-
- |
-
- |
- |
- 9
Between the 1950s and the 1990s, the medical profession did a virtual about-face on mastectomies. Previously, the surgery had been a brutal, almost barbaric procedure. A woman with a suspicious lump often went into surgery not knowing whether she would wake up without her breast. She often lost the underlying muscle and even part of the rib cage as well. As one physician described a patient who had undergone extended radical mastectomy in the 1950s: “I could practically see her heart pumping. It was separated from the outside world only by a layer of skin.”
Then in the 1970s, a drive to cut back mastectomies became intertwined with feminism and patients’ rights. In 1990, the National Institutes of Health declared radiation and a lumpectomy—in which a malignant lump is removed but much of the breast spared—“preferable” to mastectomy for women with early stage breast cancer. The less extreme surgery offered the same long-term survival rate as the more extreme one, research showed. And so low mastectomy rates became one quality measure for breast surgeons, a way one doctor sized up another.
Yet now, somehow, mastectomy rates seem to be rising again—not because of doctors, but because of women themselves. Evidence shows that when women are more involved in making their own surgical choices, with less, rather than more input from their surgeons, they are more apt to choose mastectomy. Young women also tend to opt for more radical treatment. And, at least anecdotally, highly educated ones do too. Todd Tuttle, a surgical oncologist at the University of Minnesota, told me that when he asked his female surgical residents what they’d do if diagnosed with early breast cancer, “the majority said double mastectomy.”
Some doctors worry that women are overestimating the security that more aggressive surgery offers. It’s true that the risk of cancer reappearing in the breast is slightly higher following lumpectomy and radiation than following mastectomy. But the difference has narrowed. Over 20 years, the risk of a local recurrence is about eight to nine percent following lumpectomy and about two to three percent following mastectomy. And the risk of cancer returning elsewhere in the body—the life-threatening danger, as NIH said—is the same after both procedures.
Yet many women don’t seem to see it that way. You can see this impulse reflected in the data from two leading institutions. At the Mayo Clinic, the mastectomy rate for women with early stage breast cancer fell to 31 percent in 2003, and then climbed to around 43 percent in 2006, according to an analysis presented last year. At the Moffitt Cancer Center in Florida, the mastectomy rate for all breast cancer patients also rose from around 33 percent between 1994 and 2003 to 44 percent in 2004-2007, according to another analysis. That rate has now shot up to around 65 percent, the lead researcher told me. Most of the surgeons I spoke with said they believed the increase is widespread. “There’s always a lag time with national data, but it’s pretty clear that mastectomy rates are rising,” said Monica Morrow, chief of the breast service at Memorial Sloan Kettering.*
On the surface, some of the reasons for the increase appear entirely logical. Women with mutations in the BRCA1 and BRCA2 genes, for instance, sometimes choose to remove both breasts in the hopes of staving off future disease. (Slate contributor Masha Gessen wrote movingly in 2004 about making this decision.) Women with early-stage breast cancer who discover they carry a risky mutation may tend to choose more aggressive surgery as well.
Amanda Schaffer is a science and medical columnist for Double X and Slate. Read more of her work here.
SNL: Equal Opportunity Objectifiers
Jon Hamm spent most of the Saturday Night Live episode he hosted last night shirtless.
Confessions of a Woman Comedy Writer
Allison Silverman accepts one from New York Women in Film & Television (and tells us why it's rare).
Comments
tiffany
By: tiffany77 | Wed, 09/23/2009 - 23:59
Tiffany Earrings Tiffany Earrings tiffany Earrings silver earrings silver earrings Tiffany Bracelets Tiffany Bracelets tiffany Bracelets Tiffany key ring Tiffany key ring tiffany key ring
links london Friendship Bracelets
By: linksoflondon | Tue, 09/22/2009 - 19:37
links of london Sweetie Bracelets links of london Sweetie Bracelets links of london Sweetie Bracelets links of london Sweetie Bracelets links of london Sweetie Bracelets links of london Sweetie Bracelets links of london Sweetie Bracelets links of london Sweetie Bracelets links of london Sweetie Bracelets links of london Friendship Bracelets links of london Friendship Bracelets links of london Charms links of london Friendship Bracelets links of london Friendship Bracelets links of london Friendship Bracelets links of london Friendship Bracelets links of london Friendship Bracelets links of london jewellery links of london Friendship Bracelets
Insurance will pay for
By: GingerB | Sat, 07/18/2009 - 15:33
Insurance will pay for reconstruction after breast cancer.
