“After learning she had a high genetic risk for breast cancer, Dane’e McCree, like a growing number of women, decided to have her breasts removed. Her doctor assured her that reconstructive surgery would spare her nipples and leave her with natural-looking breasts.
“It did. But while Ms. McCree’s rebuilt chest may resemble natural breasts, it is now completely numb. Her nipples lack any feeling. She cannot sense the slightest touch of her breasts, perceive warmth or cold, feel an itch if she has a rash or pain if she bangs into a door.”
“Many women decide to undergo contralateral prophylactic mastectomy despite having limited knowledge about the procedure and before completing discussions and evaluations with surgeons, according to results of a population-based study.
“However, the use of contralateral prophylactic mastectomy among women without clinical indications appeared lower if a surgeon recommended against it.”
“Five rounds of the usual chemotherapy/radiation protocol kept Alan Gross alive through decades of living with lymphoma. The treatments were grueling, but he was living proof that science was giving us ways to live with cancer. Then the disease came roaring back, and doctors told him that their medicine no longer worked. They told him to get his affairs in order.
“Every day, thousands of Americans get the end-of-life warning that Alan and his wife, Jane Townsend, heard two years ago. The words are so powerful that they can have a concussive effect, making it hard to hear, to speak, to process information. ‘Your ability to think clearly and concentrate isn’t there,’ Jane told me.”
“A survey of women with breast cancer found that nearly half considered having a double mastectomy. But of those who considered it, only 37 percent knew that the more aggressive procedure does not improve survival for women with breast cancer.
“Among women who received a double mastectomy, 36 percent believed it would improve their survival. Studies have shown that for women at average risk of a second cancer, removing the unaffected breast does not meaningfully improve survival.
“The study, which was presented at the American Society of Clinical Oncology annual meeting, looked at 1,949 women who had been treated for breast cancer. About 20 percent of the women surveyed had both breasts removed, a procedure called contralateral prophylactic mastectomy. Even among patients without a genetic mutation or family history that might put them at risk of developing cancer in the other breast, 19 percent had double mastectomy.”
“I had to take my husband back to the hospital for a second operation on a torn tendon, but the pills from the cancer trial had not yet arrived. Surely doing without one or two days of the drug would not necessarily lead to a recurrence, I told myself in an effort to still rising waves of anxiety. There were more pressing matters to attend, namely righting wrongful care.
“Two weeks earlier, a fall on the basement steps led to an operation on Don’s knee. The surgeon called it a success and sent us home. After I wrote an essay about my welcoming the prospect of caring for my beloved caregiver, the first reader responded: ‘No one has training in these tasks, especially families who are too emotionally connected to really be effective.’ A nurse judged our being entrusted with home care ‘dangerous.’ They were both spot on.
“The first night home in a brace, Don’s leg buckled beneath him and he fell again. At the ER, he was given a longer brace. However two arduous weeks later — while we thought the knee was healing — the orthopedic surgeon explained that the tendon had torn again probably because of that fall two nights after surgery: Don would need a reoperation.”
“When a man is diagnosed with localised prostate cancer, he usually faces a range of treatment options, from active surveillance to radiation therapy or surgical removal of the prostate. The patient’s personal values and preferences should be key in this choice: Is curing the cancer the only thing that matters or should he also consider a variety of quality of life issues, such as avoiding incontinence or erectile dysfunction?
“The frequent difficulty in determining the prognosis of localised prostate cancer complicates matters. Many men have low risk prostate cancer that is thought to be slowly progressing and may have no impact on their life expectancy.
“The doctor must reach an agreement with the patient when making treatment decisions. However, truly shared decision-making is possible only when the patient understands what the different treatment options entail for him personally, and the doctor understands the patient’s personal situation and desires.
” ‘Such truly shared decision-making is a relatively new phenomenon in medicine. Traditionally we assumed that the doctor always knows best,’ says Kari Tikkinen, Academy of Finland clinical researcher and adjunct professor of clinical epidemiology from the Department of Urology at the Helsinki University Hospital.”
“Women who understand the risk of over-detection and over-diagnosis associated with mammography screening have lower intentions to have a breast screening test, according to a new Lancet study.
” ‘Mammography screening can reduce breast cancer deaths but most women are unaware that inconsequential disease can also be detected by screening, leading to over-diagnosis and overtreatment,’ says study author, Prof Kirsten McCaffery of the University of Sydney.
“Over-detection and over-diagnosis refers to the diagnosis and treatment of breast cancer that would not have presented clinically during a woman’s lifetime.
“Such a diagnosis, and the resulting overtreatment, can harm women physically and emotionally.”
“Women with breast cancer often don’t know what kind of tumors they have, a new study found.
“Not knowing one’s tumor features isn’t necessarily tied to worse outcomes, but better knowledge might help women understand treatment decisions and take medications as directed, said Dr. Rachel Freedman, the study’s lead author from the Dana-Farber Cancer Institute in Boston.
“Also, she said, cancer patients who understand the basis for their treatment are generally more satisfied with that treatment.
“ ‘Nobody to my knowledge has asked how much knowledge someone had of their own disease,’ she added.
“For the new study, published in the journal Cancer, Freedman and her colleagues asked 500 women from northern California about their breast cancers, which had been diagnosed between 2010 and 2011.”