Before research showed that for some women with Stages 1 and 2 breastcancer, the absolute survival benefit from preventive double mastectomies isless than 1% after 20 years.
Before the news that some women with early-stage breast cancer don’t benefitfrom chemo and can skip it.
Thanks to advances in genomic testing and deeper insights into the biology ofdifferent kinds of breast cancer, doctors are learning that the one-size-fits-allapproach isn’t working.
Doctors are up against not only new data but also an accumulated mass ofpublic opinion seeded by policymakers and advocacy groups with strongpositions on how best to screen for and treat breast cancer.
Which went wide in the mid-1980s, it was 3%. “Our two greatest challenges,”says Dr. Eric Winer, director of breast oncology at Dana-Farber, “Are figuringout better treatments for the 40,000 women who die of breast cancer everyyear, and at same time, figure out who, on the other end of the spectrum, isgetting exposed to needless toxicity.” If only doctors could agree on how to dothat.
“Many doctors still say that any breast cancer is a failure of a patient to get amammogram or failure of a doctor to detect it,” says Dr. Otis Brawley, chiefmedical officer of the American Cancer Society.
That’s confusing to patients conditioned to treat every cancer diagnosis as anemergency, in a world that still reacts to cancer as though it’s the beginning ofthe end and in a culture where we don’t talk about death until we have to.
“How wonderful if we can learn how to do less for women.” In the U.K. wherebilateral prophylactic mastectomies are rarely performed unless a patient has agene defect or is at a very high risk of invasive breast cancer, a first-of-its-kindinvestigation is under way.