Chocolate and Gold Coins

Thursday, July 21, 2005

Radical Mastectomy

My sister died of breast cancer many years ago. Cancer robbed her of easily 40 years of life, maybe as many as 50 or 60 years of life. It also robbed her children of a mother and (if they have children) her children’s children of a grandmother. I should add to this list that it robbed my parents of a child, my brother and me of a sibling, and her husband of a spouse.

This tragedy might have been averted if she had had a forewarning of her cancer. Her cancer was rare and almost certainly genetic and unstoppable. She might have saved her life if she had known and opted for radical mastectomy.

Some women do know they are at higher risk of cancer and opt for this extreme procedure. It isn’t an easy decision to make. If you knew for sure that you would get cancer, you would have to do this. But what if the risk is probability p. For what value of p would sure a radical procedure be worthwhile?

For any woman with small children, this would have to be a serious concern. Medicine is revealing more about our genetic predisposition to cancer, and you might become aware that you are at higher risk. Would you consider such a procedure?

For husbands, do we feel a conflict of interest? We love our wives and we love our children so the thought of losing a loved one is terrifying. But a husband might…ahem…have grown fond of his wife’s breasts, and if the probability p is low, he might feel conflicted. But does this really enter into the equation?

For what value of p would such an extreme procedure be warranted? Please comment.

Also, if you care to admit (or blatantly lie about) how altruistic you are, please add your comments to this growing comment thread here.

12 Comments:

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    By Anonymous Anz, at 12:18 PM  

  • It would have to be more than 70%. But then, that is easy for me to say. I have no family history of breast cancer, even though all of my grandmothers and most of my greatgrands lived to be in their 80s.

    By Blogger Suzi, at 10:11 PM  

  • I would want p to be substantially higher than the risk of breast cancer in the general public. I think it should be, at a minimum, an increased relative risk of 2X or 3X; assuming the overall incidence in the general population is not extremely high or extremely low.
    If the incidence of the disease in the general population is 1 in 100K, and my risk is 2 in 100K, I wouldn't opt for the radical procedure.
    Now, if the incidence in the general population is 1 in 7, and my risk goes up to 2 in 7, bring on the knife.

    By Blogger Rawan, at 12:43 PM  

  • Hi Suzi and Rawan
    Suzi: you probably think that you are at low risk for this disease and I hope you're right...but before my sister, no one in the family ever had breast cancer. But then it can hide in the male genes for generations and no one would know it.

    Rawan: The odds of breast cancer are high. The incidence is about 1 chance in 1000 each year, so over a lifetime it gets to be fairly common. If that rate were as high a 1 in 100, that would be near certainty, so you would probably opt for surgery at that point.

    By Blogger Michael Higgins, at 7:24 PM  

  • Hi Michael
    I have been reading your posts for a long time now and its just plain indolence that I have not commented on any of the articles. Well this article about mastectomy just hit too close to home.

    We lost our mother to breast cancer about 12 years ago, when she was 48, about 30-40 years before she was supposed to go. The thing about cancer is that it not only kills the affected, but everone around as well. To see our mother die, 5 years after her mastectomy, one day at a time, one lymph node at a time was devastating. The trips to the oncologist, the Xrays to verify if the lungs has been affected, the excruciating wait to get the results takes its tolls. And we were still in our teens and early 20's when mother passed away. Needless to say, it was tough.

    Would I mind if my wife had to undergo the extreme procedure of mastectomy, if there was a definite possibility of cancer ? I certainly would not. Breasts, well in most cases, do not define women. I love my wife, just as I loved my mother, because of all the things that they do to make our lives so much better and liveable. I could not dream of a life without my wife and my son without his mother at the cost of something trivial, well in the grand scheme of things, as mammaries.
    Sourin

    By Blogger chappan, at 12:46 PM  

  • Hi Sourin
    My sympathy for the loss of your Mother.
    I agree that a husband would definitely agree to a wife having the surgery if the risk is high. But how high? My wife was shocked by the death of my sister (whom she was obviously not related to) and worries about breast cancer. If she were to say that she wanted to do this, I would ask, "are you sure. It is irreversible."

    But these are the kinds of questions that are hard for people to answer. What probability is too high? This is not the standard cost benefit analysis.

    By Blogger Michael Higgins, at 2:03 PM  

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