Mammography: An Imperfect Tool

The more one learns about detecting breast cancer, the murkier it gets. An opinion piece published in the LA Times earlier this month suggested that mammograms are over-prescribed because they cause doctors to over-diagnosis breast cancers. The author, a medical professor at Dartmouth, was arguing that doctors who counsel women to have less frequent mammograms, or wait until they are age 50 to begin them, might be on the right track. His theory was based on the premise that because mammograms will sometimes detect cancers that may never develop into anything dangerous, the medical community needlessly scared women with too much mammography.
http://www.latimes.com/news/opinion/commentary/la-oe-welch3-2008nov03,0,2369816.story

Naturally, I had something to say on this point, and I dashed off a letter to the editor. The LA Times was kind enough to publish my response, and I've attached it here:

Re “The excessive focus on mammography,” Opinion, Nov. 3 H. Gilbert Welch argues against excessive use of mammography because the test identifies some cancers that will never will never develop to cause symptoms or death. I also argue against too much dependence on mammography, but for the opposite reason. My cancerous breast tumor could not be seen on my mammogram, and I received a negative
result.

Fortunately, I could feel the peanut-sized tumor with my fingers and pursued necessary medical treatment. Mammography is far from perfect because it misses cancers, not because it detects too many.

It's hard to know what the best approach to cancer-screening actually is. Even with my experience with mammography, my doctors, all experts in the breast cancer field and people whom I trust, insist that I get frequent mammograms. Of course, they only use state-of-the-art digital mammography, which produces a better image than traditional film x-rays.

So I do what I'm told. But I continue to think that there must be a better way to screen women, a method that is both medically meaningful and cost effective. Until we have one, however, I will get my mammograms, but only with digital technology. (Women should ask their medical providers which type of mammography equipment they use and avoid facilities that have not yet upgraded.) Beyond that, it seems prudent for all of us to stay vigilant and know our own anatomies, so that we can detect when something has changed. While finding a lump may be scary, the idea of a tumor going undetected is even scarier.

Breast Cancer Awareness Month

October is Breast Cancer Awareness Month, and there is much to report on many fronts.

At the moment, I'm traveling in Europe, having delayed my 50th birthday celebration until now. My one year anniversary of diagnosis will be on October 23, and I'm happy to say that, all in all, I feel well. My old self is gradually returning.

On the fight against breast cancer, a couple of things you should know. Results of a recently released study showed that women with early-stage breast cancers responded equally well to lower overall doses of radiation. My radiation therapy was administered in 35 separate doses, but doctors are finding they can reduce the number of treatments markedly. So if you, or someone you know, is facing radiation for breast cancer, please ask about this study.

Second, Dr. Susan Love has launched a new effort to tap into women who are willing to participate in studies and clinical trials. Sponsored by Avon, Dr. Love's new program is called the Army of Women. Her goal is to register one million women, so that researchers can have better access to women of all ages, races, and health histories. If you have not already done so, I urge you to go this link, learn more about her effort, and sign up. http://www.dslrf.org/army/

Finally, I have agreed to participate in the Komen Walk next summer with my friend, Diana, who completed the Chicago event this year. I'm saying this in print here to prod myself a little further toward actually acting on this pledge. A three-day walk is an enormous undertaking, but it's worth the effort. Maybe you should consider walking, too.

Healthy and Cured

That's it. I'm done. Last week, my oncologist offhandedly said, "We now consider you to be healthy and cured."

He and I were talking about the level of follow-up and screening I would now have, and he wanted to put my situation in context. So he told me that from a medical standpoint, I was not that different from other women my age. Thus, he used the phrase "healthy and cured."

Whether or not he intended it, I latched onto those three little words, and I've been basking in their undeniable brightness ever since. Good health takes on such a greater significance when it disappears for a time. When it's been regained, simple healthfulness is valued as a far more precious commodity than it was before it ebbed. As Joni Mitchell wryly observed, "Don't it always seem to go. You don't know what you got till it's gone."

While Joni was mostly referring to the environment, her words provide an excellent segue for me to the next chapter (or the next blog, if you will). Simply put, the goal is to appreciate what's around me in a literal sense, and learn how I can make more out it. Healthy body, healthy planet -- it's all so intertwined.

