Over-Screening for Breast Cancer?

Earlier this month, both the American Cancer Society (ACS) and the Journal of the American Medical Association (JAMA) published communications alerting the medical community about over-screening for breast cancer. The estimate now is that 30% of the breast cancers which are found are so slow-growing that they are not life-threatening; and, some of these will disappear completely without any medical intervention at all.

Breast cancer screening has greatly improved the ability to find very small tumors; mine was only 2mm in size, and showed up on my yearly screening mammogram as a concentration of white dots, called microcalcifications, indicating an area of rapid cell turnover. The tumor wasn't found at my OBGYN exam a few weeks before; it would have taken months before it had grown large enough to be felt.

My tumor had already reached the invasive stage; it had broken through the breast duct, and was invading the surrounding tissue. At this point, the cancer cells have had a chance to reach other areas of the body, possibly creating secondary tumors. If the patient is fortunate, there has been no metastases, or tumor formation at other sites, and the cancer cells which did migrate elsewhere have been killed by the patient's immune system.

People have asked me how I feel about undergoing biopsies, 2 lumpectomies, 6 weeks of radiation, several screening scans and MRIs, and taking anti-cancer meds for a 5-year course when there is a 30% chance that my cancer wasn't deadly to begin with.

My response is that there is a 70% chance that my invasive cancer would have killed me, so I am very happy that it was found so early. If I had not gotten my yearly mammograms as recommended, my cancer might have spread to my lymph nodes, greatly decreasing the odds of my survival. Another advantage is that my node-negative status meant that I avoided needing chemotherapy, and I am very grateful for that.

I don't feel that I should have delayed treatment, hoping that my cancer would resolve itself. Once you find out that you have cancer, you just want it out of your body. It would be difficult, if not impossible, to just "do nothing" when you're diagnosed, unless there is an additional means of confirming that the cancer you have is indeed the non-fatal type.

My cancer was Stage 1, but even cancers this small, and some at Stage 0 (non-invasive) have proven deadly. There is so much that we still don't know about what causes some cancers to grow, and others to become dormant, or even totally disappear.

So, until researchers can determine which breast cancers are non-fatal, women shouldn't forego being screened. The ACS is standing by its recommendation of yearly mammograms for women over 40. That is vital for us to remember amid all of the current controversy.

Your "new normal"

As a cancer patient, your goal is to reach the end of your active course of treatment, and to get your life back to where it was before you were diagnosed. But, like so many other things, this is not as easy as it sounds, physically, mentally, or emotionally. And, the truth is: your life will never be the same. You have gone through a life-altering experience. There's a term for what you're attempting to establish: your "new normal"; meaning living as normally as possible, knowing that you cannot restore your pre-cancer life.

Your transition from a "cancer patient" to a "person with cancer" isn't easy. You eagerly hoped for the end of your active treatment period, when it seems as if all of your waking moments are spent going to medical appointments, imaging studies, chemo and/or radiation, lab testing, etc. You know that it's necessary, but you can't wait for it to be over, and you feel more like a patient than a person.

When you're placed on "follow-up", you're going to really miss the personal contact with, and support from, the majority of the wonderful people who got you through a hellish period of your life. You will feel very alone as you face the future. You need to prepare for how you will handle this transition, and what resources you'll need to establish your "new normal".

You may find that emotions which you suppressed during treatment are now coming to the surface, such as anger and sadness. This is similar to post-traumatic stress, or delayed grief. It's vital that you face your feelings and work through them; otherwise, they will prevent you from moving on with your life. Talking to family, close friends, or even joining a support group will help you realize that you are not as alone as you might feel at this time.

Chances are, you'll deal each day with physical reminders of what you've been through as well: I see my scars, and as they are healing, I'm also healing inside. I don't think about my cancer returning, but if it does, I know that I'm strong enough to face it. I won't allow cancer to "co-opt" my present, or my future. I wake up each day seeing the person in the mirror as someone who has "had" cancer, even though I still visit my doctors, take daily meds, and will be doing so for a few more years.

Many people, as part of their "new normal", choose to do something which gives meaning and purpose to their cancer experience. For me, it was deciding to begin this website, writing about my journey. Previously, I wouldn't have had the courage to do something like this, but this is one of the "gifts" of my cancer. I wanted to take something negative and turn it into a positive; I also hoped that sharing my feelings might be of some help to other cancer patients.

People also decide at this time to follow their dreams, do things they never had the chance to do before, or take their future life in an entirely different direction, such as: going on that trip they've only imagined, climbing a mountain, or starting their own business. The rest of your life from this point forward should be defined by you, not by your disease.

For me, the dream is to retire and to move to Maui. After all that I've been through, I'm even more determined to make this my reality. I want to die there, and have my ashes scattered at Keawakapu. When Lindbergh was receiving medical treatment in New York, and it was confirmed that he only had a few days to live, he asked to be flown back to Maui so that he could die at his beloved Kipahulu. I feel the same way.

Focus on your future, and do something meaningful with the life which has been "given back" to you.

Life is precious. Don't waste it!