WTF - "A virtual epidemic of preventive mastectomies" (NYT)

[denem]

There's a lot being written after Angela Jolie's essay on deciding to have a double mastectomy. As I read through a NYT opinion piece, at one point I quickly scrolled up. Yes, the author(s) were women. That was little comfort. 'Health Insurers'would no doubt endorse the tenor of their conclusions. The 'virtual epidemic' is, for the record,

Women who have cancer in one breast and decide to remove the healthy one as well, even though they do not have genetic mutations that increase their risk and their odds of a second breast cancer are very low..

Speaking as a man, I really have no idea about a decision of such gravity. But, intellectually, I would have thought that given the costs of surgery, and the nightmare of breast cancer, it is perfectly understandable that some women would choose to close the book on breast cancer there and then. Wouldn't anyone hope and pray that the intervention has been soon enough, and not want to think about going through it all again?

NTY Article:-
http://www.nytimes.com/2013/05/15/health/angelina-jolies-disclosure-highlights-a-breast-cancer-dilemma.html

[djean111]

1. I agree.

Why have the constant nagging fear?
The existing fantastically profitable business of exposing breasts to x-rays on a regular basis, expensive chemotherapy, hideously costly cancer drugs, etc. might just feel a bit wary or even threatened at the thought of dispensing with the fear and possibility, if not probability, of breast cancer forever, at one stroke.
Our corporate, profit-driven medical structure is built on detection and management, not on prevention.

[denem]

2. (sigh) Yes

follow the money.

[GeorgeGist]

3. Definition of EPIDEMIC

1. affecting or tending to affect a disproportionately large number of individuals within a population, community, or region at the same time <typhoid was epidemic>
2 a : excessively prevalent
b : contagious 4 <epidemic laughter>
3 : characterized by very widespread growth or extent : of, relating to, or constituting an epidemic <the practice had reached epidemic proportions>

Definition of HYPERBOLE

: extravagant exaggeration (as “mile-high ice-cream cones”)
— hy·per·bo·list noun

[Honeycombe8]

4. It seems reasonable, if a woman chooses that. They get reconstruction surgery,

so the boobs end up looking as good if not better, in the end.

[Ms. Toad]

8. If I make that choice,

I likely would not get reconstructive surgery.

[Honeycombe8]

18. Nancy Reagan didn't. My grandma didn't. It's a personal choice. nt

[Ilsa]

5. Well, if one-in-eight (or nine) women gets breast cancer,

I would call that an epidemic.

[Ms. Toad]

7. Interesting -

I expect to have breast cancer (both my mother and her mother did), and my mother had a single mastectomy in response to the first breast cancer. It was discovered by my father, did not show upon mammograms (even with a needle pointing to it), and they were sure it was benign.

Then more than a decade later, a second (different & invasive kind) of breast cancer was discovered by accident during a surgical procedure. She could easily have gotten away with a lumpectomy (for a 1 mm "lump&quot , but she was tired of having lumps removed (perhaps a dozen benign ones) - so she opted for a mastectomy.

I suppose her theoretical risk for that second cancer was no greater than average - but having watched it turn to reality for her I'm not sure what decision I will eventually make.

[Uben]

9. HAving the breasts removed does not mean the cancer won't return.....

There is no cure for breast cancer. My wife opted to have both breasts removed after cancer was discovered in one. The cancer finally returned 10 yrs later and she was gone in 60 days. HAving the other breast removed may have bought her time, maybe not. It was her call. It's a personal thing, and a choice women have to make when confronted with the disease.

As to whether having the breasts removed as a preventative measure is concerned, I do not know what the numbers are or the effectiveness of such actions. Were I a woman, I would do anything that gave me a better chance of not contracting this horrible disease.

[SoCalDem]

11. preventative surgery removes the healthy tissue before a cancer forms

once cancer is there, it's a crapshoot.

I am so sorry you lost her to such a horrible disease.

[SoCalDem]

10. If you view your breasts as ticking timebombs

and you are worried sick about getting cancer...and if you have the money & a doctor who will do it, why not?

There are millions of women who have all the children they plan to have, and who have a family history of it, so they may be more than eager to get rid of a potential cancer

When I was young, it was rare to hear of someone who had breast cancer...or any cancer for that matter, but decades of exposure to who knows what, and we see it running rampant.

For many it may be a choice of removal at 40-something, or years of cancer treatments ten years ahead.

I knew a young woman who had a double mastectomy and a total hysterectomy at age 28. She had 4 kids under 6, and her Mother, 2 aunts & an older sister all were diagnosed within a year's time. Mom & one Aunt died.

She had to try 3 or 4 doctors and had to see a shrink, but they did it for her.. She never regretted it for a minute.

[elehhhhna]

12. "and if you have the money "

because if you're uninsured, go die. Even ins. co's don't want to pay for the genetic testing and the surgery.

[SheilaT]

13. I read something quite recently

that essentially said the wave of "preventive" mastectomies is having no affect on the rate of breast cancer.

The incidence of, and risk for breast cancer tends to be greatly over-estimated, even though the incidence and risk are very real things.

I'm just waiting for the suggestion that all women have mastectomies at age 40 or so.

Most men will get prostate cancer at some point in their lives. Why aren't we seeing lots more preventive surgeries in that department?

[byeya]

16. It's usually the women who carry the genetic makeup to develop breast cancer at an early age

who are having the procedure. In some populations, there's a 75% liklihood of developing the deadly disease. It's an informed decision that they are making.

[SheilaT]

19. If that were true, shouldn't the incidence of breast cancer go down

from all the preventive mastectomies?

[Brickbat]

14. If people are worried about an "epidemic" of preventive masectomies, then they should support

research into the causes of breast cancer in order to stop it.

[sufrommich]

15. A big problem is that once you have breast cancer

your insurance will cover a mastectomy but will not cover the $4000 bill for genetic testing. So for a lot of women it's a question of getting a preventative mastectomy because they can't afford the testing out of pocket. God help the women who have no insurance at all.

[redqueen]

17. They'll cover removal but not testing.

And that's just those lucky enough to be able to afford insurance.

But a public option is of course out of the question.

[ismnotwasm]

21. Yup

Actually, Medicare might--IF certain criteria are met, (like you already have cancer, or are a high risk) Medicaid just won't.


Disgusting.

[ismnotwasm]

20. There are a number of treatment options

In Ms. Jolie's case, her chances of getting breast cancer was very high, and remember a preventative mastectomy is not just for breast cancer, or genetic-caused ovarian cancer but with the knowledge that cancer spreads. The origin of the cancer site is the primary site, but it can spread to other organs as well, and does.

Take colon cancer, a cancer that often spreads to the liver--You'd want treatment--chemo, possibly a colectomy and you'd also want to catch the cancer before it invades anywhere else. That being said, I completely understand the impulse to have both breasts removed, although I'd hope all women would be under the care of a very good oncologist, who is able to communicate best practice in any particular situation

Cancer is a terrifying disease, we have a lot more in our arsenal to fight it, but we don't always win. In general women are given treatment options, and choose what works best for them. When people hear any negative diagnosis, the ability to process information changes, new words and names tend outrun the familiar ones. People need to make informed decisions and understand choices available and health care practitioners need to take care that the information is understood.

There are also more reconstruction options, one of which is where fat is taken from the belly or elsewhere and 'pulled' up to make new breasts. Unlike implants, if this surgery goes well, you're done--although many women opt for implants and the surgery I'm alluding to isn't available everywhere. ALL reconstruction involves considerable discomfort.