I clearly remember the day they found my breast cancer. It was
a perfectly routine annual mammogram. I could see the concern in the
eyes of my radiology colleague even as she tried to cover it. I am a
physician myself and looking at that shadowy mass, my gut reaction was
a jolt “Oh , oh! Now I am in trouble”.
Why is it so? Why does the word
‘cancer’ trigger such immediate reaction of doom and
dread? I am a pathologist. I daily deal with cancers and other
diseases. I know the prognosis, the five and ten year survival
figures. I know that, with the latest treatments, many cancers have
remarkably good prognosis and many non-cancer diseases have dismal
figures. Yet the cancer phobia lingers.
No other disease generates such
primordial reaction. Hear disease, diabetes, stroke and kidney
failures are far more common than breast cancer and kill many more men
and women every year. But, somehow, we have grown familiar to them and
expect to live with them for a long period of time. We are not
terrified of the severe morbidities, or the slow, painful deaths or
the high cost of medical care of these diseases. But the diagnosis of
cancer, of any body part, even if small, in early stage or of very low
grade, can severely affect our sense of wellbeing.
Perhaps it is a historic fear.
After all, it is only recently, in last 2-3 decades, that the
treatments and survival figures of some common cancers have shown some
improvements. Up till the ‘70s, the prognosis of most cancers
was uniformly bleak, and the treatment modalities expensive and
painful to the extreme.
I think we fear the treatment more
than the cancer itself. The surgery, chemo and radiotherapy for most
cancers have serious, painful and permanent side effects. The surgical
removal of a breast is severely traumatic to one’s feminine
psyche. It is an overt, visible disfigurement, unlike loss of vital
internal organs. The loss of hair—another visible -- albeit
temporary—disfigurement only adds to the surgical trauma. All
this, added to the systemic illness due to the cancer killing
medications and radiations make one thoroughly miserable. It feels
like an extra punishment added to the trauma of cancer diagnosis.
Often these effects may linger for years or be permanent reminder of
the disease. It is a cruel irony that the treatment appears harsher
than the cancer itself.
Yet it does not have to be this
way. It isn’t your mother’s breast cancer anymore! Unlike
palpable lump, the breast cancers detected now a days are extremely
small, non palpable and almost invisible to the naked eye.
Consequently, the surgeries, too, are much smaller, less traumatic,
entailing removal of only a small part of the breast, rather than the
entire organ, thus making cosmetic reconstruction possible. Even
removal of the lymph nodes from the armpit has changed. It is now far
less traumatic, involving only one or two nodes instead of all, thus
minimizing the risk of debilitating swelling of the arm.
Yes, the chemotherapy and radiation
still make the hair fall out. But easy availability of wigs and other
prostheses make the changes more bearable. Even the side effects of
vomiting, anemia and weakness are far less severe with the newer
medications. Newer, less toxic and more effective anticancer drugs are
daily being introduced.
All these changes have improved the
prognosis of breast cancer significantly. Now it is just another
chronic disease one has to live with. Not unlike diabetes or high
blood pressure. In other words, nothing special. No big deal.
In the long run, I am convinced, it
is far healthier to think of cancer as another chronic disease.
Perhaps only then we will be able to get over fear and stigma of this
all too common malady. ---11/06
GOING GRAY IN THE USA
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