While reconstructed breasts aren't the real thing they eliminate a lot of problems as far as clothing and seeming like you've got all your body parts.
If you are a young slim woman, like Christine Applegate, and don't have a nice 20-30 pound tummy that can be rearranged into new breasts via surgery, then implant reconstruction is your most likely method. This somewhat imperfect method gives you a better matched set if you have both done.
So, I think with that in mind, it's easy for some women to just get rid of the future problem of another breast cancer, which actually isn't that likely anyway, and end up with two fake matching breasts.
Hormonal therapy
By: marcuswright | Mon, 06/29/2009 - 02:53
Hormonal therapy, which can reduce the risk of early-stage breast cancer coming back, should be used to treat all early-stage breast cancers with any detectable level of estrogen receptors. Tamoxifen and the aromatase inhibitors are examples of hormonal therapy medicines.
here is some information about health kit therapies and fitness.
First Aid Supplies
Earthquake Emergency Kits
Natural therapies
First Aid Kits
Beauty care and fashion
Earthquake kits
liposuction
Herceptin (chemical name: trastuzumab), a targeted therapy, which can reduce the risk of early-stage breast cancer coming back, should be used to treat only breast cancers that are HER2-positive. Chemotherapy, either before or during Herceptin treatment, also is an important treatment for HER2-positive breast cancer.
Age Related Macular Degeneration Treatment
Personal Emergency Kits
Human Osteopathy
Chemotherapy, which can reduce the risk of early-stage breast cancer coming back, always should be used to treat triple-negative early-stage breast cancer. Triple-negative breast cancer is cancer that is estrogen-receptor-negative, progesterone-receptor-negative, and HER2-negative. Hormonal therapy medicines and Herceptin usually don't work on triple-negative breast cancer.
The new guidelines also point out that hormone receptor and HER2 test results must be accurate and reliable.
The panel of experts couldn't agree on whether gene assay tests, such as the Oncotype DX test, were helpful in making treatment decisions. The Oncotype DX test looks at the behavior of a specific group of genes in breast cancer cells. The genes' activity can affect how likely a cancer is to respond to treatment. The Oncotype DX test is used on estrogen-receptor-positive breast cancers and can help doctors decide if the cancer is likely to come back; if so, chemotherapy may be recommended. Even though the expert panel's new treatment guidelines for early-stage breast cancer don't recommend using the Oncotype DX test, many doctors believe results from the Oncotype DX test can help decide which hormone-receptor-positive early-stage breast cancers also need to be treated with chemotherapy.
My mother is a 25 year breast
By: kellyalleyne@gm... | Fri, 06/26/2009 - 15:23
My mother is a 25 year breast cancer survivor who received a partial mastectomy at the age of 31, and had more tissue removed about three years ago. With the mastectomy and surgeries after, her difficult recovery and the pain she still feels has me completely against having a mastectomy for any other reason than that it is absolutely necessary. Necessary being when there is cancer present, and not pre-emptively.
I feel women who are worried about having breast cancer because of their genetics and thus have mastectomies (and reconstructive surgery) do not know what they are getting into as far as both the psychological and physical pain that comes with removing a large amount of tissue that is associated with femininity, motherhood, etc. I know as modern women we are not supposed to put so much emphasis outside characteristics, but I am sure if I lost my breasts, I would mourn their loss even if I received reconstructive surgery.
I would not consider months (and sometimes years) of pain a fair exchange for consistent, careful screenings. The genetic factors leaning towards me getting breast cancer are too small for me to undergo major, painful surgeries. However,I feel a woman should have choice in what course of treatment she will receive to treat her disease. If she chooses a mastectomy because she feels it is the right thing to do, then so be it. Cancer is a frightening disease, and to not feel in control of at least some aspect of your treatment makes it much worse.
