What to do about cancer? You have your own best answer.
Back in February, a Canadian study on mammography appeared in the news. The study results led the researchers to the claim that mammography is no more effective in preventing cancer than breast exams. Furthermore, the study implied that mammography could harm, rather than help, when it led to advanced treatments (surgery, chemotherapy, radiation) of cancers that may not have required such treatments.
Here is the original article in the New York Times.
As someone whose cancer was found by a routine mammogram, my initial gut response to this study was predictable. I find mammography rather important, given what might be going on with me (or maybe no longer going on, at all) without it. But as I read I was amazed by the assumptions that piled up on the page. The researchers determined that there were, in one out of five cases, cancers found by mammography and treated but “that would never have killed the women” and were “not a threat to the women’s health.” In the case of DCIS (ductal carcinoma in situ, the earliest stage of breast cancer) cancers detected by mammography, the rate they found was closer to 1 and 3. DCIS, by the way, “may or may not break out into the breast.” (All quotes are from the article.)
How is it that these folks can see into the future? How can anyone know for sure that a particular cancer “would never have killed” somebody, especially when that person went through one or more cancer treatments? Sure, you can say statistically that the type, stage, and grade of cancer that was removed or reduced in size is unlikely to cause death. But we can’t know for sure. And we can’t gather a group of women together with that particular type of “not-a-threat” cancer and, confident that they will be fine, require them to go untreated to see if we are right.
What if a woman with DCIS decides to forego treatment and hope that it does not “break into the breast?” Maybe she would be fine. But if it does progress and becomes untreatable, will the statistics provide any comfort to her as she is facing hospice care, thinking she would have been better off slogging through chemo and/or a mastectomy? If we could see into the future and knew we would be diagnosed with a cancer that would kill us without treatment, wouldn’t most of us choose treatment over our own demise, even if the treatment carries its own harms?
My cancer, according to detailed findings from my biopsy, mammography, ultrasound, and MRI imaging, was a low-grade, slow-growing cancer. My highly competent breast surgeon doubted it had spread, although she cautioned us to make no assumptions. I had a sinking feeling in the week before my mastectomy that it had moved into my lymph nodes – and whaddya know, it had, much to the surprise of my entire medical team. In fact my post-mastectomy biopsy results carried several surprises, one of which was that there were at least two different types of cancer, and that cancers appeared in more locations than originally noted. Earlier, when I was still interviewing doctors, a different breast surgeon had been so confident in my cancer’s lack of threat that she said I’d be fine with a lumpectomy. You can begin to see where assumptions based on statistics and norms would have gotten me, had I bought in to them.
We really want THE answer, don’t we? We want to create or read THE definitive study that tells us exactly what to do so that we may be 100% sure of a full, long life. We want the final word on THE food to eat that will prevent us from getting cancer or any other disease or disorder. We look in books and on websites for THE exercise, THE practice, THE attitude that keeps us in perfect health. We flail from one sure-thing diet to the next, one hyped-up exercise strategy to the next, one web guru to the next, looking for the one that completely resonates, completely works, completely satisfies.
I don’t know about you, but I haven’t gotten to “completely” yet with anything. And I don’t think it’s possible. In fact I think we are causing problems for ourselves in this quest for the holy health grail. We are on an exhausting journey, repeatedly swinging from high hopes to disappointment, judging ourselves when someone else’s panacea doesn’t work quite as well for us.
But, honestly: What one answer could possibly be “the best” for every individual? Each person’s body is as individual as a fingerprint, with its own unique mix of characteristics from genes, experience, sleep patterns, food intake, and chemistry linked to brain activity and emotion. What study could account for these extensive variations, or even begin to comprehend their scope?
Set the grail quest, the assumptions, and the judgment aside. If you are interested in health and life, I recommend this recipe, customizable (by you) to suit your exact body and circumstances:
Self-awareness, because your self is completely unique. Know your family history. Know your medical history. Know how you customarily feel and behave. Know how your body normally looks and functions.
Knowledge, because parts of your recipe will come from the incredible cache of knowledge growing and updating around us. In books and practices and systems, coming from educated and insightful individuals tightly focused on their respective arenas, there may be grains or handfuls or even wide swaths of information that resonate with you. When you explore what’s out there, can you select what works.
Vigilance, because change happens every day. Pay attention to changes in your mood and energy. Notice when a body part is operating differently, is in pain, or looks or feels different (and women, this especially includes breast self-examination – find more on that at http://getintouchfoundation.org/). Find doctors you trust, and understand the tests they recommend, when they recommend them, and why. If you and your doctors agree that a test is wise, get it, and on schedule.
Critical thinking, because you are the person best equipped to look at your own situation, assess relevant information, and make the choice that gets you what you need. If a doctor thinks a mammogram would be wise, you evaluate that advice based on what you know of yourself and of the statistics, and make a thoughtful decision. If you receive a negative test result but your physical or instinctual self-knowledge tell you otherwise, you press for more testing and get a different medical opinion. If you are diagnosed with cancer, you gather information on options, consult several doctors for opinions, and weigh it all in the context of your needs.
Any decision you make with self-awareness, knowledge, vigilance, and critical thinking is the right decision for you. Even if it doesn’t look right to someone else. Even if it is something others consider extreme, like an experimental treatment, refusing treatment, or prophylactic treatment. If you have taken everything into account and know you have what you need, that is THE answer you have been looking for. Not necessarily the answer that worked for that author, that blogger, that celebrity, or that athlete, although your answer may incorporate parts of those answers. Not necessarily the answer that someone said you “should” accept. Not necessarily the answer that statistics said is the appropriate choice. Your answer.
You won’t ever hear about THE answer from me. You will hear me say, over and over, I trust you to think for yourself. I encourage you to search for your answer, and when you truly find it, I will support you as you live by it.