POSTED: 1:30 a.m. HST, Oct 30, 2010
I first encountered a patient with breast cancer while working as a medical student in a free clinic in Los Angeles. A Hispanic woman in her early 40s came in with a hard, irregular mass fixed to her chest wall. It was 5 centimeters across. She had never been screened. When I told her that we needed to schedule a biopsy, she protested, explaining that as a single mother of three, if she lost any work her children would go hungry.
Breast cancer is the most common cause of cancer death among Hispanic women and the most common cause of cancer death for all other women who do not smoke, according to the Centers for Disease Control. Each year, about 200,000 women in the U.S. are diagnosed, and about 40,000 die. One in 8 women will be found to have breast cancer at some point during their lives. To be sure, females do not have an exclusive; 1 percent of all breast cancers are in males. Combining medical costs and lost productivity, the economic burden for breast cancer in the U.S. exceeds $209 billion.
Under the new Patient Protection and Affordable Care Act, preventive services must be fully covered by insurers without deductibles, co-pays or maximum limits. The U.S. Preventive Services Task Force (USPSTF) determines which preventive services are necessary and recently tightened up its recommendations for mammography to cover biennial screening for women between ages 50 and 74 only. This is contrary to a recent Swedish study that suggests mammography for women beginning at age 40 should remain the standard of care. If women between 40 and 50 do not receive screenings, many cancers will be found after it is too late. While public health recommendations benefit the common good, they do not necessarily benefit each individual. The USPSTF serves an important role in determining the cost benefit of specific screening studies in different populations, but decisions about individual screening should be made with your personal physician.
October is designated as Breast Cancer Awareness month to remind us that early detection through exams and screening saves lives. But breast cancer doesn't arise according to schedule. Awareness of the illness, preventive screening and potential treatments need to be part of our consciousness all year long. Fear of finding breast cancer causes many women to procrastinate or avoid receiving necessary screening and must be overcome. If the mammogram is suspicious, a biopsy is the standard way to make a definitive diagnosis. Critics complain that biopsies may at times be performed too readily. However, all concerned would be devastated if a mammogram raises a red flag, the biopsy is deferred and a cancer diagnosis is made too late. The evidence is clear; the earlier breast cancer is found, the better the outcome and the lower the cost in lives and dollars.
My sister-in-law once remarked that "it has been harder to recover from the treatment than from my breast cancer." Whether management involves surgery, radiation or chemotherapy, the diagnosis of breast cancer is the beginning of an intense journey. Where the road leads and how it ends is never known at the beginning. Living with breast cancer involves countless decisions about treatment, work, family, relationships, personal priorities and spiritual values.
Support of family and close friends means so much to those living with breast cancer. Psychological intervention in the way of individual, group or family counseling, and a collaborative team of health care professionals, have been shown to positively affect survival rates. Last week, Cynthia DeRosier dropped by the clinic and donated multiple copies of her recent book "The Survivor Spirit: The Beauty, Passion and Power of Breast Cancer Survivors." She wrote it purely out of a sense of service. The human stories are deeply inspiring. You are welcome to contact the clinic or come by for a free copy.
Ira Zunin, M.D., M.P.H., M.B.A., is medical director of Manakai o Malama Integrative Healthcare Group and Rehabilitation Center and CEO of Global Advisory Services Inc. Please submit your questions to firstname.lastname@example.org.