Re: [MOL] Frank cancelled trip,Christine [01462] Medicine On Line

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Re: [MOL] Frank cancelled trip,Christine

I can certainly understand why some women do it.  I had my mastectomy in
1990 but I don't know if those genetic tests had been developed then.  And
up to 1990, I was the only woman in my family who had breast cancer; my
mother died of the disease in 1991.  Maybe if my situation had been more
like the ladies in the story, I might have done things differently.  

I had already learned from other experience with surgery that any kind of
surgery is experienced by the body as a trauma and that there was a risk,
just with the administration of general anesthesia of dying.

I wonder also about the relevance of the study; I guess I would have to go
read the journal article.  It seems that there would have been so many
independent variables in the lives of the women included in the study that
it would have been impossible to control for.


martha Cerreto	 

> From: maeve alini <>
> To:
> Subject: Re: [MOL] Frank cancelled trip,Christine
> Date: Friday, January 15, 1999 12:52 AM
> 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
> 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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