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Mar 6, 2012 11:58AM
Mar 6, 2012 12:06PM
Both sources (MD Anderson and Winer's) have been ones I respect, and I often suggest to others that they seek info to make their decision from them, as to me they seem not only to be way out in front in leadership toward a more current and future approach toward dealing with bc, but also don't put blinders on when it comes to the truth about SE's, etc. and actually also put some effort into doing work to try to address them.
In this particular difference of opinion, this is what comes to mind for me:
When it comes to the numbers game, what I marvel at is that best guestimates of our individual risk are so completely blind to the full range of the basis for cancers. What do I mean by that? I mean, that even though as intelligent people we already know that various human practices do matter in increasing the likelihood of getting cancer. Smoking. Obesity. Poor diet. Lack of regular exercise. Etc. So my common sense tells me that if I tend to practice more of those negative practices, I stand more of a chance of increasing my odds of recurrence, and if I tend not to, my chance of recurrence is lower. In other words, when considering the statistics as they apply to me, I know that the worst end of the statistical estimates is most likely to be composed of those with poor practices, and the best end of the statistical estimates is most likely to be composed of those with healthy practices. So even though the range for tiny cancers does include people who end up with recurrence if they only do "x" and not more treatment, I know where I personally am most likely to be within that range. I don't see doctors ever considering or talking about that when trying to guide those with smaller evidence of cancer. It gets back to what I consider to be a dangerous philosophy that is so pervasive in making recommendations for bc. What seems like the most humane approach, i.e., overkill for many in favor of saving a few, is actually less humane because of the failure to include genuine consideration of the very real factors of human behavior so that fewer humans are subjected to the full range of the negative effects of treatment that is not benign.
I could understand, for example, a doctor telling a patient with a miniscule amount of cancer that if she practices more of those factors then she might want to lean toward additional treatment. But that is not what the NCCN guidelines take into account, and that is not what is discussed in the physician-patient session advising treatment.
I don't believe in leaving common sense out of the objective evaluation.
To this, were I the doctor advising a patient, I would tell them to take into consideration their ability to tolerate risk. If they are a person who is very highly anxious about any risk, they should lean toward doing the treatment to provide them with more peace of mind. If they are not, then it they may wish to take a different approach in dealing with the general recommendation for treatment.
12/3/2001, DCIS/IDC, Left, 1cm, Stage IA, Grade 3, 0/1 nodes, ER+/PR+, HER2+ (IHC)
1/3/2002 Lumpectomy: Left; Lymph node removal: Left, Sentinel
3/12/2002 Adriamycin (doxorubicin), Cytoxan (cyclophosphamide), Fluorouracil (5-fluorouracil, 5-FU, Adrucil)
11/15/2002 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)