OMAHA, Nebraska
United States
GOING GRAY IN THE USAWHY IS CANCER SUCH A BIG DEAL?
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
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