Women and cancer

[Cheyenne]

We haven't had a thread lately reminding women to get their annual checkups and their mammograms if they are 40 years or older.

Buried in another thread is the news that my sister recently got her first mammogram which was to be her baseline. Instead, they found breast cancer. She is now facing surgery. Thank God she went for her annual physical! I'd hate to think of the alternative.

My normal method of handling such problems is to research as much as I can to learn as much as I can about the issue. In my reading about breast cancer, I found one site which I think is excellent. It is written clearly, and in language that is understandable even if you have no medical background. It talks about prevention, detection, treatment, etc. Full of wonderful information that we all hope we will never need.

Check it out:

http://www.breastcancer.org/

And if you're 40 or older, please remember to get your mammogram! My sister had no family history of breast cancer and no symptoms at all. She thought she was healthy. It was just that first mammogram that caught her cancer in the early stages (we hope, she is still being tested to be sure it hasn't spread.)

 

[Mia62]

My sister had no family history of breast cancer and no symptoms at all. She thought she was healthy. It was just that first mammogram that caught her cancer in the early stages (we hope, she is still being tested to be sure it hasn't spread.)

Didn't you have an episode of some kind of cancer? If so - that means that there is a family history...Just because the direct correlation is not breast cancer between two family members, there is still a history of cancer.

The things that doctors look for when talking to a newly diagnosed patient include the following:
* First age of menarche.
* Age of menopause.
* Birth of children.
* Breast fed children.
* Use of birth control pills and/or hormonal replacement therapy. (Most women are immediately taken OFF hormone replacement therapy if diagnosed with breast cancer)
* Smoking history.

 

[Cheyenne]

Re: Re: Women and cancer

Didn't you have an episode of some kind of cancer? If so - that means that there is a family history...Just because the direct correlation is not breast cancer between two family members, there is still a history of cancer.

No, I don't. You're probably thinking of last year when the doctor thought I might have cancer based on my annual mammogram. Mine turned out to be a cyst, no cancer. But it scared the crap out of me until I knew for sure.

 

[SimplySouthern]

Let me be the one to add that regular gynecological checkups are tres important.

You are not too young to have cancer. Trust me. At 24, I had ovarian cancer. It was found on a visit while I had some pain during a period. However, oftentimes it's silent and you don't know it's there. Pap smear, ladies. That's where it's at.

Please.

 

[scrymettet]

Never assume the worst but play safe.
We you women.

 

[SubChristy]

I work in a hospital and unfortunately i see cancer everyday. yes, you can be any age to get cancer...please please please get checked

 

[Cheyenne]

Not one of the more popular topics at Lit, I know. But this thread is meant to be a genuine PSA.

Mammograms get a bad rap for being painful. That is NOT the case if you have someone who knows what they are doing. If you haven't gone before, don't be afraid to tell the tech doing the mammograms that this is your first time. She will probably take more time to explain to you what she is doing and why she is doing it. There is nothing to be afraid of except NOT having them done.

 

[Lancecastor]

The first time I slept with a particular grrlfriend, I noticed a lump in her right breast. It was quite large (the lump that is) and I was surprised that she said she hadn't noticed it...maybe she was in denial. She was 27 or 28 at the time I think.

I'm constantly amazed at how women can not notice or simply deny a lump in the softest part of their body...and you hear stories about it all the time, right?

What's up with that?

 

[Cheyenne]

What's up with that?

Denial may be correct. "If I pretend it isn't there, it may go away."

The time you really need to find the cancer is BEFORE a lump is even noticable. Waiting for a lump to appear before doing anything is a little like waiting for forrest fires to surround your house before you start to think about getting fire insurance. You could be too late.

 

[Agent99]

Interesting that the "Chest Av Week" thread has 79 replies and 680 looky-loos while this one only has 8/80. Kind of a sad commentary on our priorities. [not that there is anything wrong with boobage pics]

I do believe that October is National Breast Cancer Awareness Month which, hopefully, will remind women to perform monthly self-exams as well as annual mammograms.

