Thursday, June 21, 2018

Did Drinking Cause Me To Get Breast Cancer?

By Stephanie Mensimer for Mother Jones

Don’t look down. Therese Taylor repeats this mantra when she’s rising out of bed in the morning. Don’t look down. She says it when she’s standing in the shower. She says it when she’s brushing her long brown hair so that it hangs over the vacant space once occupied by her left breast. Don’t think about what you’ve lost.
She’s lost so much. Her breast. Her identity as a healthy person. Her uncomplicated sex life. Her faith in the medical profession.
Taylor has gained something too—a fury that’s uncomfortable to express when other women are dying from breast cancer and her doctors tell her she’s lucky. But when she thinks of the fear her three children endured and the months of post-surgical shoulder pain so sharp that she worried a tumor had invaded her bones, the 55-year-old Mississauga, Ontario, resident doesn’t feel lucky at all. She feels rage. Her doctors implied she had cancer and said that if she cut off her breast, she would live. Now she knows it was never that simple.
No one—not her physician or her surgeon or the pathologist or nurse or anyone else—ever took the time to explain what her mammogram and biopsy had found.
Despite what her doctor said (“It’s indicative of cancer”), the fact was that the abnormality on Taylor’s mammogram—ductal carcinoma in situ, or DCIS— is not considered a cancer by many experts, and it had only a small chance of ever progressing into an invasive cancer. The probability that it would kill her was even slimmer, about 3 percent. The thing in her breast was not a ticking time bomb, and were it not for the mammogram, she probably never would have known it was there.

Therese Taylor, who was diagnosed with a noninvasive breast cancer and regrets having a mastectomy, reveals the scars where her left breast used to be. Michelle Siu
If she knew then what she knows now, Therese Taylor would have refused the surgery. In fact, she would have canceled the mammogram. Taylor has come to realize that she lost her breast out of fear, not out of caution. She’s learned that her mammogram was at least three times more likely to get her diagnosed and treated for a cancer that never would have harmed her than it was to save her life. But perhaps the most infuriating thing she’s learned is that scientific evidence for the harms of mammography has been available—published in medicine’s most highly regarded journals—for decades.
The harder you look the more cancers you’ll find, but most will be harmless and will never threaten anyone’s life.
What scientists know and Taylor didn’t is that mammography isn’t the infallible tool we wanted it to be. Some things that look like cancer on a mammogram (or the biopsy that comes afterward) don’t act like cancer in the body—they don’t invade and proliferate in other organs. Some of the abnormalities breast screenings find will never hurt you, but we don’t yet have the tools to distinguish the harmless ones from the deadly ones. And so these medical tests provoke doctors to categorize lots of merely suspicious cells in with the most dangerous cancers, which means that while some lives are saved, even more women end up with treatments they don’t need. Whether the chance of benefiting from a mammogram is worth the risks of having one is an individual woman’s decision, but Taylor believes her doctors owed her a truthful discussion about the potential harms before she made her choice.
Over the last 25 years, mammography has become one of the most contentious issues in medicine. The National Cancer Institute lit a firestorm in 1993 when, after finding sparse evidence of benefits, it dropped its recommendation that women in their 40s get screened. Since then, most of the debate has remained focused on what age women should start getting mammograms, and the number of women mammograms help. Now, after more than 30 years of routine screenings, some experts are raising a different, perhaps less comfortable question: How many women have mammograms harmed?
If you include everything, the answer is: millions. Mammograms do help a small number of women avoid dying from breast cancer each year, and those lives count, but a 2012 study published in the New England Journal of Medicinecalculated that over the last 30 years, mammograms have overdiagnosed 1.3 million women in the United States. Millions more women have experienced the anxiety and emotional turmoil of a second battery of tests to investigate what turned out to be a false alarm. Most of the 1.3 million women who were overdiagnosed received some kind of treatment—surgical procedures ranging from lumpectomies to double mastectomies, often with radiation and chemotherapy or hormonal therapy, too—for cancers never destined to bother them. And these treatments pose their own dangers. Though the risk is slight, especially if your life is on the line, a 2013 study found that receiving radiation treatments for breast cancer increases your risk of heart disease, and others have shown it boosts lung cancer risks too. Chemotherapy may damage the heart, and tamoxifen, while a potent treatment for those who need it, doubles the risk of endometrial cancer. In a 2013 paper published in the medical journal BMJ, breast surgeon Michael Baum estimated that for every breast cancer death thwarted by mammography, we can expect an additional one to three deaths from causes, like lung cancer and heart attacks, linked to treatments that women endured.
Last year, results from a 25-year follow-up of two landmark studies tracking about 90,000 women concluded that mammography did not reduce breast cancer deaths at all.
More and more women are beginning to speak up about this inconvenient reality. Tracy Weitz, a women’s health researcher at the Susan Thompson Buffett Foundation, has publicly shared the story of her mother, Diane Olds, who died 10 days after being diagnosed with an aggressive endometrial cancer that Weitz feels may have been caused by tamoxifen treatments for DCIS. In an Elle magazine story in June, Duke University breast surgeon Shelley Hwang described the “terrible feeling” that overcomes her every time she’s asked to perform an elective double mastectomy on a woman with DCIS who “almost certainly” would have lived a long life without the procedure. In 2013, journalist Peggy Orenstein, once a staunch defender of mammography, wrote in the New York Times Magazine, “I used to believe that a mammogram saved my life,” but 16 years after a breast cancer diagnosis, “my thinking has changed.” Having read the latest studies, she wondered, “How much had my mammogram really mattered?”
Find it early; save your life. That has long been the dominant message behind mammography campaigns, and it’s a story that offers comfort—here’s something you can do to protect yourself from a truly scary disease. This message assumes that finding an early-stage breast cancer equates to preventing a breast cancer death, and if that were true, having a mammogram would be the only reasonable choice, because finding it early is what mammography does best. But at the same time that this message was becoming entrenched in our consciousness and our policies, scientific evidence was pouring in to show that it was deeply flawed. To understand why, you need to know a bit of cancer biology.

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