Failing As Usual: Double Mastectomies and "Choices" In Breast Cancer Treatment
I read with great interest yesterday's front page Washington Post article about the increase in women opting for double mastectomies when lumpectomies might suffice. And I'm writing this post because I am one of those women who made a similar choice -- to have a double mastectomy when a single mastectomy may have sufficed and because there is something in the tone of that piece (and in another article this past summer in the New York Times) that implies women are failing yet again to make the "right" choices when it comes to their medical treatment.
Or, to be more direct: that women can't win no matter what decision they make.
When I was diagnosed with Stage 0 DCIS in my left breast -- the option of lumpectomy was quickly eliminated since there were two areas of DCIS. Once it became clear that a mastectomy was necessary, my surgeon -- the head of one of the leading breast centers in the country -- recommended that I consider having the second "healthy" breast removed as well. Her recommendation was based on my family history (my mother also had breast cancer in her early 40s) and the fact that once there is cancer in one breast it's much more likely to appear in the second breast. While she certainly made a case for opting for a single mastectomy, her leaning appeared clear to me: better safe than sorry.
That was my leaning, too. And while removing the second "healthy" breast may have seemed radical or unnecessary to some people, it seemed like the right decision for me. Why? For one thing, there were the increased odds that it would appear in the second breast. For another thing, I was concerned about detection -- my DCIS, mind you, had not been detected in my recent mammogram, but only by an MRI--an MRI I'd had to push for. And then there was the relative ease of getting all the surgery over with at one time. My decision for the bilateral surgery, though unpleasant, was not difficult. Which is to say that from those earliest moments I was unconflicted about my choice.
As it turned out, that choice made the most medical sense, too. Because when the final pathology report came back a week after surgery, my surgeon called to tell me the results: there was DCIS is the "healthy" breast, too: DCIS that the MRI hadn't caught, even though it caught the DCIS in the left breast.
Arguments could be made, I'm sure, that if I'd had my right breast checked regularly the DCIS (probably) would have (eventually) appeared in an MRI, and that it (probably) would have been detected early enough for it to be safely removed either via lumpectomy or another mastectomy. But I'm not so sure. It was scary that the DCIS was lurking there, too, out of sight of two tests. Who knows how many more times it would have eluded detection?
Which brings me to my point: that no matter what choice women make regarding their breast surgery, it seems they are wrong. If they choose a breast-sparing lumpectomy over a mastecomy, they run the risk of appearing vain and unwilling to do whatever it takes to survive the disease. If they opt for a mastecomy -- or the double mastectomy -- they are overreacting or misinformed. Either way, their choices are questioned and more often than not, their decisions are seen as failures.
Cancer is the only disease, besides AIDS (and morbid obesity), where everything is your fault and where you can fail at everything from diagnosis to treatment. While I "succeeded" at being "pro-active" (pushy) about catching my breast cancer early by insisting on an MRI, some might think I "failed" at resisting the better-safe-than-sorry option.
The choices we're faced with are not black and white. I, for one, understood that the actual statistical difference between watching the right breast for a recurrence and removing it completely may not have been huge. But while it may not have been exactly a six-of-one- half-dozen-of-the-other kind of choice, it was close enough. The decision I made may not have been the "right" one by purely mathematical standards, but it was not an ill-informed or misguided decision, either. It was a valid choice.
Most women, like me, I think, understand this difference, and make their choices accordingly. Our options are less than perfect, and our decisions may be less than perfect, too. But most lesser-of-two-evils kinds of choices usually are. So let's not blame the chooser.