The internet headlines today were about a 36-year-old TV actress, Christina Applegate, who recently underwent a double mastectomy. She was diagnosed with cancer, but she opted for extra surgery because she learned that she carried the breast cancer gene. I began this blog many months ago with my own breast cancer diagnosis. As I come to the conclusion of my treatment, each week thousands of new cases are being detected. Well-known and unknown, wealthy and destitute, educated and unschooled, women of all races, faiths, and backgrounds are being told that they have breast cancer. Maybe a means of prevention is close at hand. Maybe we'll soon have better detection in order to save more lives. Keep checking here periodically, and I'll keep posting breast cancer information as I find it.

In this fight, we need to raise funds, raise awareness, raise our voices. To win this battle, we need to help each other. To be healthy. To be cured.

New Blog is Up

Although it's still in its infancy, the new blog is operational. The link is: http://eatingmygarden.blogspot.com

Meanwhile, the on-going story published here is not quite finished. I still have to see the medical oncologist next week and get my marching orders, but I am transitioning. Thanks for reading during these long months. Knowing that you've been following along has made the writing enormously fulfilling and a true pleasure.

Cap And Gown

Bring on the pomp. The circumstances call for it. Time to trade the hospital gown for a graduation gown. Let's switch out the bandanna for a mortarboard. It's graduation time. I'm done with surgery. Done with chemo. Done with radiation. I've attended my last session and passed my final doctor's exam.

I've crossed the stage, graduating from cancer patient to cancer survivor. Of course, that's not exactly how the moment feels. A better description is that I am a survivor of cancer treatment. The cancer itself, that cunning and stealthful enemy, never caused a hint of noticeable trouble. It was quietly invading, flying under radar, undetected by x-ray.

We always ask graduates about their plans. More education? New career? Answer is who knows. I have a writing project lined up, but no real plans are on the table. The radiation technicians advised me to keep busy and guard against depression. Although I'm rarely depressed, I'll heed the warning anyway. The nurse also said that I might experience an increased level of fatigue over the next week or two. After the last treatment, she explained that some radiation patients feel as if they've been hit by a bus. So, I'll watch out for that possibility, as well.

Right now, I'm just enjoying the knowledge that I no longer need to drive to the hospital every day, disrobe, lie under a huge machine for few minutes, get dressed again, and drive home. That routine was getting monotonous. I'm also trying to take in the information that I've reached the end of a 10-month trek. That my all-consuming detour through the land of breast cancer treatment is at its conclusion. For the moment, I'm paused at the main road. A little time, please, before I make the turn.

Ten Things I Learned

Although it may be cliche, it's still true: In every challenge, lessons are derived. Here are a few of the things I learned during the past 10 months while detouring through the land of breast cancer.

1. I love to blog. This fact must be obvious to those who've been reading along. But this notion extends beyond the blogosphere. The real message is not to ignore or discount one's creative side. Don't wait until retirement, or when the kids are grown, or when the garage is cleaned to nurture your creative spirit. Whether it be writing, sketching, singing, playing an instrument, dancing or sewing, make time for it. The rewards are innumerable. (Along this line, my next blog is under development, but more on that later.)

2. People surprise you. You can never predict who will step into your life when you're in the midst of an ordeal. Without being asked, people whom you barely know will reach out in a particularly thoughtful way, and, from there, they will evolve into good friends. Conversely, others whom you counted on may not be up to the challenge.

3. Don't hesitate to connect with someone going through a bad patch. Some part of us wants to hold back and not risk the emotional fallout of talking to those who are bereaved, sick, or suffering in some way. But human contact is a good thing. Pick up the phone and dial. If people really don't want to interact, they just won't answer. But they will know that you made the effort. And that knowledge goes a long way on a bad day.

4. Ask your doctor if you have dense breasts. If so, find out what screening methods, beyond mammography, are available to you, because mammograms simply don't do a good enough job on dense tissue. No diagnostic tool can prevent cancer. But good screening can lead to early detection, which can help doctors treat cancer before it spreads. Given what I know now, I would have paid for annual breast MRIs, despite the prohibitive price tag. At the very least, I would have enrolled in the clinical trials for the Sonocine, which is a whole breast ultrasound. (You can find the link to Sonocine on the list to the right.) The most compelling evidence is this: I had a second smaller tumor, the size of a pea, in the same neighborhood as the peanut-sized growth that I discovered. This smaller lump was lying deeper in the tissue. Neither I, nor any of my doctors, could feel it, and it was not visible on my mammograms. However, the radiologist saw it on my MRI. Given its location, this little tumor could have kept growing unnoticed until it was quite large. I was fortunate, really, to have had a palpable growth close to the skin. So while MRI is very expensive, think about it if you have very dense breasts.

