USS Clueless              Voyages of a restless mind

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Stardate 20010719.1540 (On Screen): There exists a genetic marker which has been found in certain women, and those who have it appear to have a better than even chance of developing breast cancer during their lifetime. A study has shown that if those women have both breasts removed before cancer is found, that they appear to have no better chance than the general population of developing cancer. At least for three years, which is all the longer this study has run. That isn't adequate. I'm also a bit horrified that this study was even done.

I'm not sure I think this result is useful. There's more to life than survival; there's also quality of life. Some women with the marker will remain healthy, and some of those who get cancer will do so when very old, and many who get it will survive through treatment. But it is widely known that a double mastectomy is emotionally devastating to many women (and well it might be) and it's not clear that it is reasonable to seriously mutilate a young woman because she might get a horrible disease later, which might not even kill her. She might then go through the rest of her life mourning her lost breasts, and perhaps thinking of herself as less than a woman, and wondering if it had really been necessary. (I'm not saying that I think that a woman having a mastectomy is less than a woman, I'm saying that they often do, which is an established clinical fact. Counselling is often necessary after this operation.)

Obviously, this is not my decision (as a man) to make; it's something any given woman who was found to have that genetic marker would have to make for herself (perhaps in consultation with her partner and family). Still, I hope (and expect) that this doesn't interfere with other research about this marker which aims to determine how it increases the risk of cancer, because that may lead to a better (i.e. less mutilating) approach to dealing not just with this kind of cancer but perhaps with all breast cancers. It's also way premature to apply the results of this study to clinical practice; it should run at least ten years before it will be valid.

I sometimes wonder whether the popularity of radical mastectomies is due mostly to the fact that it's something that surgeons know how to do. Studies have shown that in most cases removing just the lump results in the same life expectancy, and yet there are still thousands of (apparently unnecessary) radical mastectomies every year. Now the surgeons have what appears to be justification for removing healthy breasts. Good going, guys (and they all seem to be guys; I've never heard of a top-bracket woman surgeon). Perhaps we need a law that a surgeon can't remove a breast unless he's had a testicle removed. (discuss)