Activism Change

PAIN: THE Politics of Breast Cancer

Question:

“When baby boomers like me get breast cancer, learning that the mortality rate from breast cancer has remained constant over the past forty years comes as a rude awakening. I seriously doubt that the mortality rate has remained constant. For one thing, with mammography and needle-localized breast biopsies, we catch cancers before they even invade. All of those are cured. Before mammography, such tumors had to fgrow big enough to be palpated, and by then they were invasive.

   The problem, Ed, is that you don’t read data.   Also, mortality isn’t the whole story. We now know that it is not necessary to perform complete mastectomies for some types of cancer. In the past, _all_ breast cancer patients got complete mastectomies, period. Furthermore, the mastectomy they used to do included removal of the pectoral muscles, which was not only cosmetically deforming, but functionally disabling. No one removes the pectoral muscles anymore. To say that the diagnosis and treatment of breats cancer has not improved in forty years is just plain wrong, like much of the other propaganda that this "PAIN" person posts here.

   They said about as much, Ed.  But less drastic surgery has not changed the overall patterns enough really to measure.   Breast cancers are not uniform in appearance or behaviour, some are non-invasive and others metastasize long before they are detectable. It is a pretty rare  breast cancer that metastasizes before being detectable in the breast. It has been a long time since I have seen such a case.

    If the cancer was always just in the breast, then it would always be curable.   Screening is of varying clinical use but uniformly profitable. In the US the marketers target young middle class women for testing as a business. Wrong. The screening age for mammgraphy is somewhere between 40 and 50, depending on whose advice you take. I see breast cancers in 40ish and 50ish women all the time.

   Marketing is to the younger women, Ed.  Listen up. The main risk factor for breast cancer is age, and mammography is most effective in the over-50s, but the overall public perception is that it is a young women’s disease, That’s news to me, and it makes no sense. Breast cancer is so common that almost everyone knows one or more breast cancer patients, and they know the ages that tend to be affected.

   It should not be.  Marketing and the cancer establishment always pushes the very young women who get the disease.  In fact, most people who die of cancer of any type are quite old.   You should read Unhealthy Charities a book by two rightwingers, by the way, to see how the politics of this works. Breast surgery effectiveness is increased by proper timing of operations relative to the woman’s menstrual cycle. Huh? I’ve never heard that.

   You must be kidding, Ed. – Hide quoted text — Show quoted text – Success of cancer treatments is still measured by five-year mortality rates. Breast cancer survival statistics have always been tied to a 20-year gold standard as long as I’ve been in practice (15 years). Of course, looking at the 5 and 10 year benchmarks may be useful, so it pays to do those studies, too. Overall it is a brilliant presentation. Brilliantly misleading. Ed Ed Uthman, MD <http://www.neosoft.com/~uthman/   corpore servit." Pathologist                                    -Seneca Houston/Richmond, Texas, USA                

   Ed, what they posted is OLD news.

Response:

That’s funny, I have.  Vague memory.  Seems there was at least some speculation that production of hormones somehow affected the surgery. Surgery was most effective when hormone production was at a low ebb or some such thing.  I think there was a legitimate study.  Or maybe it was just another hokey theory.

I looked into this a bit. Basically, one study has shown a longer disease-free interval when surgery is done before the luteal phase. The idea is far from wide acceptance at this time, and doubtless further inquiry will follow. It’s almost too good to be true, but we’ll see, I guess. Ed Ed Uthman, MD <http://www.neosoft.com/~uthman/   corpore servit." Pathologist                                    -Seneca Houston/Richmond, Texas, USA                

Response:

– Breast surgery effectiveness is increased by proper timing of operations relative to the woman’s menstrual cycle. Huh? I’ve never heard that.

That’s funny, I have.  Vague memory.  Seems there was at least some speculation that production of hormones somehow affected the surgery. Surgery was most effective when hormone production was at a low ebb or some such thing.  I think there was a legitimate study.  Or maybe it was just another hokey theory. Success of cancer treatments is still measured by five-year mortality rates. Breast cancer survival statistics have always been tied to a 20-year gold standard as long as I’ve been in practice (15 years). Of course, looking at the 5 and 10 year benchmarks may be useful, so it pays to do those studies, too. Overall it is a brilliant presentation. Brilliantly misleading.

Indeed.  Well maybe not brilliant. Any comments on cancer vaccines?  I understand that there is currently a Phase II study of "Theratope" ongoing in Houston now.  Obviously results will be some time in coming but do you know anything about these vaccines? And no I don’t have breast cancer or expect to have it.  I am not a female. Ed

Best,   Terry "Lawyer – One skilled in circumvention of the law"                                     – The Devil’s Dictionary

Response:

        Actually, the death rate from breast cancer has remained relatively constant.  However, the death rate from each stage of Breast Cancer has gone down dramatically (much of this is a statistical Will Rogers effect, but that’s another post entirely).         The catch to that statistic falls in the famous 1 in 9 statistic. When I was in medical school it was one in 11.  Nothing has changed.  The 1 in 9 statistic refers to the actuarial risk of developing breast cancer if a women doesn’t die of something else first before the age of 85.  The 1 in 11 figure is based on a life-expectancy of 75.  As women live longer they are more likely to get (and more likely to with and from) breast cancer. —

Response:

   It should not be.  Marketing and the cancer establishment always pushes the very young women who get the disease.  In fact, most people who die of cancer of any type are quite old.