5. Find out what you can about your medical history. Ask older relatives about how their parents and grandparents died. Should you face a cancer diagnosis, doctors want as much genetic information as you can give them.

6. Do your research and know the facts of your condition. Doctors seem to respect this. If you can talk intelligently about your treatment, you and your doctors will have a more meaningful dialogue and you'll feel better about the decisions that everyone makes.

7. Chemo was not as bad as I feared. The best advice I heard from my oncologist was not to make assumptions about how chemo would affect me. He was right, because I fared much better than I imagined I would.

8. Fitness matters. But not for the reasons you think. There is no magic bullet that prevents serious illness. Eating broccoli and running six miles a day are no guarantee of immunity. However, should illness strike, being in excellent physical shape helps to overcome the rigors of surgery, chemo, radiation, or whatever the treatment happens to be. If you get sick, you want to be strong in order to fight back.

9. Enroll in the best health insurance plan that you can reasonably afford. If your develop a major illness, you want the freedom to select the best doctors and facilities.

10. You're stronger than you think and your loved ones are, too. You wonder how you will cope, should you develop a serious health problem.,or how your spouse or kids will manage. While the whole experience is scary, everyone will fall in line and do what needs to be done. I don't have enough distance on this experience yet to be certain, but I expect that a battlefield mentality takes over. You just move through whatever the next task is. Fretting and worry consume valuable energy that is needed elsewhere. My best advice is to check those emotions at the door and stay focused on the remedies.

My last treatment is tomorrow!!!! The next blog is getting underway. Stay tuned.

Power To You

Walking along the corridor of the hospital the other day, I saw another patient who I'd exchanged glances or half-smiles with, although we'd never spoken.

This woman was walking a little ahead of me, but as I was moving at a much faster clip, I quickly caught up with her. I expected that we would share the usual greeting -- or non-greeting, really -- and I would continue on my way. But as I passed by her, she turned to me and said, "I've been wanting to talk to you." So I slowed my pace to match hers, and said, "Yes?"

She surprised me by revealing that she had been watching me and wished that she, too, could leave the house with her head uncovered. At the moment, she was wearing a bucket hat, and I remembered that she always wore a hat or a wig. Cancer-related hair loss is so devastating, it was no surprise that this woman needed shoring up. I assured her that before long, her hair would come back and her hat days would be well behind her.

"Do you want to see my hair?" she said. Then, in the middle of hospital hallway, she lifted off her hat and uncovered her head, which was encased in the black netting that football players wear under their helmets. Next, she began to peel off the netting. I expected to see a combination of bald spots and patchy growth. To my surprise, this woman's dark gray hair was much longer than mine. She had more than an inch of perfectly fine hair all over her scalp.

I was dumbfounded, and stammered, "You have lots of hair. You don't need to cover it up." She demurred, although I'm not sure why. But by initiating a hallway conversation and showing me what was under her hat, she was clearly reaching out for support. I suspected that she wanted a push toward the next step.

My family and friends know that I love to offer solutions. If they present me with a quandary, they will get my ideas on the best fix, whether or not they actually want to hear them. So seizing a chance to hold forth, I suggested the following remedy: Put on some make-up, and do one errand with your head uncovered -- the post office, the bank, the supermarket, whatever. Just take on one errand and, after that, assess whether you still need the hat or the wig.

She didn't sign on to this idea, but she didn't say, "No," either. As the conversation ended, and I turned to go, she called after me. With her fist raised and clenched, she said, "Power to you." Puzzled by this whole encounter, I walked to the car thinking about all of the ways in which we trip ourselves up and let inhibitions take charge.

This happened on Friday, and I saw her again this morning. I asked if, over the weekend, she had gone out bare-headed, and she said, "No." But today she appeared stronger and with more resolve. She told me that she was going to attempt a trip to the supermarket. "Good luck," I yelled as she walked away.

We'll see what happens. I have seven treatments left. I'll consider it a victory if within that time, this woman walks into the waiting room, head uncovered and newly empowered.