breast cancer

The Futility of Pinktober

Every year, during Pinktober, I worry that we’ve lost sight of the reality of breast cancer. This year I have a writer crush on S. Lochlainn Jain, an associate professor at UC Santa Cruz and author of Malignant: How Cancer Becomes Us. In a few well-chosen statistics, Jain shows the heartbreak of breast cancer and the futility of our obsession with “the cure.”

“The numbers really are staggering. Just to take an example of one cancer: 200,000 new diagnoses and 41,000 annual deaths of breast cancer each year in the United States, a million or more American women living with it who have no idea they are ill. More than 6,000 women under the age of 49 dead of the disease each year — more than the number of AIDS-related deaths at the height of the crisis, and twice that of the annual deaths of polio at the height of that crisis. And yet the response has not been to reconsider the costs of our economic and environmental decisions but to concentrate of that elusive thing: the Cure. The promise of the curable disease, the triumphant figure of the survivor, and the rhetoric of hope all serve as part of the rhetorical work of maintaining a belief in the preciousness of each individual life. The bad faith, though, reveals itself in contradictions: the statistics built from drug trials on the one hand point out how far we are from a cure and on the other harbor the possibility that cure is possible. And yet, as researchers such as Robert Proctor argue, very little basic research on cancer is being done. One might reasonably conclude that the rhetoric of hope for a cure papers-over the actuality that after all these years, for many cancers chemotherapy treatments have improved very little, and they have improved survival rates only marginally, if at all.

This excerpt appears as a footnote in Jain’s essay “Living in Prognosis: Toward an Elegiac Politics,”

Mammography’s Failings: Rage Against the Machine

I was dismayed but not surprised by the recent news of mammography’s failings. As most of you know, per the NYT “one of the largest and most meticulous studies of mammography ever done…added powerful new doubts about the value of the screening test [mammography] for women of any age.”

But what shocked my socks off was the headline appearing in the same paper less than a week later “A Fresh Case for Breast Self-Exams.” The upbeat article highlighted what the writer called the study’s “nugget of hope,” which was that physical breast exams may be “as good as or better than regular mammograms.”

I hear the ’80s calling. They want their breast cancer screening method back.

Previous studies indicate breast self-exams are no better than mammography when it comes to stemming the tide of breast cancer deaths. I covered the topic for Time in 2008. The Cochrane Collaboration (an international organization that evaluates medical research) had just reviewed studies of breast self-exam that involved nearly 400,000 women. Their conclusion? Breast self-checks had no benefit. 

So, before we roll back the clock, before we go back to touching our breasts out of fear, before we give women deja vu, I’d like to hit the pause button.

Can we all please take a collective moment of silence to mourn the failed promise of mammography?

Regardless of whether you choose to believe in mammography (like Amy Robach over at ABC) or you are a dubious science reporter twice screwed by breast cancer (like me), last week’s news was a devastating blow.

Then I’d like to break the silence with a giant primal scream. Because when I think of the tens of billions of dollars spent chasing the “early detection myth,” I can’t help but think of how those billions might have made a difference for the hundreds of thousands of women who are no longer with us. And that makes me hoppin’ mad.

So. Please take a moment of silence and then follow it up with a big scream.

On Pink Washing: Dear Food Makers, Please Shut Up.

Pink washing health claims on food packaging are obnoxious. They are confusing, misleading, and (often) inaccurate. As a science journalist, I know that 99.9 percent of these health claims are hogwash, and I find it morally offensive that food marketers prey on people’s fear of disease to sell products. I actively avoid buying products with health claims or pink washing. So, imagine my surprise when I opened a new container of miso and found a giant health claim lurking beneath the lid. Sneak attack!

MisoSoup

Nothing kills my appetite more than a pink-ribbonly reminder of my mortality. Thanks Mr. Miso!

I will give them a tiny prop for including a study citation, even though its presence could be construed as manipulative because it adds superficial credence to the claim. So, I walked my anger right over to PubMed and looked up the study. A tiny part of me (the sucker part) hoped the health claim was true. But a much bigger part of me (the pompous part) wanted to feel “right” and, therefore, justified in my anger. Guess which part won?

Here’s the miso dish: In 1990, 21,000 Japanese women filled out diet questionnaires that included a question about miso soup. (BTW: Diet questionnaires are notoriously inaccurate because, really, who can remember what they ate for breakfast? Much less for breakfast six weeks ago?) Researchers followed the women for nine years and charted how many got breast cancer. In the end, fewer cases of BC popped up in those women who (reportedly) ate 3+ bowls of miso soup a day.