_All_ marketing efforts for any product or service showcase people at the young and attractive spectrum of the population. Any reasonably canny consumer knows this and accounts for it in making decisions. Big deal. This is not the sign of some Trilateral Commission conspiracy or something that George would have us believe is running health care. Ed Ed Uthman, MD <http://www.neosoft.com/~uthman/   corpore servit." Pathologist                                    -Seneca Houston/Richmond, Texas, USA                

Response:

– Hide quoted text — Show quoted text – /* Written by peg:greenleft in igc:greenleft.news */ Title: Unfiltering the information on breast cancer Patient No More: The Politics of Breast Cancer By Sharon Batt Australia & New Zealand Edition Spinifex Press, 1996. 431 pp., $24.95 Reviewed by Dot Tumney “When baby boomers like me get breast cancer, learning that the mortality rate from breast cancer has remained constant over the past forty years comes as a rude awakening. Success of cancer treatments is still measured by five-year mortality rates. via PAIN Forum http://www.applicom.com/pnews/

   I wonder why the above ‘news’ so shocks.   The politics of cancer (as in the American Cancer Society) have been putting out slanted information 50 or more years.  Doctors don’t keep track of mortality statistics.  After all, if all the treatments have an ‘equivalent’ effect, then another way of looking at it is that all are equally ineffective.

Response:

“When baby boomers like me get breast cancer, learning that the mortality rate from breast cancer has remained constant over the past forty years comes as a rude awakening.

I seriously doubt that the mortality rate has remained constant. For one thing, with mammography and needle-localized breast biopsies, we catch cancers before they even invade. All of those are cured. Before mammography, such tumors had to fgrow big enough to be palpated, and by then they were invasive. Also, mortality isn’t the whole story. We now know that it is not necessary to perform complete mastectomies for some types of cancer. In the past, _all_ breast cancer patients got complete mastectomies, period. Furthermore, the mastectomy they used to do included removal of the pectoral muscles, which was not only cosmetically deforming, but functionally disabling. No one removes the pectoral muscles anymore. To say that the diagnosis and treatment of breats cancer has not improved in forty years is just plain wrong, like much of the other propaganda that this "PAIN" person posts here. Breast cancers are not uniform in appearance or behaviour, some are non-invasive and others metastasize long before they are detectable.

It is a pretty rare  breast cancer that metastasizes before being detectable in the breast. It has been a long time since I have seen such a case. Screening is of varying clinical use but uniformly profitable. In the US the marketers target young middle class women for testing as a business.

Wrong. The screening age for mammgraphy is somewhere between 40 and 50, depending on whose advice you take. I see breast cancers in 40ish and 50ish women all the time. The main risk factor for breast cancer is age, and mammography is most effective in the over-50s, but the overall public perception is that it is a young women’s disease,

That’s news to me, and it makes no sense. Breast cancer is so common that almost everyone knows one or more breast cancer patients, and they know the ages that tend to be affected. Breast surgery effectiveness is increased by proper timing of operations relative to the woman’s menstrual cycle.

Huh? I’ve never heard that. Success of cancer treatments is still measured by five-year mortality rates.

Breast cancer survival statistics have always been tied to a 20-year gold standard as long as I’ve been in practice (15 years). Of course, looking at the 5 and 10 year benchmarks may be useful, so it pays to do those studies, too. Overall it is a brilliant presentation.

Brilliantly misleading. Ed Ed Uthman, MD <http://www.neosoft.com/~uthman/   corpore servit." Pathologist                                    -Seneca Houston/Richmond, Texas, USA                

Response:

