I love breast cancer awareness month. As a breast medical oncologist, it gives me an opportunity to spread the message of how important early detection is for improving the success of breast cancer treatment. I am surprised regularly at the number of women who either are not doing mammography at all or who do it every couple of years when they remember. We know that women who are participating in annual screening mammography are the patients most likely to have their cancer detected at the earliest stages and subsequently have the best outcomes.
Except when they don’t.
Imagine that you have been doing mammography faithfully like clockwork every year. You are screened in a high-risk clinic with breast MRI or one of the other advanced tools available. You had genetic testing done based on your family history, and it turned up normal. And three months after your mammogram, you feel a mass in your breast. You call your doctor. Ultrasound. Biopsy. CANCER. Unfortunately, the type of cancer that pops up in this scenario is high-risk. You need chemotherapy, surgery, radiation. And after all that treatment, your cancer will still have a significant risk of coming back or spreading.
Imagine that your cancer was detected early. Stage 1. You were the lucky one. You had surgery, no radiation, no chemotherapy. You only had to take a pill. You had good cancer. Years later, after breast cancer was barely a thought, a back pain that would not go away turned out to be metastatic breast cancer. Cancer has shown its ugly face again after all those years. Suddenly your luck seems to running low.
Imagine that at age 32, long before screening mammography is a part of your vocabulary or insurance coverage, your blood work shows some abnormalities. It gets rechecked and shows no change. You go for CT scans. A “little something” is in your liver. Then a biopsy and suddenly you have metastatic breast cancer. Before breast cancer was ever supposed to happen. Too early in life for early detection.
Imagine how standing next to a grocery store display of pink socks, and pink scarves and pink coffee mugs encouraging you to “celebrate the women in your life” can reduce you to tears if your wife died of breast cancer last March.
Each day, 113 persons die of metastatic breast cancer. For persons living with metastatic breast cancer, the cute slogans can be painful. “Fight like a girl” seems to minimize your experience when you are fighting for your life. “Early detection saves lives” is a painful message when you did everything right and still have metastatic disease. “Save Second Base,” jokes and cookies that look like breasts don’t feel very funny when you are not curable. A delicate pink ribbon can be embarrassing when you are man diagnosed with breast cancer.
This October, I am asking you to share the message of early detection. To celebrate all the progress, we have made treating and understanding breast cancer. But know that there is still not a cure for everyone. And, like in much of modern life, we need to try to understand that each of us has a different experience. Some cancer survivors want to celebrate. Some want to make jokes. Others want to forget. Others simply can’t forget because the disease won’t let them. Take time to know the experience of those in your life.
As for me? You’ll find me wearing a pink ribbon and encouraging screening mammograms. You’ll find me giving hugs to the heartbroken and leading clinical trials for persons with advanced stage cancer. You’ll find me supporting improved access to genetic testing so that we might find more “previvors” (before cancer ever strikes). You’ll find me donating my resources to support both early stage and metastatic breast cancer research. You’ll find me trying to create an October for everyone.
Stephanie Graff is an oncologist and can be reached on Twitter @DrSGraff.
Image credit: Shutterstock.com
