The breast cancer shell game: one in eight

Dear True,

Like most all women I am terrified of breast cancer. I’m a glutton for every news story about the latest research and that’s how I know about the shell game: a con trick that deceives the eye and hides the ball under movable walnut shells. The mark has to guess, based on deceptive information.

One in eight women will have it. Like every other person on the planet I have lost beloved friends and relatives to this dreadful disease that devours the necessary equipment designed to nurture babies and goes on in many cases to metastasize either sooner or later. I also have a treasury of friends who are survivors, and looking at those who survived and those who perished it seems like a lottery.

Evaluating the conventional wisdom that every woman hears from her doc: do self-examinations, have mammograms, it is readily apparent that neither technique does an even adequate job.

Mammograms catch about 80 percent of cancerous tumors according to one study, by any measure not good enough. Self-examinations are fraught with terror and error. As one who has the so-called “fibrocystic breast disease” which means lumpy breasts, I never have a clue about where a real, hard lump might be hiding beneath the constantly movable cysts. Still I am told that I should keep doing the self-exams. Pfui. The last time I went for a doc appointment based on my self-exam many years ago the (female) doc told me, in essence, that I was deluded. “Pt feels lump” was written in my chart.

Some say that breast X-rays for women in their 40’s could cause more harm than good. Others (American Cancer Society) ask for annual MRI’s for women “at high risk for breast cancer.” But the same study adds that too many women perceive themselves at overly high risk. Say WHAT? In other words, women are overly fearful of breast cancer without good reason. What is good reason? The “risk” factors are absurd, at least in absence of DNA work. Mother or sister with breast cancer? Hmm, it seems now that Dad’s genes are just as potent as killers. And what of those who are adopted, or have no sisters? Too bad for them.

MRI imaging is by far the most accurate method of finding cancerous lumps. But the corporate health care system decrees that only the “highest risk” candidates deserve this expensive diagnosis. The official excuses for not making the MRI universally available? It costs too much (of course)… but the one that really bugs me is this: it has too many false positives (5 percent) that cause psychological damage to the women.

Hello, hello? NO woman on this earth would prefer a false positive to a false negative. If there is a way to routinely catch the cancers in their earliest stage with great accuracy, there is NO excuse to withhold it from the women like me who don’t make it to the highest risk categories. We can deal with the false positive, trust me on this…. I live with personal false positives all the time with my “diseased” breasts.

In 1990 I lost one I loved a lot, who had thought she was cured. The conventional wisdom at the time was that lumpectomy was as good as mastectomy, now discredited. Within a month after a “clean” CAT scan following chemo and radiation, she was diagnosed with metastatic liver cancer and she lived only six more months.

So many of us have died. Others struggle to survive. A woman in Cook County has advanced breast cancer despite her annual mammograms; it was just very fast-growing. I demand ZERO TOLERANCE for shell games, for who gets the lucky dice and the state-of-the art tests. “Significant” family history? Does it include aunts on both sides, as in my case? Probably not. Anyway nobody has offered me a genetic test or biopsy or MRI.

Zero tolerance for me means, not allowing any woman to die because of the health insurance shell game, ably enabled by the sensational press. Or, as in my case, because I don’t have any health insurance at all.

It wouldn’t be so bad if there weren’t other options that work better, but there most definitely ARE. MRI is only one. There are several types of breast cancer, and I have checked out Wikipedia to learn more and so, my dear woman friend and sister, can you. Learn about the five stages, Zero through Four, gene expression profiling, a baffling array of treatment and prevention options including double mastectomy for those at highest risk, radiation, and systemic therapy including chemo or hormones like tamoxifen. Wikipedia says that some “natural” remedies like flaxseed or traditional Chinese medicine may be beneficial. What do you know about “viral” breast cancer? The confusing and contradictory studies of risk factors like diet, alcohol use, X-ray mammography and a bewildering array of other possibly insignificant variables?

Nancye Belding
Grand Marais

Here are a couple of links you can explore first:

In New Cancer Guideline, a Host of Uncertainties - New York Times

Benefits of Mammograms For Women in 40s Challenged - washingtonpost.com