/* Written by peg:greenleft in igc:greenleft.news */ Title: Unfiltering the information on breast cancer Patient No More: The Politics of Breast Cancer By Sharon Batt Australia & New Zealand Edition Spinifex Press, 1996. 431 pp., $24.95 Reviewed by Dot Tumney Nothing delights a reviewer like a juicy quote explaining the reason for a book in a dozen lines. So: “When baby boomers like me get breast cancer, learning that the mortality rate from breast cancer has remained constant over the past forty years comes as a rude awakening. We feel bewildered rather than privileged by the treatment choices we face. A second shock is the discovery that breast cancer – unlike most other cancers – is a disease of affluent countries. The getting and spending of money neither protects us from getting breast cancer, nor offers us a sure cure if we are stricken. “Breast cancer activists have, nonetheless, led the lobby for increased spending on breast cancer research. Before we go any further we need to look closely at the information that passes the consumerism filter – and examine what gets left behind.” The consumerism filter channels information for general consumption into a neatly marketable win-win profile. Spend money on medical equipment, drugs, research and see the economy and health both flourish. The limitations of the equipment, the side effects or poor performance of the drugs and whether the research is targeted for the maximum benefit of the patient, present or future, is another matter. These, along with past performance, are screened out. They are messy, not to mention unprofitable. Batt provides in-depth discussion of all aspects of the breast cancer industry in the US and Canada, and additional local material is added at the end of each section. The mammography debate proceeds on a footing of confusion between screening and diagnostic testing and gets cloudier. Breast cancers are not uniform in appearance or behaviour, some are non-invasive and others metastasize long before they are detectable. Screening is of varying clinical use but uniformly profitable. In the US the marketers target young middle class women for testing as a business. The main risk factor for breast cancer is age, and mammography is most effective in the over-50s, but the overall public perception is that it is a young women’s disease, so the public health usefulness of mammography is limited. A recent survey in Australia also revealed this perception so some of the advertising here is being re-targeted. A public health system has better potential for making real use of screening. Treatment is almost as messy. Batt provides an enthralling history of the evolution of standard treatments and their waxing and waning. As well, there is the matter of access to facilities or the abilities and interests of practitioners. The happy ending of the win-win scenario requires the best equipment, the most expert personnel, the best possible information all round and a version of the disease that the treatment is effective for. Real life often fails to cooperate. Breast surgery effectiveness is increased by proper timing of operations relative to the woman’s menstrual cycle. Does the surgeon remember to check, has the woman the nerve or the knowledge to request it, will a surgeon who fails to take account of timing find his performance statistics adversely affecting career prospects? Success of cancer treatments is still measured by five-year mortality rates. This statistical limitation is even too narrow for the health bureaucrat these days. It’s never been much chop for the individual victim; surprising numbers of people fail to be uncritically grateful for being simply alive. The consumer is getting picky and resentful about discovering adverse effects afterwards. Especially with breast cancers which are not medical emergencies, there is plenty of time to consider and plan. This may, of course, deprive the doctor of a shattered and unquestioningly compliant patient. Cancer coverage/advertising in the media is not a rainbow. It is terror or miracle depending on whether it’s for charity fundraising or selling a new wonder drug. Informed consent becomes a purely legalistic notion in this context. “Treatment partnerships” resemble more a token shareholding of an employee. The terror aspect impels a panic-driven dive into treatment, and the miracle aspect raises expectation beyond the capacities of mere medicine. Then there is the cosmetic aspect. It is the patient’s job to minimise discomfort felt by spectators when confronted by the deficiencies and limitations of treatments. As far as external appearance is concerned, one must assimilate. Reconstructive surgery, breast prostheses, wigs, make-up are all nice sidelines in themselves, as well as making sure women can’t casually visually identify each other. I have no doubt the cosmetic efforts are not intended to fool insurance companies or employers or producers of treatment regimes. Walking about casually displaying the limitations of the medical miracle is not an approved form of rugged individualism. The individual tragedy is of course immensely marketable, but a couple of hundred all at once looks as if it might become unmanageable. Batt deals well with the inevitable conflict between the individual need to access whatever is available and the problems of longer term assessments to see if the methods used work in the short term, provide quality of life improvement or cause problems down the track. Fee-for-service medical systems designed around disease management are not designed to follow the complexities of developments over a lifetime. Treating patients and studying population outcomes are different industries. The clinical trial is the only thing on offer to try to blend the two. Alternative measures, especially those the woman can use herself, such as diet, have the additional benefit of being patient directed, and the approach of healers restores the human interaction missing from radiotherapy treatment rooms. The single treatment paradigm – whether conventional or alternative – gets short shrift. Batt has a great talent for diverting one’s gaze from the individual peaks to the overall scenery, to connections rather than fences. I found her discussion of all those things that come under the heading of prevention meshing nicely. Prevention is the area where political activism is least tied to simply lobbying for information access and resource availability. Prevention involves attention to environmental factors, lifestyle changes, direction of research and who is running what in whose interest. Overall it is a brilliant presentation. Sharon Batt describes her personal story, lots of other people’s stories, medical/scientific technicalities, political inevitabilities, industrial imperatives, the development of an activist group and the lessons learned from AIDS activists. She emphatically rejects the personal guilt/it’s your own fault scenario, whether pushed by aggro medicos or alternative egomaniacs. An unputdown-able thriller of a resource book.<F41559sn<F255D First posted on the Pegasus conference greenleft.news by Green Left Weekly. Correspondence and hard copy subsciption via PAIN Forum http://www.applicom.com/pnews/

Response:

Filed under: Lobbying

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