It might be worth adding that mammograms are not painful for the majority of women. And even on the offchance that there is any, the slight discomfort lasts 30 seconds, tops.

 

[Aurora_s_Flame]

I am glad to have seen this thread today. I lost my mother two years ago this day to ovarian cancer. Cancer does not discriminate age, race, sex, financial background...it just is. Keeping healthy and having regular checkups are key. More people should take the time to stop, think, and do such things...if not for themselves, then for their friends and family. "Early detection" can be two of the best words in the world....

Just my thoughts,

~ Rora

 

[Sandia]

There's some research that suggests preventative testing is not nearly as useful as we're led to believe.

Basically it's the slowest growing and least dangerous tumors that are most likely to be found.

The most dangerous tumors are also the most likely to have metastized before they can be detected.

 

[Black_Bird]

We haven't had a thread lately reminding women to get their annual checkups and their mammograms if they are 40 years or older.

Good idea. I have a close friend whom recently found a lump in her breast. She seems to be scared shitless. Soo... I empathize.

 

[Cheyenne]

There's some research that suggests preventative testing is not nearly as useful as we're led to believe.

Basically it's the slowest growing and least dangerous tumors that are most likely to be found.

The most dangerous tumors are also the most likely to have metastized before they can be detected.

I don't know what "preventative testing" is. Testing (like mammograms) does nothing to prevent cancer, it only can detect it after it is already there. Unless you are talking about using genes to predict which women are prone to cancer, that would be predictive but again, not preventative.

There are some people who think mammograms have too many false positives (like mine last year) which scare women needlessly. As a woman who went through that, I'm here to say I would much rather be scared needlessly then miss a cancer that I could have found if only I'd gone for my annual mammogram.

Do you have a source for your comments about about which tumors are more likely to be found? In all the research I've done in the past two days, I have not seen that.

 

[Aurora_s_Flame]

There's some research that suggests preventative testing is not nearly as useful as we're led to believe.

Basically it's the slowest growing and least dangerous tumors that are most likely to be found.

The most dangerous tumors are also the most likely to have metastized before they can be detected.

I know this for a fact, but still annual physicals ARE important. It is better to do then to not...

Again, just my opinion...

~ Rora

Edited to add : That what I "know" is that "The most dangerous tumors are also the most likely to have metastized before they can be detected." This is what happened with my mother...less than a month between her diagnosis and her passing.

 

[Sandia]

Another problem you pointed out, Cheyenne, is false positives. In cases where where the incidence of a disease is small, even a small error rate can lead to more erroneous diagnoses than correct ones.

For example, if the error rate of a particular test is one percent, and the chance of having that particular disease is less than one percent, you'll get more false positives than true ones.

And that doesn't take into consideration false negatives (cases where somebody has the disease, but the test fails to detect it.)

There's a lot of pressure on doctors for a variety of reasons to recommend testing.

This journal talks about some of the problems.

Physician uncertainty underlies many medicolegal concerns and may result in the practice of "defensive medicine." Although defensive medicine may have consequences in terms of quality of care and utilization of resources, a precise definition of defensive medicine is elusive; one physician's "defensive" medicine may be another's "careful" medicine. Economics, including the cost of the test, the costs of the interventions triggered by positive test results, and who is paying the costs, can also play a large role in determining whether a technology will be offered or used. Studies suggest, however, that malpractice concerns are on physicians' minds, and that physicians believe that these concerns influence their clinical practice. Most of the medical malpractice literature involves physician specialties such as radiology, pathology, surgery, and obstetrics and gynecology. However, PCPs may become increasingly embroiled in malpractice issues, due in part to their essential role as care managers attempting to balance the appropriateness and cost of care, the continued shift of care to the outpatient setting, and the increase in "failure to diagnose" claims.

