[Mtngrl]

This is a fascinating and thought-provoking thread.

One interesting thing about it is that even we, who are "experts" in a sense, do not all agree.

I read the "The Last Word on Nothing" post yesterday and reposted it on facebook. I highly recommend it for its message that the old model of breast cancer as something that starts small, gets progressively worse (at a steady rate) and is invariably fatal if not treated has been discredited. On this forum there are at least two women who were diagnosed and treated at Stage 0 and are now Stage IV. Twenty to thirty percent of people with "early" stage breast cancer will go on to Stage IV. Six to ten percent are Stage IV at diagnosis. Some breast cancers, in some women, will never metastasize and therefore will never be a threat to their lives. In some people, with some cancers, the cure is actually worse than the disease. Prostate cancer is an example. Unfortunately, with breast cancer there's no way to tell which is which. This muddy, cloudy state of facts is not as "celebratory" or romantic as the "early detection = cure" message. It takes longer to say it, and process it.

The U.S. "war on cancer" has been going on for 40 years. Some cancers with clear causes (lung and stomach) are much less prevalent now. Some others (Non-Hodgkins Lymphoma and Acute Lymphoblastic Leukemia) are more "curable" than they used to be. And although the number of people dying from breast cancer hasn't changed, the population has increased, so the percentages are going down.

Mammogram has its own risks. Radiation to the breast might actually cause cancer. There is certainly a link between radiation exposure and breast cancer. It can also lead to a false sense of security, with false negatives and to increased anxiety, expense and unnecessary risk, with false positives. Pre-menopausal women have a lower risk of contracting breast cancer and a higher rate of inaccurate results from mammograms. That is why routine annual screenings for women in their 40's is not the best use of health care resources.

Diagnostic mammograms, as opposed to routine screening, are another story. I am grateful for my diagnostic mammogram/sonogram, which I got because of some changes in my breast that I noticed first.

I know a woman who was Stage IV at diagnosis, which occurred one month after she had a "clear" mammogram. She found an enlarged lymph node under her arm. So much for "early detection."

It's extremely difficult to link environmental factors with cancer risk. It is also the case that many known carcinogens are under-regulated, possibly due to excessive industry influence on the legal process. Nowadays, too, the "job-killing regulations" meme is so pervasive you hear it on both sides of the aisle, but very few people are saying we need "life-saving regulations." I think we do. And, in fact, regulations and restrictions actually spur innovation and economic growth.

It's time that more attention was paid to the "common good" in all its dimensions. Maybe by being too focused on one kind of illness public health advocates are shooting themselves in the foot. The disparities in health care access in the US are indefensible. Maybe we could all do more overall good by working hard to remove the injustices and inequities.