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8B – Daily News – Monday, October 25, 2010 Breast cancer , can we be too aware? By H. GILBERT WELCH Los Angeles Times (MCT) I'm a physician who has had concerns about Nation- al Breast Cancer Awareness Month for years. They per- sist despite my wife's breast cancer diagnosis a decade ago (for the record, she's fine and shares my con- cerns). I worry that the cam- paign has led women to be more fearful of breast can- cer than they need be: the "1 in 8" or "1 in 9" statistic, in particular, serves as a poster child for how to exaggerate risk (both because it encom- passes an entire lifetime and because it's not the chance of dying but of being diag- nosed). Equally troubling is the relentless promotion of screening mammography as the solution. That the campaign's principal founder is a manu- facturer of breast cancer drugs doesn't make me feel any better. Nor does the appearance of pink as a fall color in the National Foot- ball League. Knowing my concerns, a reporter recently asked me, "What do you think women should be aware of?" Here's my list: 1. Breast cancer is an important cancer. If nonsmoking women want to worry about any cancer, breast cancer is the one to worry about. The reason is simple: It's the cancer they are most likely to die from. But this risk should be kept in perspec- tive: A woman's chance of dying from breast cancer in the next 10 years is in the range of two per 1,000 (if you are age 40) to 10 per 1,000 (if you are age 75). And always consider the flip-side of these statistics: The chances of not dying from breast cancer in the next 10 years are 990 per 1,000 — or better. If you are a woman who smokes, worry about lung cancer instead, and heart disease. 2. There is a serious debate about the value of screening mammography. You know this. But what you might not know is that this debate persists despite 50 years of research involv- ing more than 600,000 women in 10 randomized trials, each involving years of follow-up. No screening test has been more exhaus- tively studied. That the debate persists in the face of this wealth of data tells you something: Screening mammography must be a close call. (Note that doctors don't debate the value of treating really high blood pressure; that issue was settled more than 40 years ago with a trial of less than 200 men in less than two years). The reason screening mammography is a close call is simple: It produces both benefit and harm. The combination of heightened awareness and increased screening has undoubtedly led to more breast cancer diagnosis. And a very few women have benefitted by avoiding a breast cancer death. More, however, have been harmed by unneeded Put your Holiday Season Business on the Red Bluff Express Reach 6,050 residential households in 96080 that Do not subscribe to The Daily News! Ideal for Daily News Advertisers: The most cost-effective way to achieve nearly 100% HOUSEHOLD COVERAGE 4-Page full color Broadsheet insert to the weekly MVP Direct Mail Package In ZIP code 96080 on the dates below 5” x 5” FULL COLOR AD BOX Just $2000 total For Daily News Advertisers Some conditions apply Direct Mail Deadlines/Home Delivery Dates: TUE 11/9 Deadline TUE 11/23 Deadline Delivery WED 12/8 TUE 12/7 Deadline Delivery WED 11/24 Delivery WED 12/22 Catch the Express to maximize your share of local spending in November & December! 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One told me that her doctor said she could no longer be a patient if she didn't accept screen- ing. (Imagine my mechanic saying he would no longer work on my car if I wasn't willing to have him check my coolant system for leaks.) To be fair to my primary care colleagues, such coer- cive practices may not reflect their own beliefs but rather that they too are being coerced. Ensuring that all women are screened has become one of the most prominent metrics in healthcare "report cards." There are practical reasons for this: It is easy to mea- Barber Shop $ Cheers 600 Open 6 days 570-2304 259 S. Main St. Tractor Supply Center Senior Cuts sure, easy to understand and hard to argue against. So regardless of what informed women want, it gets done (remember, we doctors got into medical school because of our ability to get good grades). Screening is a choice. Those who like mammog- raphy and want to do every- thing possible to avoid a breast cancer death should feel good about doing it every year if they wish. Those who don't like the procedure or the prospect of being turned into a patient unnecessarily should feel good about not doing it or doing it less often or starting it later in life. 4. Unlike screening mammography, there's no debate about diagnostic mammography. Doctors agree about what to do when a women (like my wife) notices she has a new breast lump: Get a mammogram. Diagnostic mammography is the tech- nology we use to figure out what the lump is. That's not screening; that's diagnosis. And no one argues about it. 5. There have been real improvements in breast cancer treatment. All the focus on breast cancer detection has over- shadowed a more important story: Breast cancer treat- ment has improved over the 22755 Antelope Blvd. Red Bluff, CA 96080 (530) 527-9166 last 50 years. Breast cancer surgery has gotten a whole lot more sane. Radical mas- tectomy is largely gone, and more women are given a choice between simple mastectomy and breast- conserving surgery. But arguably the biggest improvement involves adju- vant therapy, the chemotherapy and hormon- al therapy that follows surgery. After summarizing 194 randomized trials, the international collaboration of Early Breast Cancer Tri- alists concluded that the addition of adjuvant therapy cuts the breast cancer death rate in half. That's huge. 6. Too much disease awareness may not be good for your health. Breast Cancer Aware- ness Month serves as a pro- totype for "disease aware- ness" campaigns. Too often these morph into campaigns to find things wrong with healthy people. Our med- ical care system is extreme- ly capable in this regard. We can detect miniscule abnor- malities in the body's anato- my and its chemical milieu. And, as if that's not enough, we increasingly change the rules to narrow the defini- tion of "normal": Lower blood pressures have become hypertension; lower blood sugars have become diabetes. Many interests are Open Mon. thru Sat. 10am – 6pm OK TRIMMER •Trimming and cleaning are easy with quick release and replaceable grill. •Powerful, efficient and quiet motor • Works well with flowers and various herbs •One person works as fast as ten or more. Select from 15 varieties of scissors! served by this behavior. But that may not include yours. That's because health means more than the absence of abnormality. Health is also about how people feel; it's also a state of mind. H. Gilbert Welch is a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice. MELODIE POISSON for Corning City Council VOTE “Help us cut costs and rebuild our city” Paid Political Advertisement