How did you discover your cancer?

[hutchibk]

Hey DL, I would like to take a stab at an alternate take on your conclusion....

Even if there were no harms, why would we advise doing something that makes no difference to outcome?

Nothing makes a difference in our ultimate outcome. We all die one day. From something. If not from a disease or an accident or an act of malice, then from old age. There is no such thing as "saving a life" - it should actually be called "extending a life" - even if it is a firefighter pulling a person out of a burning building.

I really bristle at the theory of "harms caused by hyper-vigilance" because I think women are emotionally strong enough to weather false positives in favor of the power of knowledge.

If the end purpose for all research is to save lives, then we might as well stop now, as nothing in the end will ultimately "save our life." Perhaps the end purpose for all research should be more simply stated as designed to cure disease and remove it as a speed bump in the middle of life along the way to the ultimate outcome all humans face.

As to the quote above, it does make a difference to outcome to the degree that we have some control over our immediate short term outcome. Finding it as opposed to not finding it allows us to take measures to extend our lives, i.e. treating it. I don't know for sure whether or not I would still be alive 6 years later from my diagnosis if I hadn't treated it or hadn't know about it for another few years, but I suspect that given the course of mine, I would not. I would rather have known early and had reasonably "small measure" choices that I tolerate well and incorporate into my life, than find out at stage IV and have less choices, less time and absolutely less hope. Whether that treatment cures it or buys more time, it is valid. And the diagnostics that brought me here (BSE, mammo, ultra sound and biopsy) are all valid, too.

[Becky]

But... at least if you are doing BSE and find the lump you do feel as if you were giving yourself your best shot.

I did find mine and at least felt that at that moment (and every moment of every BSE prior to then and after then) that I was doing myself a good turn - something good for myself and my health. I figure it was better to find it at 1.9 cm (and one positive node) than perhaps several months later at 2.6 cm and 3 positive nodes. It is true that either way, I would probably still be here 5+ yrs later (or not perhaps). However, we are all told over and over again that our prognosis is better the earlier we are diagnosed.

So, I will continue to check my boobies once a month. I've learned the lay of my landscape and my new landscape to know if a new tree is there that was not there before and it gives my mind alittle comfort to make sure its okay. I dread doing it, I have to admit (because maybe something IS there this time) but I do it because I feel it is something I do for my health overall. After all, I've come this far and don't want a brand new bc to take me down just because I didn't even know it was there when I could have.

Everyone's different though.

[Debbie L.]

(warning, it took me so long to write this that I was timed out and had to sign in again, even though it still knew who I was. sorry for the length but Brenda and I do tend to get going)

Hi Brenda,

You and I have enjoyed this debate before (smile). Correct me if I'm wrong, but my understanding is that your style values finding small things. My thinking is that the biology and response-to-treatment is more important than size. Brain mets excepted.

I think when we've discussed this before, it's been about mets vigilance. I think that we've agreed to disagree - noting that it's partly a matter of style and personality although I do have other concerns (like the cost) about ultra-vigilance when we have no evidence of benefit. Again, brain mets excepted. And I do allow that there is the possibility that one day, we may learn that finding, for example, a small liver met and zapping it, as we do with a small brain met - will be an improvement that extends life. But we don't know that. There's a heck of a lot that we don't know.

But now we're talking about primary detection which in some ways is different (we do have bushels of evidence that seems to say that larger is worse and vascular/lymphatic invasion is worse). The argument to that, which makes sense to me, is that those things (larger, more spread) may not be, in themselves, worse things, or even things that happened because of time - but are simply markers that go along with the more-aggressive (faster growing, more invasive) cancers, and thus the worse prognosis relates to the biology that caused the larger size or farther spread.

You are right, we are all dying. But we are also talking here about saving lives in a breast-cancer-specific way and so I think "saving" lives is an okay way to phrase it. If the cancer doesn't return and some other fire gets us at 90 - well then we can say that we were saved from dying of breast cancer. Can't we? (except now there is the argument that some tumors may never threaten life and/or may regress on their own but my guess would be that those are not HER2+ ones).

What else. Oh yeah. Harms. I didn't even go there because I'm not sure it strengthens the argument. But the harms are not just to peace of mind. The extra radiation is a harm (especially perhaps to the BRCA+ cancers) and the biopsies carry the risk of any surgery plus there are some questions about what role the growth factors involved in wound healing might play r/t cancer occurrence and/or growth. And now with MRSA and other resistant bugs, any invasive procedure becomes more worrisome.

But I think the bottom line is that we're back to our ongoing agree-to-disagree place. You are sure that finding a cancer with BSE a month before you might have noted it by chance in the shower will offer you a longer lifetime - whether from a cure or from control of mets. I am not sure of that. I don't see any evidence that says that might be true. And it bothers me that we are/were spending so much money and effort to tell women to do something that we don't know will help them. I'd much prefer that we spent that money finding out more about breast cancer. Especially important right now is finding out which cancers really are a threat. For us on this board, who are HER2+, that may not seem very important, because all HER2+ cancer may be a threat. But with the majority of breast cancers, it's not so clear.

Debbie Laxague
PS: how do you make that quote box? I can do copy/paste and change colors/fonts but when I click on "quote" below, nothing happens. I'm on another list where the quote thing works, so I don't think it's my computer.

[alicem]

I missed the statistics that support the recent mammogram recommendations. What percentage of cancers are found because of mammograms given to women in their 40's? 20%? 10%? What person out there wants that person whose life might be saved - but won't be because of the new treatment recommendations - to be someone they love dearly?

The mammogram that saved my life was done when I was 52. However, it had been too many years since my previous one. Perhaps the calcifications might have shown up on a mammogram 3 years earlier when I was 49 and it still might have been just DCIS, stage 0 and the Her2+++ invasive cancer that had to be treated by chemo would never have happened. I blame myself for this, but I had become complacent. My primary care physician had told me in my early 40's that I would NEVER get breast cancer. HAH!!!

Lets fast forward to the next treatment that might fall under the gun for the next round of "cost savings/harm prevention" - - biopsies. When my calcifications were found, I was told not to be worried because in my particular situation, 90% of the time it would turn up nothing. Because 10% of the time it does turn up cancer, it was the recommendation to have a biopsy. I fell in the 10%. It worries me that the same argument could be made for biopsies in my situation. Statistically, calcifications like mine are nothing. Statistically, 90% of the women are put under the "stress" of a biopsy for no reason. Is the cost of these "unnecessary" biopsies for those 90% TOO GREAT??? In my opinion, NO!! If it weren't for this particular standard of care, I would be facing a different outcome entirely. My mammogram found calcifications. My calcifications led to a biopsy. The biopsy led to a lumpectomy. The lumpectomy led to a mastectomy. The mastectomy FOUND MY INVASIVE CANCER before my lymph nodes became involved!! If it weren't for the biopsy, I believe the cancer would have progressed to the point where my odds of survival were greatly reduced. It scares me that in the future, a women with my scenario might face a totally different result - because it was more important to cut costs.

[Patb]

My breast cancer was found with a yearly
mammogram by a deligent Dr. who kept
reading and reading it, called me in with
a slight suspicion because the tumor was
very deep and hard to see. It was Grade
3 and growing fast. Thanks to him and the
treatment I received I know I have at least
lived three more years. I believe we have
to do all we can and if that doesn't work
we can say without regret we did all we could.
Brenda I agree with you with all my heart.
You are a rock star.
patb

[loricar3]

Routine yearly mammogram found the 2.5 cm tumor.