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Some Doctors Claim Breast Cancer Is Overtreated

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schweppes
07/10/09

In reply to Some Doctors Claim Breast Cancer Is Overtreated
I think this is more about "giving patients all the information" - - - I think a lot of times, the second people hear the C-word, it's sirens blaring, wanting the most aggressive treatment possible when, for some individuals, it might be better for long-term health to be a little less vigorous. If you have a slow-growing cancer and you're older, it might make sense for you not go through the whole shebang.
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Atomic Bowling
07/10/09

@schweppes: Well that's one thing I wonder about - how much do they have to do to determine which type of cancer it is? Because if it's just a matter of a biopsy (which I think is unpleasant but non-invasive for most people), then the doctors should definitely be trying to highlight for patients those instances when aggressive treatment might not be wise. If they have to start major treatment to make that determination, then it might be kind of a moot point.
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formergr
07/10/09

@Atomic Bowling: There's a growing push in healthcare for what's called "informed decision making", and there are tools developed to accompany it.

Basically they are neutral videos or pamphlets that present to the patients all the costs and benefits from a certain procedure. It's intended to be separate from the physician's counsel, since he or she can't know everything about the patient's outlook on life, family, philosophies, or religious influences-- all things that can influence their treatment decisions. Also, it's kept separate because surgeons tend to recommend surgery, ya know?

It tends to be used most for things like prostate cancer treatment in older men, lower back surgery, lumpectomy vs. mastectomy for breast cancer, etc. All procedures that don't often have clear-cut science backing one exclusively over the other. Instead, they are situationally dependent.
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morninggloria
07/10/09

In reply to Some Doctors Claim Breast Cancer Is Overtreated
Men will look for any excuse to handle breasts. The other day, it was "whoops, the train stopped abruptly and my hand brushed them." What's it going to be tomorrow? "You have cancer and now I have to touch them a lot."?
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hippichx sez PEACE PLEASE
07/10/09

In reply to Some Doctors Claim Breast Cancer Is Overtreated
Doctors can distinguish between the two if they take a biopsy, then view the cells under a microscope. Many doctors will send a sample out to a lab to be stained for Her2/Neu. The amplification of this gene is correlated with fast progressing breast cancers. My personal belief (having been through other cancers) is, "if in doubt, cut it out." The sooner, the better.
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PinkSoxHat
07/10/09

@hippichx sez PEACE PLEASE: Seriously. If I have something in my breast that may be, possibly, we're not sure it's cancer, cut it out. I'd rather lose a breast for the possibility of cancer than lose my life because they were wrong.
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Red-headed bookworm
07/10/09

@hippichx sez PEACE PLEASE: My mom has had multiple instances of breast cancer. One of these cases has metastasized to her lung. While it's slow growing and she isn't on chemo now, I would hate to have that happen to someone else because of breast cancer not being treated aggressively enough.
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andBegorrah
07/10/09

In reply to Some Doctors Claim Breast Cancer Is Overtreated
"Doctors say metastasizing cells just being emotional."
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wtfox?!
07/10/09

@andBegorrah:"But prostate cancer cells, on the other hand, are just having a bad day."
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lucystrawberry: Tier 2 is the new black
07/10/09

In reply to Some Doctors Claim Breast Cancer Is Overtreated
This is clearly evidence that government run breast cancer screenings are dangerous and causing untold unnecessary suffering. Thus, government should stop funding it and all other health initiatives. UNIVERSAL HEALTH CARE MAKES PEOPLE DIE.
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hippichx sez PEACE PLEASE
07/10/09

@lucystrawberry: Tier 2 is the new black: by michael moore... coming soon to a theater near you.
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thePrototype
07/10/09

@lucystrawberry: Tier 2 is the new black: I know right, I was listening to Glen Beck this morning and he was going on about how you are 12% more likely to die of cancer in the UK than in the US, so therefore we shouldn't try to improve on the model we currently have.

If my commute to work wasn't so short I would have called in to tell him that as usual, he was completely missing the point.

the sad thing is I hear people parroting him and Rush all day long... and believe it :(
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Triphena
07/10/09

In reply to Some Doctors Claim Breast Cancer Is Overtreated
I know chemo, radiation, etc. is awful, but all the same, if I've got any sort of cancer, TREAT THAT SHIT, YO.
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margareita metermaid
07/10/09

@Triphena: I agree-- I'm of the 'better safe than damn sorry' school of thought here.
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jonesy
07/10/09

In reply to Some Doctors Claim Breast Cancer Is Overtreated
I am a biomedical scientist working in pathology, dealing with breast FNAs, WLEs and mastectomies. This subject has been much discussed today in the lab. The general opinion is we would all rather go through screening and everything it entails, catching a benign or malignant lesion as early as possible, than risk breast cancer. This includes several members of staff who have suffered breast cancer.
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Penny
07/10/09

In reply to Some Doctors Claim Breast Cancer Is Overtreated
It's not "unnecessary" if the doctor cannot distinguish between dangerous and non-dangerous cancer.
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kelsium
07/10/09

@Penny: It seems sort of counter-productive to even point out that some benign cancer is treated if they can't tell the difference. Perhaps instead of researching what percentage of cancer is treated "unnecessarily" someone should figure out which is which.
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LadyFabulous
07/10/09

In reply to Some Doctors Claim Breast Cancer Is Overtreated
So, correct me if I'm wrong, but isn't cancer dangerous, period?

