anxiety. So what is the alternative they suggest? I looked over the website trying to find what the NBCC suggests for breast cancer surveillance and found no alternative. Instead, I found a lot of materials which states what the NBCC is against. Although I admire the group for its effort to advocate for better breast cancer treatment and critical evaluation of research, I got a very negative impressive from their advocacy materials. After reading their list of myths, I was left thinking that “breast kills you and there’s nothing you can do about it.” That’s a damn infuriating thought.

What is the use of NBCC protesting self-exams? Are they really trying to claim that self-exams are of no use? Finding a lump or seeing changes in the breast is what drives many women with breast cancer to seek medical help. Granted there are many more cases that turn out to be benign, but no one knows until they get a follow-up on it. There is no logic to telling women that self-exams are useless or even harmful! If the concern is the biopsies and other invasive procedures done in response to an unusual self-exam, then why not critically evaluate the protocols for those procedures? If there are safer ways to screen for breast cancer, then why not advocate for them alongside the “myth-busting”? Sending out shower cards that simply say monthly self-exams do not save lives seems extraordinary self-defeatist. Without providing a more comprehensive message of what the best practises are for reducing mortality from breast cancer, their message could actually be doing harm. It’s already done me some harm, by just simply pissing me off.

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