The rush to (over) treat

We all know the two groups of people:

The ones who get a booboo and say 'no big deal' and clean it later, even if just in the shower later on, vs. the ones who rush for the antibacterial soap, alcohol, bacitracin or neosporin, and bandaid. Well maybe they aren't two solid groups but there are two sides to the equation with scatterings in between. 

With breast, or any type of, cancer, there is often a rush to say 'get it out of me!' But that is starting to change, especially in view of concerns with overtreatment of DCIS, that some people say 'I'll wait'. I can see that.

I think the typical patient has lemming traits where they agree basically with what the doctors tell them, and if they do not agree, they find another doctor who they agree more with. How often do we stop and say, 'now that I know what it is, I can wait and make a decision'. I think we need to stop and think with a diagnosis and say 'what are my choices?' and 'can I wait?'  And not to skip 'what are the pros and con's of immediate treatment'.

Doctors are also starting to change their train of thought as well.

We have learned so much about the side effects of treatment that I think they need to be a big part of our medical decisions. And we should consider no treatment among the options. Its my body and my choice.

Finding the balance

More tests or fewer, more meds or fewer. Does this mean fewer diagnoses and more deaths? I don't think it has to. We just need to find the balance.

We need to focus on finding, not what is the most we can do, to what is the best thing that can be done for the patient. Go read this article to learn more. I strongly agree with this theory.

I can't tell you how many times I have felt over-tested, -poked, and -prodded, because of 'my medical history, they have to be sure'. I can't tell you how annoying that is. Really? Can't they just say that's the best thing for you? Or is that not what they mean?

There is a current leaning in the medical/insurance world to cut down on the amount of tests, scans, and medications for patients. American medical costs are the highest in the world and American patients are blasted by ads and mailings from manufacturers on the newest, most expensive treatments, which are often unnecessary. And patients ask for more scans.

I get it. I have asked doctors why no more scans or tests? And the answer is 'there are no reasons to have any scans, there are no changes'. I can live with that. And I get mailings from Pfizer to go on Xeljanz, which is probably no better than my current drug combinations. And that new drug costs a fortune.

There is a tiny part of my brain that screams 'cure me', give me more tests, find a fancy pill, do something so I can go back to my former healthy self. But the rational part of me knows that isn't a reality. I can dream can't I?

Are any of these people who are so upset about not enough testing and medications patients? If my doctor says this is what's best for you, I'm happy. Its the right balance for me.

As patients we need to accept what our doctors say is enough. And we still need to be vigilant against under treatment, but that's another story.

Over- and Under-Diagnosis and Treatment of Breast Cancer

I found this interesting discussion on over and under diagnosis of breast cancer and how to avoid it. Its definitely worth the read.

The big take away I found in the article is that the best way to avoid overdiagnosis is to get screening done at a breast center where the radiologists read mammograms daily. Through their jobs, they see many more breast images than other radiologists who are not as specialized and much more apt to correctly diagnose breast cancer.

Also, better education of patients and oncologists will also help with preventing over-treatment. Often the first reaction at a cancer diagnosis is 'get rid of it now and make sure it doesn't come back!' Fear takes over and the reaction of a patient goes instantly to get rid of it.

But maybe if the patient takes time to educate themselves on treatment possibilities the fear can be controlled. And the doctor is educated enough to provide the support to help the patient make the best choices and not the impulsive choices. Then the chance of over treatment can be reduced.

I think that this issue of over treatment and over diagnosis for many ailments needs more awareness and focus. We need better trained medical personnel who are able to better read screening images and provide better diagnoses. We also need additional training for medical personnel to help patients make better decisions. Finally we need more information available for patients to reduce the fear at diagnosis so they are able to make better decisions.

Low risk 'cancers'

So is it cancer or not? Sometimes they can't tell. For example which cases of DCIS will go on to turn into a potentially fatal breast cancer. Or which cases of thyroid lesions will actually grow into thyroid cancer? There is a growing epidemic of new cases of thyroid cancer and the question is which cases that are discovered will actually turn into cancer that could be fatal and which will not.

So what do you do? A lot of people fear the word cancer so much they just want it out of their body. One school of thought for the thyroid lesions that should not become a problem is to rename them "papillary lesions of indolent course". That just sounds so 'benign'.....

So if the word 'cancer' is taken out of the discussion, active surveillance might be better. I mean why go through surgery, etc for something that doesn't require treatment?  "In many cases, active surveillance may be preferred over surgery by patients with small, relatively benign cancers that could take decades to grow to any appreciable size or cause life-threatening problems."

I have so many body parts currently under 'active surveillance' for multiple issues that I have lost count. I would be happy with that for additional body parts instead of surgery, chemo or radiation. This is much easier with thyroid cancer where the area can be easily ultrasounded and palpated to monitor growth. But not so much with DCIS where breast cancer can be much quicker to grow and harder to find.

Language can have a big impact on people's opinions of their diagnosis. The word cancer strikes fear into most people's brain. It paralyzes them, they are instantly going to die! But as more and more is learned about cancer, its detection, and treatment, maybe the best bet is to retrain our brains as to what will kill us and what won't.

An example is when AIDS was discovered it was instantly a terminal disease. Now people are living for decades with it and it is now chronic and not fatal. But the term AIDS still strikes fear into many but that is slowly calming.

I hope that the word 'cancer' also does not always strike fear into all as more and more of us are still around to talk about our diagnoses decades later.