What is a non-threatening cancer exactly?
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Penny
07/10/09

@LadyFabulous: I don't know a lot about cancer but I thought there could be benign growths that were not in any danger of harming the body. Then again, I am not sure why they'd be called cancer....
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Triphena
07/10/09

@LadyFabulous: My mom had a form of skin cancer, I can't recall the name, but it was something that would never metastasize and wouldn't really do much. After awhile, it probably would have disfigured her nose a little, but it wouldn't have killed her.
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hippichx sez PEACE PLEASE
07/10/09

@Penny: when it comes to breast cancer, the tissue is highly proliferative. in fact, it is one of the few tissues from which stem cells can be found in adults. sometimes, a specific cell will divide/multiply out of control, causing a benign growth, but it is not necessarily dangerous. on the flip side of that, every time it multiplies it runs the risk of mutating... and therefor these lumps are more likely to become cancerous than the normal breast tissue. thus, the "watchful waiting" stage. i've said this once, and i'll say it again, my personal choice is always to have it cut out. i'm young, however, and i know in some older patients, the cost/benefit ratio is not the same.
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margareita metermaid
07/10/09

@LadyFabulous: ok, so hopefully some real docs will weigh in here, not just someone who watches 'house' and old 'er' repeats, but i think cancer just means cells that have mutated. and some of these can prove to be life threatening, and some not. so, i knew someone with skin cancer (abnormal cells in an area on her back) but it wasn't the kind that would multiply and accelerate and kill her.
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LadyFabulous
07/10/09

@Triphena: Oh ok. So not dangerous, but still cancer. Got it. Thanks!
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thesciencegirl
07/10/09

@LadyFabulous: There are some forms of cancer that grow so slowly that they wouldn't ever rally cause health consequences, especially when you're talking about screening older individuals.
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schweppes
07/10/09

@thesciencegirl: For instance, I remember reading that something like 50% of men who die after the age of 70 had prostate cancer - - - but it was never detected/treated because, on balance, it wouldn't have made a difference and could actually have done more harm than good.
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thesciencegirl
07/10/09

@schweppes: Exactly! If a man lives long enough, he is very likely to eventually get prostate cancer, but aggressively treating it in an eldery person could be more harmful than the cancer.
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Trulymadlyme
07/10/09

@thesciencegirl: And if I'm correct, there are some cancers that basically can rid themselves of the human body. I'm thinking certain childhood brain cancers.
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thesciencegirl
07/10/09

@Trulymadlyme: There are some that spontaneously regress, though I can't think of the types off the top of my head.
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schweppes
07/10/09

@thesciencegirl: learn something new every day:
Spontaneous regression of cancer is reported in virtually all types of human cancer, although the greatest number of cases are reported in patients with neuroblastoma, renal cell carcinoma, malignant melanoma and lymhomas/leukemias.

source: http://www.ncbi.nlm.nih.gov/pubmed/9891219

(and let's just imagine hyperlinks & paragraph breaks)
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Edited by schweppes at 07/10/09 1:16 PM schweppes was starred schweppes was unstarred

babyruthless
07/10/09

@schweppes: My (94-year old) grandmother died a few years ago, and they suspected that she had stomach cancer--she was having pains, etc., but she had also recently started the fast decline towards death. Her doctors wanted to screen and find out whether she did, in fact, have cancer, and she looked at them and said "Why? I'm not going to treat it, so what does it matter if I have it?"

She died not long after from complications from a broken hip. I'm glad she didn't have to go through chemo.

On a related note: isn't the recommendation that breast cancer screenings stop after a certain age--like 80, because at that point, it would likely grow so slowly that it won't be what gets you anyway?
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sciencerules
07/10/09

@LadyFabulous: So, everyone else who's weighed in here is right--you can have a tumor that's just kind of hanging out, not really hurting anything or anyone, unless it's in a bad place (your brain, for example). The problem is that in breast tissue, the risks are so great and the proportion of cancers that are invasive (that is, spreading to bone or brain) is so high that doctors tend to err on the side of "get that out!"

Non-threatening cancers include Kaposi's sarcoma (as long as you're not HIV+), a lot of skin cancers aside from melanoma or squamous cell carcinoma, cancers of the heart and the membranes that surround it, because your heart is super adaptive and the surgery to take it out is really risky.

Basically, things get called cancer or tumors if they're growing abnormally. It's the breakdown past that point that's crucial. Invasive cancer? Get that shit out. Small tumor that's just kind of hanging out? Up to the patient.
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Yahtzii
07/10/09

@LadyFabulous: Cancer equivalent of this?
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Edited by Yahtzii at 07/10/09 1:29 PM Yahtzii was starred Yahtzii was unstarred

Trulymadlyme
07/10/09

@schweppes: Yay science!

But yeah, there is a suffering/benefit analysis taken by cancer patients. I understand the impulse to throw the kitchen sink at a tumor, but I can see the benefit of not doing so if that kitchen sink is only going to give you a few weeks, if not months, to live, miserably.
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LadyFabulous
07/10/09

@Yahtzii: That got you hearted so hard!
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LadyFabulous
07/10/09

Thanks everyone! That did answer some of my curiosities!
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