"Trying to support her emotionally and spiritually for those six
years she survived taught me how superficial it is to try to keep
these organs if they are diseased. One female physician who said
she'd wish to be as far away from her breasts if they were cancerous, rings
true."
I can speak to this issue personally, having been diagnosed with breast
cancer last fall. The decision about whether to have lumpectomy/radiation
or a mastectomy should hopefully be done with full knowledge of the options
and the risks/benefits of each, just like the infant feeding decision.
Currently, statistics show equal outcomes, in terms of 5 year mortality
rates and 5 year recurrence rates in the same or the other breast, whether a
woman opts for lumpectomy/radiation or mastectomy. Traditionally, if one
chose a lumpectomy, then one also did radiation to the breast (5 minutes a
day, for 6-7 weeks, following the end of chemotherapy). That was to kill
any rogue cancer cells that might be floating around in the tissue in the
vicinity of the primary tumor.
If one opted for a mastectomy, then the theory was that since most of the
breast tissue was removed, you didn't need radiation. Some people chose
mastectomy because they 'feared' their breasts. Others chose mastectomy
because they didn't want to go in for daily radiation treatments for 6-7
weeks, which can be a real hardship if the treatment center is several hours
away from where you live. Some people chose mastectomy because they had
such small breasts that a lumpectomy wouldn't leave much tissue anyway.
Some people chose mastectomy because the lump was deep in the breast tissue,
near the chest wall, making it dangerous to do radiation because of the
potential for damage to the heart and lungs. There are many *medical*
reasons for choosing one over the other, but the statistics generally said
the outcomes were equivalent.
In just the last year, more and more oncologists have been recommending that
even people who have mastectomies should also undergo radiation treatment.
Why? Because even the best, most thorough mastectomy cannot remove all the
breast tissue, which can be under the arm, up by the clavicle, etc. The
oncologists in the most recent research have found a small but statistically
significant higher rate of recurrence in women who had mastectomies compared
to women who had lumpectomies with radiation. The recurrences tend to be at
the site of the mastectomy scar, on the chest wall -- where they are
difficult to treat with either surgery or radiation. So, it would appear
that lumpectomy with radiation is now considered to have slightly better
outcomes than mastectomy without radiation. Since they just started doing
mastectomies AND radiation, the 5 year survival statistics for that course
of treatment are not yet available.
Each woman should have full access to information about the options
available to her and the research about the outcomes. People shouldn't
automatically get their breasts "lopped off" from a diagnosis of cancer.
Lopping off your breasts is NOT a guarantee you won't get breast cancer in
the first place, or have a recurrence after a diagnosis and treatment.
Many women with cancer do not view their breasts as "enemies" or out to get
them. They do not necessarily view their cancer as an enemy to be defeated,
either. I highly recommend the following book to anyone interested in the
cultural aspects of cancer diagnosis and treatment: "Teratologies, A
Cultural Study of Cancer" by Jackie Stacey, a British sociologist who had a
teratoma.
Katherine A. Dettwyler, Ph.D.
_________________________________________________________________
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