Friday, October 12, 2007
Since it's Breast Cancer Awareness Month, I should point out that I've done a series here about breast cancer and related issues (one, two, three, four, five; and this about breast lumps.) My "memorable patient" series included this lady with advanced breast cancer; and there was a post about Elizabeth Edwards and her recurrence. I've admitted some outdated views on immediate reconstruction, and lamented my near miss with national notice regarding outpatient mastectomy. None of it does justice, perhaps, to the fact that over my career, by far the greatest number of patients I saw was women with breast problems. In fact, I'd have to say that one factor in my eventual burnout was the increasing number of young women with breast cancer that I was seeing; those office encounters are much worse for the woman and her family, of course. But they took a heavy toll on me as well, time and again, nearly daily.
It was the appearance on NBC news, a couple of nights ago, of a person who has annoyed the hell out of me in the past that reminded me of my recent silence on the subject (which is only because I think I've said most of what I have to say.) This love-ly person is mentioned in one of the above-linked posts. She'd gotten early fame by appearing on various shows claiming that the only reason mastectomy was invented is because men like to mutilate women. Sigh. It's hardly worth responding to something like that. Upping the ante, she also liked to say that if your doctor tells you you need a mastectomy, find another doctor, because no woman ever needs one. Complete and utter bullshit, then and even now. I'd like to believe she wasn't dumb enough actually to have believed it, but was just trying disingenuously to get attention. I do give her credit for having written a quite good "breast book," and I've seen her, more recently, being generally reasonable. But last night she did it again: questioned by Brian Williams about the most important thing a woman can do regarding breast cancer, her answer was always to get a second opinion before embarking on treatment.
I have no problem with the idea of second opinions: when there's any reason at all for uncertainty, I encourage them. ("Always" is a little dogmatic, though.) But what got me was her reasoning. As complicated as the field has become, she said, it's impossible for any one doctor to "keep up." So see two? Like if no one person knows enough to be trusted, getting another will magically fill in the holes? Two wrongs make a... what? I question the math. Anyhow, it's not really a big deal. Getting a second opinion is perfectly sensible, no matter the issue at hand. It's just that, after those years of listening to the woman's crazy rants back then, I have a hard time giving her much credence now. Even when she's right.