"You're so lucky."
"We caught it early."
"Nobody dies from this."
In the cancer sweepstakes, I had more or less hit the jackpot: Stage 0 breast cancer, which shows up on a mammogram as a cluster of tiny white pinpricks, the calcified remains of once-healthy cells.
Like more than 50,000 other women that year, I received a diagnosis of ductal carcinoma in situ, commonly known as DCIS. Over the past two decades, as breast screening has become more widespread and sophisticated, rates of DCIS are skyrocketing; it now accounts for up to 25 percent of all new breast cancer diagnoses -- including, in recent years, those of Sheryl Crow, Martina Navratilova and Wanda Sykes.
Unlike more aggressive, invasive cancers, which have spread into breast tissue, DCIS gets its name from the fact that it is "in situ," still cozily ensconced within a duct. And therein lies the problem.
Because once you've seen those little white pinpricks, the machinery of cancer treatment gears up, and there's no slowing it down.
That reality is at the heart of news released Oct. 24 that, for the vast majority of women, mammograms have little life-saving benefit. In fact, nobody knows whether early-stage cancers like mine will ever develop into serious disease.
In this most recent study, researchers at Dartmouth University calculated that the number of women whose lives are saved each year by early detection is between 4,000 and 18,000 -- a small portion of the 230,000 women diagnosed with breast cancer annually in the U.S. and a minuscule fraction of the 39 million American women who undergo mammograms every year, according to New York Times health writer Tara Parker-Pope.
For tens of thousands of the rest of us, that means treatment, regardless of whether our lives are at risk. Unlike with prostate cancer, which is undergoing its own debate about the value of screening for much the same reasons, there's no such thing as "watchful waiting" with DCIS. (I can't help but wonder whether this is because the medical establishment is so much more horrified by the notion of a man's impotence than it is by a woman's loss of a breast.)
Researchers have been chipping away at the sanctity of mammograms for a while. The issue last hit the front pages two years ago, when a government advisory panel recommended delaying regular screening until age 50 for most women, and then only once every two years instead of annually.
Back then, breast cancer blogs and message boards lit up with angry reactions from physicians and patients, many of whom, thanks to the success of breast cancer awareness campaigns, have "imbued the mammogram with a kind of magic," in the words of prominent women's health advocate Dr. Susan Love.
This time, Pope notes, the response has been more circumspect. As an editorial in her own paper put it, "Women will face a difficult choice. Fewer than 1 in 1,000 healthy women screened over a decade will have a cancer found at just the right moment for successful treatment. The rest will undergo a decade's worth of radiation for no medical benefit or, worse yet, undergo unnecessary treatments that can be harmful to eliminate tumors that would never have killed them."
Tell me about it. My Stage 0 cancer required surgery and radiation, followed by more radiation in the form of mammograms every six months. And when the DCIS showed up again five years later, the treatment was even more aggressive. This time -- with no way of knowing when, or even if, the disease would turn on me -- the breast had to go.
For me and 138,000 other women whose cancers will be detected on a mammogram this year, all the talk about the cost of overtreatment isn't academic. Yes, the sums are staggering: Mammography screening alone costs $5 billion a year, to say nothing of the costs of surgery, radiation and chemotherapy. But there's a human cost too, and I don't hear much about that in all the debate about lives saved and dollars spent.
Questioning whether early detection does more harm than good sometimes makes me feel like a traitor to the pink-ribbon sisterhood, and I take some comfort in the fact that public opinion is finally catching up with me. Don't get me wrong. I do feel lucky. I'm healthy, I have a loving partner, an interesting job and, thanks to the talents of a terrific plastic surgeon, a killer rack. But when it comes to wearing the label of breast cancer survivor, I'm with Groucho Marx: I'd rather not join any club that would claim me as a member.