Breast cancer surgeon challenges status quo
By Katie Hafner, New York Times
Late one afternoon this summer, Laura J. Esserman, a breast cancer surgeon at UC San Francisco, sat in a darkened room scrutinizing a breast MR.I. With a clutch of other clinicians at her side, she quickly homed in on a spot smaller than a pencil eraser.
She heard the words “six-millimeter mass.” Her response was swift:
“No.”
Meaning no biopsy.
Most doctors, including the radiologist seated next to her, would have said yes. But Esserman, who has dedicated much of her professional life to trying to get the medical establishment to think differently about breast cancer, foresaw only unnecessary anxiety for the patient, who had had several biopsies in the past — all benign.
Esserman, 58, is one of the most vocal proponents of the idea that breast cancer screening brings with it overdiagnosis and overtreatment. Her philosophy is controversial, to say the least. For decades, the specter of women dying for lack of intervention has made aggressive treatment a given.
Dr. Esserman is one of the most innovative surgical oncologists in the country. I should know – I used to work for her at UCSF, and I was also her patient! The most important piece of information I ever received from Laura, was the ability to “take time to make the best decision”. Most cancer patients think their disease is like a wild-fire, raging at rocket speed through their body. The truth is, that most cancers are slow-growing (with exception of specific agressive cancers, such as “Inflamatory Breast Cancer” – which is not the cancer most commonly diagnosed in women). Time to learn more about your options and make an “informed decision” is critical to the best outcomes in a cancer diagnosis.
And, yes – Laura does sing for her patients… we used to call her surgeries “medical musicals”. She is also a professor of radiation oncology at UCSF and uses all of this talent to push the research agenda at the national level. She is no stranger at the NCI. That all said, I encourage all women to be screened; to get a second opinion after a breast cancer diagnosis – preferably at a University Medical-Cancer Center; and to take the time to make an informed decision on treatment.
For those who know someone who has been diagnosed with breast cancer, I highly recommend you buy them what we refer to as the “Bible of Breast Cancer” – “Dr. Susan Love’s Breast Book”. It is in paperback and costs about $20 – and it is the most difinitive resource guide to breast disease. It is written for the lay person, and is not intended to be read front-to-back… it is an incredible resource book, fully illustrated, to explain all you could ever want or need to know about breast cancer. I hope the South Lake Tahoe Library has several copies available for loan.
October – this is Breast Cancer Awareness Month… not “think pink” month. Locally, we can support the Cancer League who provides help for all cancer patients. Otherwise, contribute carefully to organizations who put the money into research (not big salaries)… and you can always check off on your tax return, to contribute to CBCRP (CALIFORNIA BREAST CANCER RESEARCH PROGRAM).
October is Breast Cancer Awareness Month. Stay informed and stay healthy!
Thank you, Irish, for reminding the readers to “think before you pink” as well as to consider all options when faced with any serious diagnosis. Despite all the pink ribbons, 40,000 American women and men (yes, men can get breast cancer too!) die every year from metastatic breast cancer.
This well written article about Dr Esserman points out one of the many shortcomings in our treatment of breast cancer: we don’t even know which cell abnormalities will lead to invasive cancer and which won’t, and which will spread outside the breast (metastasize) and which won’t. No one dies from DCIS. No one dies from cancer that remains in the breast.
Frankly, we are all pretty darn aware of breast cancer, thanks to the 30 years of Susan G Komen pink ribbons and races “for the cure”. However, 40,000 people died 30 years ago and 40,000 will die in 2015. The only reason the rate of breast cancer deaths is declining is because we are adding thousands of cases of DCIS, most of which will grow extremely slowly and never become invasive or metastasize, to the denominator.
So this October, as Irish said, question where your money is going. Donate to our local cancer league, or a national organization like METAvivor (metavivor.org) where 100% of donations go to funding metastatic breast cancer research.
I am living with metastatic breast cancer, and at the same time, am literally dying for a cure. A pink ribbon is not a cure.