The word awareness is like nails on a chalkboard. Even in areas of the world, or communities in this country that are not in this pink stranglehold, I submit that what we need is **education** not awareness.
Let's discuss facts, let's discuss science, let's discuss evidence, let's discuss research direction. And let's put some things in their proper perspective. Some of what we are being sold may have been relevant decades ago, but we are long beyond the days of women going to sleep on an operating table not knowing if they would awaken intact or missing a breast.
The media bandwagon? Shrill. Soundbites. Early detection saves lives. Early detection is the key to the whole thing. NOT. It's a myth that is going to be sold and resold and bantered all over the place. Shame on them for doing the same thing every single year. Shame on them for not setting the record straight. They have the platform, they have the audience and they have the ability to change the conversation. It's easier to recycle the same old feel good story. Find it, remove it and wear that pink badge with pride.
There's nothing wrong with that scenario. Indeed, it's wonderful. What's wrong is the lack of balance, the ongoing insistence that this IS the story.
Early detection is a tool. It's just one tool and it's woefully inadequate in the grand scheme of things. Women must get their mammograms. Yes (or maybe in some cases a sonogram or an MRI might be the best tool for the job). I think it's imperative that we do not lose the message. Screening is important. The thing we must remember? Early detection is just that. Early detection. It's not a guarantee of anything.
One of the first places I recall reading about early detection and its shortcomings was in this NY Times piece which dates back to October of 2011. It raised many eyebrows. I wasn't sure how I felt about it then. I'm fairly certain I may have been insulted. It's logical. The earlier a problem is identified, the earlier the problem may be addressed and ultimately, the quicker the problem may be resolved. That logic, however, presumes to be dealing with something where logic might apply. Cancer is not logical. There are no rules.
I know how I feel about it now. It all makes sense. Some lives will be saved by early detection and some won't. There will be over treatment because of better imaging leading to even earlier detection. We are barking up the wrong damn tree. It's not about seeing what's there, it's about understanding what we are seeing. Until we can stop the nonsense of making imaging more sensitive and get into the cellular makeup of what we are finding, yes, we will over-treat.
Unfortunately, (I'm not going to quote statistics but I do know it's greater than 50%) more cases of DCIS will never cause a problem than those which would go on to become invasive, but until we know how to differentiate, asking someone with a diagnosis of DCIS to watch and wait before acting takes an exceptional personality type. I'm not the watch and wait type so I do know which side I would fall upon should I have had a DCIS diagnosis.
Solutions create problems. This mammography solution has created countless other problems. Thanks to decades of focus on early detection, we've been completely distracted from the reality of what we should be doing. Saving lives.
I urge you to read the NY Times article. And I'd like to encourage you to take three minutes to watch this video. Diagnosed at Stage Zero, this is Theresa's Dream:
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