Hello bOObs Bloggettes:
I’ve come across some slight inequities when treating women’s cancers vs. men’s that I think I should point out. The reason for the discrepancy is unclear.
Here’s what Dean Ornish, renowned doctor and researcher, said when I interviewed him several years ago:
“In the case of prostate cancer, there was a major study in the New England Journal of Medicine that showed that maybe one out of 49 men who as early stage prostate cancer benefits from the surgery. The US Preventive Services Task Force said maybe we shouldn’t even biopsy men for prostate cancer because there’s such intense pressure to, quote, do something when you find out you’ve got early stage prostate cancer. But the treatment may be worse than the disease in most people. You know, because oftentimes people who have surgery for prostate cancer radiation or chemo, get maimed in the sense of they can’t have sex because they’re impotent. They’re wearing diapers because they are incontinent for little if any benefit and huge economic and personal costs.”
Okay, so researchers are concerned about over-treating men’s prostate cancer — which they should be. But what about women’s breast cancers? Is the concern as high for us?
I’ve blogged before about the Stage 0, pre-cancer of Ductal Carcinoma in Situ and the over-diagnosis and thus over-treatment of that disease. But research has been slow to turn its opinion around until recently. Researchers are now stating that maybe medicine should Watch and Wait before treating these women with mastectomies and radiation because they don’t know how many of these pre-cancers might become invasive years later — even though medicine years ago changed the Standard of Care for Stage 0 testicular cancer in that it should not be treated, and instead undergo Watch and Wait.
But the over-diagnosing and over-treating scenario is the same apparently for prostate cancer as it is for breast cancer as well — when a man or woman discovers the possibility of cancer in their bodies, most want it cut out or treated immediately. The difference is that DCIS is Stage 0 (hence the Latin words in situ meaning “in place”) and prostate cancers, while they could be stage 0, could be a higher grade. So now it appears they are questioning the need for the PSA test followed by biopsy for many men. This is because, as Dr. Ornish mentions, patients and even doctors believe that all of these cancer stages should be treated even though it’s largely a slow growing cancer and the patient will most likely die of something else (depending on their age at diagnosis).
Same thing goes for women. Women want the pre-cancer out of their bodies (and many doctors would recommend this) as they don’t want to take any chances with it spreading. This is understandable. So most women will run to get a biopsy (which largely will show a benign situation) and must undergo all that angst in the meantime waiting for the pathology report.
Let’s hope that in the near future that they can figure out statistically how many of these pre-cancers spread so that both men and women stop getting treated needlessly. Liquid biopsies (see previous blog) may prevent a lot of the pain and surgery many have to endure in the meantime.
Blog at you soon, thanks for reading and helping to spread the word! (Please see the “share” links below.) And we’d love to hear comments from you! (see below as well)
Stay healthy,
Megan
Megan Smith, M.S.
Director, bOObs: The War on Women’s Breasts
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