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Wishful Thinking and Breast Cancer

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All too often, when it comes to breast cancer, we seem to get caught up in wishful thinking and forget about science.

We use wishful thinking when it comes to breast cancer screening guidelines. We get angry at the experts who tell us studies show that mammography is less beneficial for women in their 40s. We focus on the idea that if only every woman had regular mammograms every cancer would be found early and cured.

This ignores the biology of breast cancer, which tells us that there are at least five or six different kinds of breast cancer that grow at different rates. Some are slow enough to be found early by mammography, but others are too fast growing or fast spreading to be "caught" at the exact right time. Instead of arguing about screening guidelines, we need to face the science squarely and focus on prevention, so that we can learn how to avoid cancer in the first place.

We use wishful thinking all the time when making treatment decisions. When a woman is diagnosed with breast cancer her first reaction -- understandably since she is scared to death -- is to do anything she can to insure that she is cured and make the fear go away. This fear (accompanied by wishful thinking) often leads people to do things that are not supported by the science.

One example of this is the studies that show that the number of mastectomies for breast cancer has been increasing in the U.S. each year. This is not happening because doctors are finding bigger tumors, or because mastectomy is a better treatment. It is the result of wishful thinking: "If I offer my breast or breasts to the gods, I will surely get my life back in exchange. If I have no breast tissue, I never have to go through this again."

In reality, a mastectomy never removes all of the breast tissue. (I am a breast surgeon, so I should know.) The breast tissue does not come neatly packaged so that it be easily removed, which is why there always is some breast tissue left behind in the skin, around the muscle and at the edges. In reality, the local recurrence rate after mastectomy is 5 to 10 percent, and the local recurrence rate after lumpectomy and radiation is 5 to 10 percent. It is exactly the same. And the cure rates are the same as well.

The critical issue is getting the tumor out with a rim of normal tissue and dealing with any cells that might have escaped -- which is what radiation, chemotherapy and hormone therapy are for. It seems like the more radical the surgery, the better the results should be ... but that is really just wishful thinking.

Finally, there is the wishful thinking about diet. The headlines scream that if you eat blueberries or drink red wine or don't drink red wine you will not get breast cancer. We all want to believe this magic.

In reality, these findings come from observational studies, which show you a correlation but cannot prove cause and effect. If you knew that all drug addicts drank milk as babies, would you really think that drinking milk as a baby could make you a drug addict? Of course not. That's a correlation. It's not cause and effect. Exercise and maintaining a healthy weight have been shown to reduce risk, but what you eat seems less critical.

This October, let's make an effort to move away from wishful thinking and demand good science to direct our actions. And lets all promise that when we are scared to death because we have just learned that we or someone that we know has cancer, we will help each other to take a deep breath. The diagnosis of breast cancer is not necessarily an emergency. You have time to consider all the options and not rush into wishful thinking.