Basically they're saying doctors never get sued for telling somebody to take a test.

This site talks about a test for a different kind of cancer - prostate cancer.

Data suggest that screening often detects what may be indolent, nonaggressive prostate cancer. The treatment of such a cancer with radiation or radical prostatectomy can result in significant morbidity, including urinary incontinence and impotence, without a proven decrease in mortality.

This site says the benefits of testing for breast cancer have not been proven.

The evidence on overall reduction in death rate from randomised trials and from epidemiological studies falls short of showing much evidence of effect.

There's a lot of pressure on physicians to recommend testing because there's really no downside - for them - to recommending it. And of course most patients would rather be safe than sorry.

A physician is positively reinforced for recommending screening, regardless of the test result, because a negative result makes a patient grateful for reassurance and a positive result makes a patient grateful for early detection.

Basically what I'm saying is the case for testing's been overstated.

 

[Sandia]

This is about an article that was published in the Lancet, a medical journal, by some European researchers.

Breast-cancer screening programmes may not save lives, according to a new examination of clinical trials. The controversial findings have led to calls for a re-evaluation of the routine monitoring procedure undergone by numerous women.
*
*
*
Mammography detects small changes in breast tissue that may indicate the beginnings of a tumour; results influence how doctors proceed. Treatment usually involves surgery to remove the abnormal tissue or the whole breast, followed by radiotherapy, chemotherapy or hormone therapy.
*
*
*
Screened women were also more likely to undergo aggressive treatment. Some of this may have been unnecessary, say the authors - some tissue changes are benign or slow-growing and would not put lives at risk. Treatment also creates its own problems - for example, radiotherapy leads to an increased chance of heart disease.

In other words, some people die from treatments for cancers that might not have killed them.

Conversely, some people will credit early detection, surgeries, and chemotherapy for saving them, when their lives might not have been endangered in the first place.


http://www.nature.com/nsu/011025/011025-5.html

 

[Cheyenne]

Another problem you pointed out, Cheyenne, is false positives. In cases where where the incidence of a disease is small, even a small error rate can lead to more erroneous diagnoses than correct ones.

For example, if the error rate of a particular test is one percent, and the chance of having that particular disease is less than one percent, you'll get more false positives than true ones.

And that doesn't take into consideration false negatives (cases where somebody has the disease, but the test fails to detect it.)

There's a lot of pressure on doctors for a variety of reasons to recommend testing.

This journal talks about some of the problems.

Physician uncertainty underlies many medicolegal concerns and may result in the practice of "defensive medicine." Although defensive medicine may have consequences in terms of quality of care and utilization of resources, a precise definition of defensive medicine is elusive; one physician's "defensive" medicine may be another's "careful" medicine. Economics, including the cost of the test, the costs of the interventions triggered by positive test results, and who is paying the costs, can also play a large role in determining whether a technology will be offered or used. Studies suggest, however, that malpractice concerns are on physicians' minds, and that physicians believe that these concerns influence their clinical practice. Most of the medical malpractice literature involves physician specialties such as radiology, pathology, surgery, and obstetrics and gynecology. However, PCPs may become increasingly embroiled in malpractice issues, due in part to their essential role as care managers attempting to balance the appropriateness and cost of care, the continued shift of care to the outpatient setting, and the increase in "failure to diagnose" claims.

Basically they're saying doctors never get sued for telling somebody to take a test.

Basically what I'm saying is the case for testing's been overstated.

I didn't understand "preventative testing" to be the same as "defensive testing." Defensive testing is done by doctors all the time to keep from being sued, not just in regard to breast cancer.

As for your breast cancer article, this sums it all up for me:


"The other six trials were much more favourable to screening (Figure 1), and consistent in the extent of benefit. Combined they had a number needed to screen to prevent one breast cancer death of 661 (506 to 950). Pooling all eight trials produced a number needed to screen to prevent one breast cancer death of 1040 (755 to 1672). "

"Perhaps the best we can do for now is to tell women the truth and let them decide. Tell them that one woman in every 1000 who undergoes breast screening may be prevented from dying from breast cancer, but there may be no benefit at all. Women should demand the best unbiased evidence on the benefits and harms of screening."


