Re: [MOL] Frank cancelled trip,Christine [01425] Medicine On Line


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Re: [MOL] Frank cancelled trip,Christine



To All

Does anyone have any comments about this recent report on breast cancer 
alternatives from the Mayo Clinic?

Maeve


Published Thursday, January 14, 1999, in the San Jose Mercury News 



Extreme cancer surgery backed

BY DENISE GRADY
New York Times 

For women with a high risk of breast cancer, a study being published 
today offers hope, but at a cruel price. Removing both breasts while 
they are still healthy reduces the risk of getting breast cancer by 90 
percent, the study found.

Researchers at the Mayo Clinic in Rochester, Minn., studied 639 women 
who had their breasts removed from 1960 to 1993. Their findings, 
published today in the New England Journal of Medicine, are widely 
regarded as the most reliable information to date on the long-term 
effectiveness of the surgery. 

``It is a horrifying choice, one of the biggest decisions I've had to 
make in my life,'' said Ronnie-Jane Polonsky of Oakland, who had a 
healthy breast removed two years ago. Although not a participant in the 
study, she is one of many American women who opt for the surgery because 
they feel the odds are against them.

Polonsky was diagnosed with cancer in one breast when she was 37; 
despite treatment, it recurred when she was 52. She also was haunted by 
memories of her mother's painful, ultimately fatal, battle with breast 
cancer decades earlier.

``I didn't want it to shadow my life. I wanted to be done with it,'' 
Polonsky said.

Like Polonsky, the women in the study were considered ``high risk'' 
because of a strong family history of breast cancer or a personal 
history of breast lumps needing biopsies. Tests developed in the 1990s 
to detect genetic mutations also provide an indication of women who may 
be at risk.

Surgeons had been performing the procedure, known as bilateral 
prophylactic mastectomy, on such women since the 1960s, assuming it 
would reduce a woman's cancer risk. But they did not know whether it 
really did, or by how much.

One way high-risk women can try to protect themselves is by having 
regular mammograms and breast examinations in hopes of detecting the 
disease early enough to cure it with surgery, chemotherapy and 
radiation.



Another alternative

The only other way such women can protect themselves against breast 
cancer is by taking the drug tamoxifen, which in a large study last year 
was shown to reduce the risk of the disease by about 45 percent. But 
women are supposed to take the drug for only five years because it is 
thought to be ineffective after that time. In addition, tamoxifen may 
cause blood clots or uterine cancer in some women, and although it 
reduces the risk of breast cancer, studies have not shown that it lowers 
the death rate from the disease, as mastectomy does.

Moreover, many high-risk women sense a time bomb ticking in their 
bodies. ``I felt that I had to watch (the healthy breast) so carefully, 
go in to see doctors so often, have so many mammograms, worry over every 
minor change in my breast -- that I just couldn't live with it,'' 
Polonsky said.

``This is a very important paper,'' said Dr. Patrick Borgen, chief of 
breast surgery at Memorial Sloan Kettering Cancer Center in New York, 
who was not involved in the study. ``It's the first credible 
calculation.''

But Borgen and other cancer experts, including the authors of the paper, 
cautioned that the findings should not be used to pressure women into 
having their breasts removed.

``The study doesn't mean we should sell the surgery to more women,'' 
Borgen said. ``But women who are considering it now have a hard-core 
fact to use as they're making their calculation.''



Fears about study

San Francisco breast-cancer activist Barbara Brenner said she fears that 
people will think the surgery is an acceptable solution to preventing 
breast cancer -- rather than searching for underlying cause. 

``We need to be looking at what is causing breast cancer, and working to 
eliminate those causes,'' said Brenner, an attorney who is director of 
the advocacy group Breast Cancer Action. ``If we just take off the 
breast, we're covering up the real problem.''

She also urged women to seek advice from a genetics counselor about 
their individual risk factors, so they have an informed opinion about 
their choices.

Individual women involved in the study, and others who have undergone 
the procedure, have no way of knowing whether it spared them from cancer 
that might have killed them, or cost them their breasts to protect them 
from a disease they would never have contracted.



Only two deaths

Among the 639 women studied, the researchers concluded that at least 20 
and as many as 40 women would have died if they had not had their 
breasts removed. But there were only two deaths.

Dr. Barbara Weber, an expert on breast-cancer genetics at the University 
of Pennsylvania, and co-author of an editorial that accompanied the 
study, pointed out that although the procedure theoretically saved 18 
lives, 621 other women who had their breasts removed probably would have 
survived without the drastic operation.

The number of women in the United States who have had their breasts 
removed in hopes of preventing cancer is not known but may be in the 
thousands. There is no registry of cases. Researchers said women who 
wanted the surgery tended to be those who had seen mothers, aunts and 
sisters die young from breast cancer.

Like most women who undergo the surgery, Polonsky had her breasts 
reconstructed with implants and skin taken from her abdomen. Images of 
stars were tattooed where the nipples used to be.

Two years later, she is still adjusting to a loss of sensation on her 
abdomen. The feeling of her new breasts is becoming familiar.

``My breasts look great,'' Polonsky said. ``I never had a single regret 
about it.

``It didn't buy complete peace of mind. . . . But once I made the 
decision, I never looked back. It was definitely the right thing for 
me.''




------------------------------------------------------------------------
Mercury News Staff Writer Lisa M. Krieger contributed to this report.


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