A few caveats: the study’s small sample size means its accuracy is suspect; miso’s magic only applied to postmenopausal women (bummer for me); I live in the West, not Japan, so my confounding factors are enormous; and, finally, who eats 3 bowls of miso soup a day for years on end? Not me.

When it comes to health claims, even those with citations, don’t be a sucker. Health claims on food packages are nothing but savvy marketing with a scientific sheen. I can only hope that, if we all vote with our dollars, food makers will get the message that we don’t want our fears manipulated at the grocery store.

Radiation=No bueno for breasts

Worried about getting breast cancer from your shower curtain? Don’t be. Instead, worry about getting it from your doctor’s willy-nilly use of radiation.

This month’s Archives of Internal Medicine includes a special report penned by the smart folks at the Institute of Medicine (IOM) and paid for by the deep, politically dubious pockets of Susan G. Komen for the Cure. In a nutshell, the experts said, stop sweating bullets over the noxious chemicals in everyday stuff (ie: bisphenol A in plastics and phthalates in perfumes). Instead, start sweating doctors writing scripts for radiation-based diagnostic tests like it’s a goddamn ticker-tape parade and cancer is the grand marshall.

The IMO starts by stating the obvious. Radiation causes cancer. Um…yeah. Tell it to Madame Curie. And then comes the forehead-smacking stuff. The IMO estimates that “2,800 future breast cancers would result from 1 year of medical radiation exposure among the entire US female population, with two-thirds of those cases resulting from CT (computed tomographic) radiation exposures.” Ironically, many doctors order CT scans to look for cancer. So, in layman’s terms, our fear of having cancer is giving us cancer.

This damned-if-you-do-damned-if-you-don’t news is magnified by the fact that CT use has skyrocketed nearly 5-fold in the past 20 years. In 2012, an estimated 75 million people (half of them women) will have a CT scan.

What doctors don’t tell you (because some of them don’t know) is that in the terms of radiation exposure 1 CT scan equals 500 X-rays. Yes, you read that right. 1 CT scan = 500 X-rays. The real kicker? Up to 30% of those CT scans are unnecessary.

Per my earlier posts, I suspect that radiation exposure in my early teens contributed to the breast cancer diagnosis I received in my late 30s. Of course, no one knows. But this new report adds to a growing pile of evidence that overuse of radiation has serious consequences. (And don’t get me started on CT scans and kids.)

Recap: respect radiation as a diagnostic tool. A CT scan may very well save your life if you have internal injuries from a car accident or a burst appendix. But, if you’re not in immediate danger, ask your doctor about other options. He/she might have to rely on more old-fashioned diagnostic tools, such as skill, knowledge, and intuition, instead of just irradiating you.

Truth, Certainty, and Dickinson

Since my breast cancer diagnosis, I wrestle with a lot of things. Two biggies are truth and certainty. My cancer diagnosis (x2) and the medical mishaps that followed violently severed every strand of trust that tethered me to my body and to the medical profession (both conventional and otherwise).

I am only beginning to acknowledge the depth and meaning of that loss. To feel deeply unmoored; to physically recoil from scientific evidence presented as “truth” or “fact” is made more difficult by the fact that I am a medical journalist.

Specifically, for the past 15 years I’ve reported on women’s health. I’ve written hundreds of articles on topics such as how to protect yourself from cancer; how to live strong after cancerhow bright light might cause breast cancer, and (my personal favorite) top cancer-fighting supplements.

So here’s my question: How can I continue to write about health in a way that meets my needs and my editors’ needs? How can I embody the voice of authority my editors demand? Expect? How can I continue to participate in and profit from the propagation of a “journalistic certainty” that is deeply disturbing to me?

If anyone has any answers, please let me know.

Until then, I will share an Emily Dickinson poem; if, for no other reason, than to know where I put it. I know nothing about poetry, but last month, when I stepped through the doorway of Dickinson’s home, a perky volunteer handed me the poem below. The poem was in easy-read type on a pale green sheet of paper.  The leaflet has floated around my desk every since, daring me to lose it, taunting me with the suggestion that it might contain the answer to my questions. Maybe it does.

Tell all the truth but tell it slant –

Success in Circuit lies

Too bright for our infirm Delight

The Truth’s superb surprise

As Lightning to the Children eased

With explanation kind

The Truth must dazzle gradually

Or every man be blind –

Emily Dickinson, 1872