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 Breast Cancer: Revisiting Accepted Wisdom in the Management of Breast Cancer - Part 2 
 

It is remarkable that for all our progress in medicine, a JAMA article49 from 1895 reads as though it were from a current journal describing contemporary practice:

    [T]he widespread and increasing prevalence of cancer of the breast, its painful and terrifying features, and, above all, the very great attendant mortality, render it one of the most important of surgical conditions and one in which the most strenuous effort should be made to cure.... Operations for cancer of the breast are designed to be curative or are merely palliative, and it is needless to say that the end in view is determined by the extent of the neoplasm.... [M]ammary cancer is a curable disease, and ... the keynote to its successful management is to be found in the earliest possible diagnosis, prompt and wide excision and careful observation of the patient during the remainder of her life.
How problems are framed determines which solutions are delivered. In answer to the question, "How can local recurrence be eliminated?" one course of therapy--mastectomy--is mandated. If one asks, instead, "What is the least invasive therapy, will do the least harm, and provide equivalent survival advantage?" another intervention is pursued--lumpectomy. If the question is "What environmental, dietary, hormonal, or genetic factors, if any, contribute to the disease or its amelioration?" this launches the investigator onto other trajectories, such as chemical pollutants that are carcinogenic (some because they mimic estrogens in the body), or fatty diets that appear to increase risk, or genetic predispositions. And if a breast cancer is classified according to its growth rate or the type of cells present, this leads in still another direction--one that does not treat all breast cancers equally, classifying them by many different criteria. Patients have the right of treatment choice, but most women are so poorly informed that they cannot choose wisely.

Personal Story as Metaphor: Medicine as Savior or Slayer
I grew up listening to my father talk about work around the dinner table. Invariably in the middle of a bite of mashed potatoes and green beans, he was summoned to the emergency room to repair the fractured femur and lacerated calves of a teenager whose Harley had slid in the sand. At 10, squeezed onto the end of a bench next to a mammoth high school athlete, I'd watch my father trot onto a muddy New England football field, crunchy with frost, his trench coat flapping behind him like wings One evening after chocolate pudding, eyes shining with zeal, he described new surgical staples that made it possible for him to close bowel resections twice as fast. Often he worked tirelessly into the night while we were asleep. Although usually an energetic optimist, sometimes he'd surprise me with grouchy, venomous criticism. Later, my mother would whisper discreetly that it wasn't me--that my father had a patient sick with pancreatic cancer and he was desolate because there was nothing he could do. I observed first-hand his distaste for powerlessness in the face of irremediable disease.

Although completely devoted to the practice of his craft, my father was a reluctant patient. At 69, he needed to have cataracts removed but stalled for several years, eventually trading the benefits of improved night vision for his diffidence. Opening his closet door, he was amazed to find that all his suits weren't the monotone grey he had perceived before the surgery. It was awesome to me that after spending his life wielding the scalpel, he was so wary of it himself.

(Excerpted from Alternative Therapies in Health and Medicine)
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 About The Author
Harriet Beinfield LAcHarriet Beinfield, L.Ac. and Efrem Korngold, L.Ac., O.M.D. have pioneered the practice of Chinese medicine in America for the last 28 years as educators, writers, and practitioners. They are the co-authors of the......more
 
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