Sunday, October 12, 2008

She was one of those 'natural' people, and the odd x-ray terrified her.

She was one of those 'natural' people, who always wanted to do things naturally, and even the odd x-ray terrified her. Too much radiation. She once wore a cast on her arm for 6 weeks after falling off a horse, for what could have been just a sprain, just to avoid the two x-rays it would have taken to rule out a fracture.

So, obviously, getting a mammogram was out of the question.

Her doctor tried over and over again to explain to her that a mammogram gives you a very minimal amount of radiation, the same amount as living in a city for 7 months (0.7 milliseverts) - the average U.S. citizen is exposed to 3 mSv per year of 'background' radiation.

The mammogram would have picked up her breast lump long before she felt it, long before it was diagnosed as cancer, and long before she would have to get her breast surgically removed.

A few years later, she started losing weight suddenly, then one day coughed up a startling amount of blood. She had never smoked, so lung cancer never even crossed her mind. Fortunately the radiation dose of 1 chest x-ray (0.1 mSv) no longer scared her, given her past experience, so she got the x-ray her doctor recommended to check it out. Unfortunately, however, breast cancer can spread to the lungs, which is what her doctor found on the x-ray. She died a few weeks after I met her in hospital, surrounded by her family, and countless beautiful flowers and cards showing how much she would be missed.

The week before she died, she said to her doctor over and over, over the sound of her oxygen and between short, gasping breaths, "I should have listened to you. I should have gotten that mammogram."

I had a conversation with another patient last month who is younger than my dad, an incredibly friendly and cheerful man, who is dying because he was too afraid to have a doctor stick a finger up his bum. Had he done that, his prostate cancer would have been discovered a long time ago, long before the it had the chance to spread to his spine, ribs, and legs, forcing him to live his last few months unable to get out of bed and suffering from excruciating pain every time he tried to take a breath. While you are celebrating Christmas with your family this year, his family will be celebrating their first Christmas without him.

It takes a lot to wrap my head around the fact that I am meeting and treating patients who will be dead very soon.

It's harder to accept the fact that a good number of these patients, who drink litres of alcohol a day, smoke like a chimney, don't get off their couches, and especially those who don't bother getting screened for cancer, could have had much longer lives.

Yeah, the screening tests we have aren't perfect, and some of them are uncomfortable and seem a bit undignified. But they do save lives, and so if you are in that age group, there is no excuse to not get them done.

This is not the place to get medical advice, so talk to your doctor about getting a prostate exam, a pap smear, or a mammogram. Sooner rather than later, please.


MamaMay said...

Actually you do give advice:

" to your doctor about getting a prostate exam, a pap smear, or a mammogram. Sooner rather than later, please."

Personally I think that is the best advice you can give.

Anonymous said...

One of the dirty little secrets about cancer is that individual histopathology - tumor genetics, the specific type of tumor cells the individual has, how aggressive they are, how well they respond to treatment and so on - plays a bigger role in survival than any of us would like to think. At some level, it's almost a matter of pure luck whether you have the "good" type that responds well to standard tx, or the "bad" type that is refractory and resistant.

Tragic as these two cases are, sometimes early detection makes no difference in the overall outcome. We don't like to hear that, because we want to believe we're in control of our destinies. But we're not totally in control.

As a society, we have conflated screening and prevention, when in fact they are not the same thing. We also have conflated early detection and survival, when in fact the one does not necessarily follow the other. There are many cancers for which no reliable screening or early detection even exists.

That said, by all means, get screened! But be aware of its limitations. :(

Dragonfly said...

As someone with a family history of breast cancer (an aunt died at 32 from it) and bowel cancer (a grandparent on each side), I couldn't agree more. (And eat lots of fibre and don't smoke).