Last week I felt a lump in my breast – ran to a doctor, got a referral for an ultrasound – fortunately I have nothing to worry about; however I was seriously worried, even though I am only twenty -four and not single person in my family has had breast cancer as far as I know. The chances of the lump being cancerous were extremely low.
A few years ago I had a mole removed, because of its possibly cancerous properties. I was not even a bit worried or anxious about the whole process –when the doctor’s office called with the results, I did not even remember that the results were coming back on that day. Why did I experience these two fairly routine medical experiences in such a radically different fashion? If anything an ultrasound is a painless imaging test, while the removal of the mole is a procedure that results in stitches, follow-up appointments, and a visible scar on my upper arm.
Why the discrepancy? I blame the pink ribbon…and it all represents; breast cancer garners an enormous amount of public attention. It is perhaps one of the few cancers that has a genetic test of sorts – that has lead to the phenomena of women cutting off their yet-to-be cancerous breasts (it will be a cold day in hell before men preemptively remove their prostates!). There is also some research to suggest that women are having radical mastectomies when it fact they could just have the lump removed witha similar outcome, and this has been known for decades, and studies have also found that at least 29% of women who are eligible for the less invasive surgery are not told about their options. Recently research has also confirmed that mammography is dubious at best – and harmful at worst because of its high rate of false positives it may actually be causing cancer women to have their breasts removed.
However, there is one conversation that we are not having about breast cancer – breasts are not just for men (or women) to look at – their also a female sex organ at least for many women – and no reconstruction surgery can bring that back. While, surely I would agree that it is better to be alive without breasts, than vis-versa – the question of living without breasts, or having breasts and maybe getting cancer is a very different one.
So – what does the “pink ribbon” represent – you ask. To me it is just another way of owning the female body, through plastering the cancer that affects women’s breasts on the cans of tuna fish and frosted flakes, manufacturing anxiety to such a degree that women are cutting of their yet to be cancerous breasts, and praising the natural look of reconstructed breasts. Oh good – no big loss men can still enjoys the show – but the woman lost a sex organ.
thank you for this post. i have also found it to be ridiculous how many women get double mastectomy’s in fear of breast cancer. for many women, their breasts are very important to their identity as a woman. i remember reading this little article in 2003, when i used to read ms. magazine, about consumerism and the pink ribbon campaign, you may find interesting:
http://www.msmagazine.com/sept03/horton.asp
i also find the RED campaign to be quite irritating..how is purchasing a red shirt form the gap going to find a cure for aids????
Dear a girl:
I was somewhat disturbed by reading your blog entry on your ‘irrational’ fear of breast cancer and felt compelled to say this.
You start by mentioning women who opt for a prophylactic bilateral mastectomy; the key here is that they have a genetic mutation that makes developing breast CA a near certainty. Even at such overwhelming odds the decision, medically, is not clear cut. It is an individual decision that has to be made by the patient and her doctor. It is not your place to condone it, nor is it a manifestation of artificially drummed up anxiety.
The importance of breasts in woman’s identity and sexuality is undisputed. It is inescapable that the high risk of cancer of the breast in women would provoke anxiety and fear. As a guy, I am fortunate that that penile cancer is far down the list of likely medical man-killers. Had it been killing as many men as car accidents or diabetes, I’d undoubtedly be more concerned. The emotion many women are experiencing when thinking of BCA may be that of fear, but it’s certainly not irrational. What they should feel is a very real and rational apprehension. I will agree with you on one theme of your blog entry: BCA and its risks are misunderstood and misrepresented. However the risks are real and significant, and instead of describing breast cancer awareness as an offensive and unreasonable castration-in-disguise movement you should examine and appreciate its true purpose (if only for your own good).
You wondered why finding a lump in your breast provoked anxiety and compelled you to see a doctor. You attributed it to irrational fear as if you ran to get tested for Ebola virus the moment you felt under the weather. People don’t get infected with Ebola virus in the US, so yes, that would be irrational, but almost a quarter-million women get BCA every year. Being young and having no family members with BCA may make it seem like an urban legend. I wonder if you know any survivors of breast cancer; hearing their stories makes a distant disease personal and all too real.
As part of being a medical student, I have interacted with a number of women undergoing some form of BCA treatment. Invariably, they feel fortunate that their cancer was detected sooner rather than later. The reason that so much attention is given to BCA screening is because in many of these women the cancer could have been detected earlier had they followed the prevention guidelines. You are attacking mammography by citing research which you have not read. The death rates due to BCA have been steadily declining over the years because of the public campaign and effectiveness of mammography in detecting the disease. Are you seriously not going to get a mammogram when you are 40 or 50?
Bottom line, first, I think we agree that women should know more about breast cancer. Perhaps you can make an argument that it should provoke less anxiety. But you are dead wrong on your presumption that the fear is irrational. Second, your main point that the widely advertised drive for breast cancer awareness represents an assault on your ownership of your body is deeply misguided. The purpose of the ‘pink ribbon’ is to prevent tens of thousands of women from suffering and untimely death.
