As with all of my writings and presentations, on LactNet, and elsewhere, my
goal is to provide women with full and accurate information, so that they
can make whatever choices they want/need to, based on their clear
understanding of the consequences of those choices.  That applies to
breastfeeding vs. bottle-feeding, and duration of breastfeeding.  It also
applies to decisions women make about how to deal with suspicious breast
lumps.

I don't believe in keeping information from people (in this case, that
breast surgery is a risk for later breast cancer) because of what some women
might, theoretically, do with that information (avoid a needed biopsy or
lumpectomy).

It is clear in the breast cancer literature that the techniques for early
detection are not risk-free (just as formula is not risk-free).  Mammograms
involve x-raying the breast.  X-rays are known to cause cancer.  Biopsies
and lumpectomies involve cutting into breast tissue.  Cutting into tissue is
correlated with higher rates of cancer.  Some women will get breast cancer
from mammography screening.  Some women will get breast cancer from having
had a biopsy or lumpectomy.  A recent study suggested no benefit to monthly
breast self-exams, at the population level.

This doesn't mean that people shouldn't do breast self-exams, or shouldn't
have mammograms, or shouldn't have biopsies or lumpectomies of suspicious
lumps.  It means that people need to know what the risk/benefit ratio is of
each option, and add that to their own personal feelings and comfort levels,
because we all worry about different things.  But I cannot condone
withholding information from people so that they don't really know what they
are choosing.

This thread began with a post about a pregnant or lactating mother who had a
lump, and the doctor wanted to immediately do a lumpectomy, rather than
other, less-invasive diagnostic techniques, or taking a 'wait and see'
approach to see if the lump grew over a month or two of time.  Or was it
that the doctor wanted to take a wait and see approach, while the woman
thought an immediately lumpectomy was in order?  I can't remember the
details of the original post!

I think the statisticians would say that if every woman with a lump (or a
white spot on a mammogram) had a lumpectomy, the net result would be a lot
of unnecessary pain, suffering, worry, and expense.

The difficulty is to put a price tag on the unnecessary pain, suffering,
worry, and expense.  If you save one woman from dying of breast cancer, but
99 have needless lumpectomies and are thereafter at increased risk of breast
cancer -- is that worth it?  Well, it is if you're the one woman, but not if
you're one of the 99 who ends up with cancer that she wouldn't have had if
she hadn't had the lumpectomy.  And how do you calculate the 'value' of all
the needless pain, suffering, worry, and expense of all those lumpectomies
in the women who don't develop cancer?

The same problem is true of high C-section rates, if you'll indulge me for a
moment.  If you do 100 C-sections and thereby save one baby from dying due
to fetal distress, but put 99 mothers and babies through unnecessary
C-sections (with all their attendant pain, suffering, worry, and expense) --
is that worth it?  And if you do enough C-sections, someone will die from
the C-section.  And some babies will have breathing difficulties after
C-sections (because they weren't squeezed through the birth canal), and some
women will get infections at their C-section sites and have to go back to
the hospital, and some babies will end up bottle-fed because their mother
couldn't cope with recovery from major surgery and breastfeeding, and on and
on.

If you try to understand the cost/benefit ratio of a high C-section rate,
the tendency is to only study the benefits -- how many babies didn't die,
who would have died if no one had C-sections?  The tendency is to disallow
or dismiss the costs of unncessary C-sections to all the mothers and babies
who had them -- to say those costs don't matter, they don't count, there's
no way to measure them.

It's true that there's no easy way to measure them, but that doesn't mean
they shouldn't be considered.  How many women should have to suffer
unnecessary C-sections in order that one baby should live who otherwise
would have died?  There are no easy answers.

Kathy Dettwyler




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