To me, if I am that one woman in 1,000 who is prevented from dying from breast cancer because I take 1/2 hour from my life every year to get my mammogram, I'm satisfied that the testing is worth it.

Also, there are many cases of breast cancer which will not result in death but will result in more extensive treatment if not found early. I'd rather find a cancer in early stages where I can have a lumpectomy rather than in later stages where I need a total masectomy, or even a radical masectomy.

I didn't read your info on prostate cancer as it has nothing to do with my topic of women and breast cancer.

 

[Rubyfruit]

now that i have insurance, i'll be getting my annual and another mammogram as soon as possible....right after i get back on zoloft.... but anyway,

close call in my family last year when the doctor found aggressive cancer in my cousin during a routine mammogram. she had a double mastectomy the beginning of this year and is doing well now.

very scary stuff.

 

[Sandia]

The point of the Lancet article, Cheyenne, was that the studies that were most flawed were also the ones that showed a benefit.

The best studies, on the other hand, failed to show the one in one thousand benefit you're talking about.


The studies on other kinds of cancers are relevant because the same kinds of systemic biases that lead to excessive reliance on screening in other cancers also lead to excessive reliance on sceening in the case of breast cancer.


Many people assume there's no downside to testing - that nothing bad can happen from getting tested; that bad things happen only from not getting tested.

I'm arguing that's not quite true. In the first place testing can lead to unnecessary and even life-endangering surgeries and other procedures.

In the second place, all that testing drives up the costs of health care, and if there's no benefit, it's money wasted.

In the third place, the resources that go into testing could be used in other, more productive ways. Ways that might lead to increases in life expectancy.

 

[SexyWench]

I can't emphasize how important the mammogram is in conjunction with your monthly self-exams and annual medicals. I know, my mom finally (after her 2 daughters badgered her about it) scheduled a complete medical check up. During that visit, the doctor didn't detect anything in her breasts but the mammogram did. She was diagnosed with stage 3 breast cancer and surgery was scheduled for the Fall of 1996. In the spring of 1997 she underwent chemo and radiation treatment for six months and a regimen of Apo-Tamox. Just this past spring she was declared cancer free.

 

[~GoldEyes~]

Good to see this thread,

I have breast cancer. I found the lump myself last October, Had my checkups faithfully, every 6 months, TUrned out to be stage II breast cancer. Lymph nodes were also cancer. I have had 3 surgeries, chemo and just finished Radiation about 2 weeks ago. I am going back to the onc. for checkup on Monday the 15th. There was NO history of breast cancer in my family. Age has nothing to do with it. I just th ankful I found the lump before it had spread any further. I wish all of you, anyone that you love or know, the best. PLEASE PLEASE, get you checkups, follow through always.

Love
Golden Eyes

 

[~GoldEyes~]

WHY IS IT

We have had so many LOOK at this thread, and so few posted?

 

[~GoldEyes~]

That is a great sight, cancer board. I have another one if you are interested. Breast Cancer Just Us. Bulletin Board I go to all the time, I have met wonderful women on this board.

Breast Cancer Just Us

 

[zipman]

Many people assume there's no downside to testing - that nothing bad can happen from getting tested; that bad things happen only from not getting tested.

I'm arguing that's not quite true. In the first place testing can lead to unnecessary and even life-endangering surgeries and other procedures.

In the second place, all that testing drives up the costs of health care, and if there's no benefit, it's money wasted.

In the third place, the resources that go into testing could be used in other, more productive ways. Ways that might lead to increases in life expectancy.

I'm curious if you're a doctor, or know anything about breast cancer asides from what you've seen on a website?