I read the article by Deb Stewart, “Acting on Fear” (The ASCO Post, August 15, 2011, page 1) with interest, disappointment, and empathy.
“Acting on fear” in cancer treatment generally, and particularly in breast cancer, is not uncommon. Hence, I was most interested in the article’s major thrust, as expressed in the first two paragraphs. Ms. Stewart describes how she rushed through with the decision to undergo mastectomy for her breast cancer. As she states, “I just acted on fear.” Or as some might cynically say, “the patient’s fear was exploited by the caregivers,” leading to major disfiguring surgery, which was most likely unneccessary.
Reading through the rest of the article, I was disappointed to find that the author—a nurse and breast health educator at Johns Hopkins Avon Foundation Breast Center—makes another unfortunate decision. After a second breast cancer diagnosis, she chooses mastectomy for her contralateral breast. Despite her claim that she “took control” this time, I believe she was again acting on fear, or at best, basing her decision on erroneous science.
Ms. Stewart claims, “I felt that having had cancer before and having it now, I would likely have it again.” Her second cancer in the opposite breast 20 years later is a new cancer. There is no reason to believe that she is at higher risk to “have it again.” If the patient does have breast cancer again, it will most likely be recurrent disease, elsewhere. Risk for distant recurrence is identical whether the patient has had breast conservation therapy or modified radical mastectomy.
In fact, an article in the same issue of The ASCO Post (“Patients with Early Breast Cancer Benefit from Regional Nodal Irradiation,” page 3) reports that breast preservation and regional node irradiation (if indicated) reduces distant recurrence, based on results of the Canadian MA.20 trial. Radiation is not generally administered with modified radical mastectomy but is always done with breast conservation (per the National Comprehensive Cancer Network guidelines).
All surgeons (and others) should be encouraged to read the last section of Ms. Stewart’s article, headed “Loss and Change.” Her insights here might help caregivers guide mastectomy-leaning patients “in their transition through the stages of treatment and beyond” the initial phase of fear and anger. ■
—Gilbert A. Lawrence, MD,
Radiation Oncology, Faxton Hospital
Utica, New York