[dlaxague]

Thanks, Mary Jo, (or is it Marejo - how do you spell your name?), for saving me the time to respond with my personal stance on this, which is pretty much exactly your personal stance. Plus you said it better than I would have (smile).

Once again, we see that there are SO many reasonable and perfectly good ways to deal with a breast cancer diagnosis. We cannot tell someone else how to do it. We can offer a variety of options, and tell stories of what worked for each of us, as individuals. But each person has to consider the options and make his or her own decisions, based on their mind/heart/gut/spirit - and that decision will be exactly the right decision for them. I'm sure of it.

I used to question and argue heatedly with thinking that differed from mine, as if (hah!) there could be only one right answer. But having watched for awhile now I realize that was such a narrow and ego-centered perspective. Now all I care about is that all sides are presented. I offer my stance not to argue against someone else's, but to make sure that readers who are still exploring what is right for them will have all the information and all the choices and perspectives on the table.

There IS one more aspect to this discussion which is never popular and I rarely get responses when I mention it. But I'll throw it out there anyway. (Climbing onto soap box now.) If you live in the US, you know that we have major issues in health care. We particularly have issues of access to care for the underserved populations - the poor, the immigrant, and sometimes the elderly. And increasingly, that group includes the working and not exactly poor but the insurance-poor (high deductibles, incredible monthly premiums, etc). In the broad sense, there is a finite number of health care dollars to spend. If we, with no evidence to support our desires, demand scans every six months forever, after a primary breast cancer diagnosis - we are ultimately helping to deprive the underserved of basic health care services. Scans are really expensive. There is no evidence that detecting a recurrence before there are symptoms will make any difference to quality nor length of life thereafter. I know there are reasonable questions about this - I addressed them myself in another thread a few days ago. But I cannot support every HER2+ person who has completed primary treatment getting regular scans to reassure them. My Scots genes rebel. It's just too expensive.

I know that classically we are supposed to look at risk/benefit. But at some point, we are going to have to also look at cost/benefit. I hope that we'll look at it before we (this country) are in full-on crisis but I'm beginning to lose hope about that. An incredibly unpopular thing to discuss, especially if you are a politician, an ill person, or an ill person's loved one. But the cost of the technology that we now posses has FAR outstripped our ability to pay for that technology, and we are going to have to figure out what to do about that. We are going to have to ration care, and justify costs using some kind of cost/benefit or risk/benefit formula. Regular scans post-adjuvant primary breast cancer treatment is not going to score very high on that scale. Treatment of the major chronic diseases - diabetes for example, will score high -big returns for small outpay. Scans after primary breast cancer is the opposite - very small returns for huge outpay.

This issue plays a part in my reluctance to ask for any kind of regular screening in the absence of symptoms. Who am I to ask for such indulgence when people in this country are suffering for lack of very basic healthcare? The reasons Mary Jo stated so articulately also play a part in my choice - probably a larger part. But still, two+ years ago when I had persistent headaches and my PCP suggested an MRI, and I had the MRI, and it came back clear - I felt guilty for having been a poor steward of the resources. I guess I'd have felt better if it had found something (sorry, gallows humor, but not entirely untrue).

Stepping carefully down from soapbox now. I think that I get more strident in October - it's all the pink stuff. And this is only October 1st. Sigh.

Debbie Laxague