Friday, July 4, 2008

Back into the blogging mode...

I was reminded by a patient that blogging actually involves updating my posts with some kind of regularity!  Well, I do appreciate that advice and I am back to continue what I started back in the spring.  I think that I was looking at each post as a chapter in a textbook rather than as a running discussion of topics of interest to me and those involved in treatment of breast cancer.  I would appreciate any comments from readers regarding topics that I can blog about and I will try to get back in the habit of posting more regularly.

This month I have several breast reconstructions scheduled.  Interestingly, all of the cases are bilateral reconstructions, and in 3 cases, the cancer is only in one breast and the mastectomy is being done prophylactically, and in 1 case, the patient has tested positive for a BRCA gene mutation and is electing to have prophylactic bilateral mastectomy.

I recently read a book by Jessica Queller called Pretty Is What Changes: Impossible Choices, The Breast Cancer Gene, and How I Defied My Destiny. She is a television writer in her mid 30s who is tested for the BRCA gene mutation after her mother dies of ovarian cancer, after surviving breast cancer.  It is a frank account of her emotions upon learning the results and how she dealt with the choices she had, ultimately choosing bilateral mastectomy and reconstruction with tissue expanders and implants.  She did seem to suggest that a female plastic surgeon was somehow more "qualified" to understand her ordeal, though I would suggest this as a generalization.  In any case, I thought it was a timely book, considering that the BRCA gene mutation testing is inevitably going to become more common, and prophylactic mastectomy seems to be a choice that many more patients will be considering.  

I am aware that women often choose to have a mastectomy of the normal breast at the time of mastectomy to treat the breast with cancer (prophylactic on the normal side, therapeutic on the side with cancer).  What I hear from women who make this choice is that the uncertainty of knowing what the future holds if the normal breast is not removed, the need for constant mammographic screening, the question of why they got breast cancer in the first place, which by itself serves as a risk factor for the development of breast cancer in the future, leads many women to consider bilateral mastectomy.  With reconstruction outcomes improving, I think that women see a bilateral mastectomy with reconstruction as an empowering choice.

As always, I look forward to hearing from readers especially for suggestions regarding future blog posts.


Just One of Many said...

I believe the recent Newsday story about the actress, Christina Applegate, is a real eye opener for those who cannot otherwise understand the difficult decision some of us have faced, and the factors that go into that decision. I admire her for her candidness and sense of humor, and I think she will help many women along the way.
The Newsday story quotes Dr. Brian O'Hea from Stony Brook as saying that women who have chosen prophylactic mastectomy "are some of the happiest patients...because the burden of an expected cancer has been lifted - and they are free". I couldn't have said it better myself.
Newsday also cites a statistic that I find amazing: "Last year a U of Minn. study found that between 1998 and 2003...double mastectomies increased by 150 percent for women who had breast cancer on only one side".
I was bombarded with statistics that told me everything except what other women were doing. After my decision, I was given the impression that I was part of a growing "trend". Not that I think we should make our decision based on trends, but it was very hard to decide to do something still considered radical to many.
On another note, the idea that some women believe a female physician is more "qualified" in understanding them boggles my mind. Some women I know have no idea how their own bodies work, yet they are worried that a male doctor cannot understand them. Women (and men) should be looking for the most qualified doctor....Just my humble opinion.

Just One of Many said...

This week I read the book you mentioned, PRETTY IS WHAT Jessica Queller.
I had mixed feelings about it while I was reading it because, on one hand, I cannot relate to her lifestyle and circumstances at all. She's not like me or anyone I know. She decided on which coast to have her mastectomies done when most of us are deciding which hospital and doctor based on our insurance plan. On the other hand, everything she had to say about the testing and decision making process were spot on. All in all, worth reading.