"I believe the difference is
By: kendobunny | Sat, 06/20/2009 - 21:32
"I believe the difference is simply that more women don't feel their self-esteem is wrapped up in their breasts." I think that particular shot was unnecessary. My mother died of breast cancer when I was a small child, and I have already dealt with the fact that that makes me somewhat more likely to develop breast cancer, as do my naturally large breasts. I've also decided that if I am diagnosed, I will save a mastectomy for the last resort. Imperfect though they may be, I like my breasts. I had to learn to like them despite all the hassles and headaches and backaches and crude comments that come with them. It has little to do with my self-esteem, as the greatest blow to my self-esteem came from my early breast development. I just have come to see my own breasts as something more than lumps of fat and milk ducts: they are what my grandmother bequeathed to me (the big breast gene comes down from her) and what my mother wasn't allowed to keep.
I see no problem with women doing whatever they like with their breasts. But please don't assume that those of us who love our breasts are just really proud of our sweater puppies. Even with the sag and the veins and the stretch marks, I'm attached to mine.
breast cancer, mastectomies
By: Ruth Pennebaker | Thu, 06/18/2009 - 11:01
What's an "unnecessary" mastectomy, anyway? I guess you could say I chose a bilateral mastectomy almost 14 years ago -- but I had in situ lobular on my "good" side and invasive lobular on the other. At a harrowing time like that, don't forget the primacy of emotions. You are scared to death and your breasts have become objects of disease. They are not, as another commentator pointed out, vital organs. If a bilateral mastectomy makes you feel safer (and I know there are arguments contradicting the wisdom of this), why is choosing it considered a problem? At that point, you have so few choices -- none of them good.
I have to add a comment of support for saline implants, too. The rest of my body may be yielding to gravity, but those two implants will be perky forever. (I should also add that I once got in a contest with another friend flexing our implants at a breast cancer center. I looked up and saw a man staring at us, clearly horrified. I'm pretty sure he almost fainted.)
MRIs
By: vpostrel | Wed, 06/17/2009 - 17:20
I wouldn't downplay the helpfulness of MRIs in detecting breast cancer in younger women with dense breast tissue, which makes mammograms almost useless. I had numerous mammograms, beginning when I was 29, to assuage the paranoia of various doctors who felt normal lumpiness in my very dense breasts. Finally, when I was 47, a tiny change led to a biopsy which led to a cancer diagnosis. But the cancer looked extremely minor until a pre-surgery MRI turned up a large, completely separate cancerous area in the same breast (and what turned out to be a benign hot spot in the other breast). I say this NOT to recommend mastectomies--I personally had two significant lumpectomies on my cancerous breast, with complete node removal during the second--but simply to suggest, backed by my surgeon (http://www.uclahealth.org/body.cfm?id=458&action=detail&ref=17376) and medical oncologist (http://www.uclahealth.org/body.cfm?id=458&action=detail&ref=6741), that in pre-menopausal women, MRIs are quite useful. You have to beware of false positives, but that's what biopsies are for.
That said, according to my oncologist, a lot of women are asking for MRIs because Christina Applegate recommended the tests, and they've somehow gotten the message that MRIs will prevent--rather than detect--breast cancer.
Why worry?
By: Biotunes | Wed, 06/17/2009 - 14:00
Why is this something to be worried about? We're talking about body parts that for most of us are functionless for most of our lives. You are ignoring all the women out here (including me) who have always considered (large) breasts to be a hindrance, for many reasons. (For example, I never was fully conscious of why I had always disliked running until my bilateral mastectomy.)
Doctors now seem very careful to make patients aware of the data that show breast conservation is a reasonable choice in most early cancers. I believe the difference is simply that more women don't feel their self-esteem is wrapped up in their breasts. One can certainly argue the opposite position from yours, that this is a positive development. In my case I would go so far as to say that having a medical excuse to get rid of my breasts was the one positive aspect of the whole miserable cancer-treatment experience.
I also think that doctors and commentators who haven't had to make these decisions belittle too much both the short- and long-term effects of radiation. If you have just been through chemotherapy, six weeks of daily radiation doesn't really seem like a walk in the park, and it often can cause permanent damage.
You are also conflating radical mastectomy with simple mastectomy. Radical mastectomies are no longer done because they do not improve outcome. So to be clear, a mastectomy today means removing only the breast, and perhaps some lymph nodes to check them for cancer spread. You are simply left with a man's chest, sans nipples.