Your conundrum as to why the ultrasound for a lump in your breast provoked so much anxiety betrays your skewed view about BCA. You had your own brief run-in with breast cancer, with a happy ending. But instead of recognizing the grim reality and ensuring your own health and knowledge of breast cancer, you are troubled by extreme examples of cancer prevention. I assure you, women who choose to remove two healthy breasts know far more about breast cancer than you do. And for them the anxiety of the decision did not come from the back of the frosted flakes box, but it may very well have saved their lives.
A two points…
1) -You are attacking mammography by citing research which you have not read – how do you know that? I linked to the blog summarizing the research for the purpose of having all the links to the actual research in one place. My question is whether you have read the research – if you did you surely would not be asking the following question “Are you seriously not going to get a mammogram when you are 40 or 50?” The research found that only 1 in 2000 women was saved from cancer and 10 women out of 2000 underwent cancer treatment and had their breasts removed for no reason. At the very least, with odds like that choosing to not have a mammograms in my 40th is a rational decision. For a woman who has a genetic predisposition her odds might be different – the research did not deal with that.
2)The “unreasonable castration-in-disguise” – find me any literature about breast cancer that discusses – not just the appearance aspect of not having breasts, but the “sex organ” part – I surely have not read any narratives or support literature that gives voice to the loss of sexual pleasure from not having breasts – perhaps the reason man like touching them, is because women like having them touched. On the other hand the prostate cancer discussion is all about the sexual pleasure of the man involved.
I think the mole would be less scary to me than the lump because I would be able to see the lump and no that it was not yet cancerous or doing anything crazy. whereas a lump under the skin would be a big unknown; i would have no idea what was going on under the skin.
There is a concept in medical literature called Evidence-Based Medicine (EBM). It’s essentially a rating scale on how good the data is. For example, if a treatment is based on an ‘expert opinion,’ or a 6-patient case report, it’s considered worthless. If it was derived from the records of thousands of patients, it’s given its due attention. The issue at hand is a combination of good and bad EBM. In your post you are referring to a letter published in BMJ http://www.bmj.com/cgi/content/full/338/jan27_2/b86 , a respectable peer-reviewed medical journal and sensationalized in the UK by several physicians. The letter reviews recent research appropriately, but targets a carefully selected aspect of breast cancer screening, that being a) miniscule mortality reduction and b) unnecessary surgeries. It also accurately describes the inadequacy of the information leaflets in providing balanced info to patients. The numbers that you bring up (as did this BMJ letter) are from the Cochrane Review, the Holy of Holies of EBM. Cochrane Reviews analyse large studies and pool the data for statistically powerful and meaningful results. In this one Cochrane looked at 7 large studies, for a combined half a million women altogether, and came up with the numbers. ( http://mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD001877/frame.html ) The shortcoming? Cochrane’s super-analysis can only summate the data contained in the studies he looks at. As it happens, those studies looked at mortality numbers, but not on morbidity reduction attributable to BCA screening. (e.g. removing both breasts of an undetected BCA or removing a lump for an early-caught CA). Cochrane review makes no mention of morbidity, and thus, he cannot recommend against screening. His only recommendation is women invited to screening should be fully informed of both benefits and harms. (Morbidity is too diverse an outcome to analyze by pooling data) Unfortunately for a lay person, you have to be at a medical library computer to get free access to actual studies (unlike Cochrane reviews and expert letters, which are available for free). But I found one article from http://www.ajronline.org/cgi/content/full/184/5/1508 which describes a study of roughly 1000 people. The main point there is that regular mammo detects lumps that are too small to pick-up on a breast exam. Both women will live (no change in mortality) but the one who had regular mammo will need less invasive surgery (e.g. lumpectomy vs mastectomy), thus potentially preserving her sex organ.
Which brings me to this:
2. A very common complication of prostate resection is erectile dysfunction and urinary symptoms. You are correct, it receives its due attention. Perhaps the fact that mastectomy is a loss of a sexual organ should be more discussed. However, the fear of erectile d/f is not causing anyone to turn down life-saving surgery for prostate cancer. Women who are faced with breast surgery are also aware and dreading the inevitable outcome. Penile pumps and reconstructed breast are poor alternatives to sexual organs, but that’s the best modern medicine can do. It’s a sad reality; a claim that BCA screening is an assault on women’s ownership of their bodies is an opportunistic and rather poor argument.
As always…I love receiving feedback on what I write….
Last point: I think you are conflating two things – normal women who have no genetic predisposition towards breast cancer, and women who do. The rules for both of those groups should not be the same as far as screening is concerned. And for women with no predisposition, a decision not to be screened for breast cancer is surely a rational decision.