In the past month or two, I saw three young girls for a lump in their breast. One was 19 years old, the others 15 and 12. The mother of the first girl was recently diagnosed with breast cancer and was finishing up chemotherapy. I put the ultrasound probe down and saw a benign appearing mass, most likely a fibroadenoma. I told them that just that. I looked into both their eyes and there was no sense of relief.
Ok, maybe they need more than that.
Not entirely sure what it is they needed to hear, I continued on:
“The options for management include watching it in 6 months or biopsy. I am not sure if you would want to consider biopsy, given your own personal experiences and that way you will have a definitive answer.” The mother breaks down crying.
Oh shoot. I said the wrong thing.
I gave the mother a moment. She apologized. It was okay. By now I have gotten used to cancer patients having moments where they just need to break down and cry. Finally, when she was able to gather herself, I tried again:
“I am 99% sure that this is not cancer. It would be incredibly unlikely in someone of this age to have a mass that looks like this end up being cancer. If she were my daughter, I would opt for watching it, just to make sure it does not rapidly grow.” Finally, I see some relief in my patient and her mother’s eyes.
I don’t know know why I even mentioned biopsy as an option. I almost never suggest biopsy in someone of this age because it is so unlikely to be something abnormal. If it were my own daughter, I wouldn’t have even worried for a second. Now, in this situation, the patient’s mother had breast cancer, and that probably contributed largely to their fear, and probably to some degree mine. But the mother of the second girl I saw did not have cancer. The mother of the third, 12 year old girl, repeatedly asked me if the several benign cysts were normal. I couldn’t help but to wonder if this is just a normal parental response, or is there so much hype around breast cancer that we are now making our teenage daughters check their breasts for lumps.
I see the look of fear almost every day in my patients’ eyes. For many patients, if I offer six month follow up, I get this look of “are you sure?” I have actually done biopsies when I didn’t think someone needed them because the patient wanted it. Many women can’t stand the thought of waiting, as though there was a ticking time bomb in their breast.
Awareness is a good thing. It helps people take initiatives to get preventative services that might actually save their life. But all of this awareness has instilled a great deal of fear, in not just patients, but their doctors as well. We have to live up to the notion that early detection will save our patient’s life. Don’t miss that breast cancer when it’s early! If you don’t biopsy and something turns out to be a cancer, be ready to explain that to your patient (and possibly their lawyer)… And it’s not just radiologists who fear it too. When my partner and I felt that we could safely follow certain things in a year, we received some nasty responses from referring physicians who basically told us that that was not the protocol and we were putting them at risk for lawsuit. They would no longer send us patients unless we forced people to come in at 6 months for followup.
I agree with Peggy Orenstein about how the “awareness” aspect of breast cancer is borderlining on hysteria. We, as a community, need to have a rational outlook on breast cancer so we can better focus our energies on prevention, detection and treatment, and make sure that what we are doing is really helping women.