How Should We Address Breast Cancer When Norms Continually Change?

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Accompanying Photograph: Andy Katz/Demotix/Corbis

When faced with decisions about breast cancer treatment or screening, it can be hard to know what to think.

Gayle Sulik, The Guardian, Oct. 20, 2015

Three decades ago, researchers believed breast cancer was one disease, so it made sense to treat it that way. However, the usual battery of slash (surgery), burn (radiation) and poison (chemotherapy) didn’t always work and often caused irreparable damage, sometimes death.

Since then, the theory of breast cancer has been fine-tuned and revised. We know it’s several different types with multiple causes and progressions; that the harms of screening mammograms are greater, and benefits smaller, than once believed; that fewer radiation treatments can do the same job as more; that high-dose chemotherapy does more harm than good. This updated theory of breast cancer, amended with scientific research and clinical observation, helped to change many practices and protocols.

But the norms surrounding treatment and diagnosis have been slow to change, and new research can upend decades of conventional wisdom. When it comes to breast cancer, it can be hard to know what to think. Do I get screened or not, starting at what age, and for how long? If I have breast cancer, how aggressively should I treat it? What if I do nothing?

I can’t answer those questions definitively, and neither should anyone other than a well-informed member of a person’s healthcare team. But I can help put these decisions in perspective and explain why breast cancer is such a moving target.

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