Breast cancer: What should women do?

Why can’t the Canadian Cancer Society and other organizations be honest with women about the so-called early diagnosis of breast cancer?

Let’s be upfront and say, “There is no way to diagnosis breast cancer early enough.”

But let’s also tell them that breast self-examination (BSE) should not be relegated to the Smithsonian.

Sad reality
Dr. Nancy Baxter is associated with the Canadian Task Force on Preventive Health Care. Her report states:

• 19,200 Canadian women will be diagnosed with breast cancer this year
• 5,500 will die from the disease, whether they practised BSE or not.

Many breast cancer organizations and women are not amused. After all, if you’ve told patients for 30 years BSE is worthwhile, it’ s a trifle embarrassing to admit you’ re wrong. Particularly when organizations have raised millions of dollars preaching this theme.

Women believe in BSE
Newspapers have also been full of stories of patients who discovered their own breast lumps. They’re convinced that early detection by BSE saved their lives.

Dr. Baxter’s report didn’t shock me. I’ve always known t sad reality of breast cancer-that there is no way to diagnose breast cancer early.

What women want
This is not what women want to hear:

• 99 per cent believe that mammography diagnoses breast cancer in its early stages.

You can’t blame women for thinking this way. After all, the Canadian Cancer Society has preached this theme for years.

There’s some justification for this. It’s one way to persuade women to see their doctors for both a clinical breast examination and a mammogram.

Next page: Mammography can’t detect cancer

Mammography can’t detect cancer
But it is not being honest with women as it gives them a false sense of security. Mammography simply does not detect early breast cancer.

Rather, it diagnoses breast cancer as early it can be detected-and  there’s a huge difference between these two statements.

Why? Because breast cancer takes time to develop to the point where it can be seen by mammography.

This interval may be five years or longer. And that provides ample time for malignant cells to metastasize to other areas.

This is why so many patients who are diagnosed by mammography die in spite of this fictitious diagnosis of early breast cancer.

Pap smear comparison
To put it another way, the diagnosis of breast cancer by mammography is a lump diagnosis. And by the time a lump is diagnosed as cancer, many patients are destined to die.

The Pap smear, on the other hand, is a cellular diagnosis, which detects microscopic pre-cancerous cells. This is why fewer women who get an annual Pap smear die of cervical cancer.

I realize that Dr Baxter’s report and this column are depressing news. Women who fear breast cancer want to believe they have some control over their destiny. But there’ s little point in fooling ourselves about the tragedy of this disease.

What to do?
To be sure:

• Visit to the doctor every year for breast examination
• Get regular mammograms

Unfortunately, it will have no effect on survival rates for about 70 per cent of the women who follow this procedure.

So what should women do? I don’t agree that women should stop examining their breasts. This is still the way most cases of breast cancer are discovered.

A woman’s dilemma
Unfortunately, women face  a dilemma with mammography. Mammography is a technical procedure that can occasionally miss a malignancy. There is also the possibility of false positive results.

The phone call informing a woman that an abnormality has been discovered and further tests are required causes many a sleepless night.

Until we get a better test for breast cancer, BSE along with doctor examination of the breast and mammography is the logical approach.

Dr. W. Gifford-Jones is the pen name of Ken Walker, MD, who practices medicine in Toronto.