I think that there is much in what Katherine says - many are benign. I am
surprised that the surgeon is so keen to operate with no investigation
[unless there are 'sure' signs such as fungating growth]....BUT I think
advising women to wait and see has inherent risks. YES the surgery MIGHT be
a factor in later problems BUT if a tumour is excised before metastasing
then outcomes are obviously much improved.STILL there is much to be said for
a conservative approach but I feel we should be able to put faith in the
professional judgement of the doctors concerned [sadly there are many
instances where this seems to be misplaced faith] and consequently it is a
case of balancing personal wishes against medical advice in the light of
[hopefully] full and frank information.
In a situation such as that in the UK we have what is called a 'postcode
[?zipcode] lottery' which means
different authorities in various regions have different waiting times. I'm
not attempting to justify this scandal just stating a fact - thus the
earlier a woman enters the system the better. I'm not clear from the post
whether you are advocating delay before an initial consult - and am assuming
that if I'm not sure others might also be confused [although I may just be
being fatheaded!].
Tony [and breast cancer is on the increase in men too]
----- Original Message -----
From: "Katherine Dettwyler" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Thursday, June 28, 2001 12:57 PM
Subject: Waiting and watching with breast lumps
> Here's my .02 on waiting and watching for breast lumps.
>
> I disagree with Pat that nothing is to be gained by waiting. On the
> contrary, many a breast lump turns out to be just a benign lump.
>
> One of the easiest non-invasive ways to distinguish nasty from nice breast
> lumps if whether they grow over time. By the time a breast lump is big
> enough to be palpable, if it is cancerous, it has been in existence for
> about 10 years on average. Waiting a few months isn't going to make much
> difference on long-term outcomes.
>
> Typical breast cancer tumors double their size every couple of months.
They
> start out with one abnormal cell, then grow to 2 cells, then 4 cells, then
8
> cells, and so on. That's why one month the tumor is too small to feel
(say
> 1/8" across) and after several months it's easy to feel (1/4" across).
And
> of course if you weren't checking, and waited several more months, it
would
> be 1/2" across, and several months later 1" across, and so on.
>
> Breast surgery (for any reason) is one of the big risk factors for
> developing breast cancer, so you want to avoid surgery on your breasts for
> any reason -- including "let's get that lump out of there just in case."
> The first lump may not have been cancerous, and the woman goes away
> reassured that she merely had a 'benign fibroadenoma' or whatever, but the
> surgery may then trigger a cancerous lesion at the site of the surgery --
> many years down the road.
>
> If you find a lump, most physicians will do a mammogram and an ultrasound,
> even a needle biopsy. But many will also take as the first step a "watch
> and wait" approach. If the lump has not increased in size after several
> months, then it's almost definitely NOT cancerous -- because a cancerous
> tumor would most likely have doubled in size during that time. If the
lump
> has stayed the same size, then there is no need for risky surgery. If the
> lump has gotten bigger, then the surgeon will recommend a needle biopsy or
> go straight ahead with a lumpectomy.
>
> My reading on this topic suggests that one should be very conservative
about
> doing surgery on the breasts, for any reason. Because we have been taught
> in the US to freak out about breast cancer, many women are demanding (or
> going along with their doctor's recommendation) to have a lumpectomy for
any
> lump. Hardly anyone is told that breast surgery itself increases their
risk
> for breast cancer.
>
> For anyone who works with breasts (all of us here) I highly recommend two
> books: "Patient No More" and "Teratologies" -- about the cancer industry.
>
> Kathy Dettwyler
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