All too often, when it comes to breast cancer, we seem to get caught up in wishful thinking, and forget about science.

We use wishful thinking when it comes to breast cancer screening guidelines. We get angry at the experts who tell us studies show that mammography is less beneficial for women in their 40s, and focus on the idea that if only every woman had regular mammograms every cancer would be found early, and cured.

This ignores the biology of breast cancer, which tells us that there are at least five or six different kinds of breast cancer that grow at different rates. Some are slow enough to be found early by mammography, but others are too fast growing or fast spreading to be caught at the exact right time! Instead of arguing about screening guidelines, we need to face the science squarely and focus on prevention, so that we can learn how to avoid cancer in the first place!

We use wishful thinking all the time when making treatment decisions. When a woman is diagnosed with breast cancer her first reaction understandably since she is scared to death is to do anything she can to insure that she is cured and make the fear go away. This fear (accompanied by wishful thinking) often leads people to do things that are not supported by the science.

One example of this is the studies that show that the number of mastectomies for breast cancer has been increasing in the U.S. each year. This is not happening because doctors are finding bigger tumors, or because mastectomy is a better treatment. It is the result of wishful thinking:  If I offer my breast or breasts to the gods, I will surely get my life back in exchange! If I have no breast tissue, I never have to go through this again!

In reality, a mastectomy never removes all of the breast tissue.  (I am a breast surgeon, so I should know.) The breast tissue does not come neatly packaged so that it be easily removed, which is why there always is some breast tissue left behind in the skin, around the muscle, and at the edges.  In reality, the local recurrence rate after mastectomy is 5 to 10% and the local recurrence rate after lumpectomy and radiation is 5 to 10%! It is exactly the same!  And the cure rates are the same as well.

The critical issue is getting the tumor out with a rim of normal tissue and dealing with any cells that might have escaped which is what radiation, chemotherapy, and hormone therapy are for.  It seems like the more radical the surgery the better the results should be . . . but that is really just wishful thinking!

Finally, there is the wishful thinking about diet! The headlines scream that if you eat blueberries or drink red wine or don’t drink red wine you will not get breast cancer. We all want to believe this magic!

In reality, these findings come from observational studies, which show you a correlation, but cannot prove cause and effect. If you knew that all drug addicts drank milk as babies, would you really think that drinking milk as a baby could make you a drug addict? Of course not! That’s a correlation. It’s not cause and effect.  Exercise and maintaining a healthy weight have been shown to reduce risk, but what you eat seems less critical.

This October, let’s make an effort to move away from wishful thinking and demand good science to direct our actions. And lets all promise that when we are scared to death because we have just learned that we or someone that we know has cancer, we will help each other to take a deep breath. The diagnosis of breast cancer is NOT an emergency. You have time to consider all the options and not rush into wishful thinking!

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22 Responses to Wishful Thinking and Breast Cancer

  1. Chemobabe says:

    I appreciate your straight talk about wishful thinking versus science.

    Is part of the increase due to prophylactic mastectomies with more BRCA testing? Also I read in Cure Magazine that prophylactic contralateral mastectomies slightly decrease the chances of secondary cancer in HER2+/ER & PR- women under 40. My point is not to verify this daa point but to say that our increased knowledge of tumor pathology allows us to parse data in specific instances that might warrant mastectomy, where that knowledge did not exist previously.

    Food for thought. Thanks again for the great column.

  2. tobycat says:

    I understand what you are saying about the fact there is always some breast tissue left and your chance of recurrence is never 0%, but I just don’t understand how the rate can be the same as lumpectomy. Let’s say for argument sake that 10% of breast tissue is left after mastectomy and 80% is left after lumpectomy. Just by statistics alone, you should have a higher chance of recurrence in lumpectomy because you have more breast tissue for the cancer cells to grow. If I have a local recurrence after a mastectomy, I would have had that same recurrence if I chose lumpectomy instead (because the same breast tissue would have been there in both instances) However, can the reverse be true also? If one has a local recurrence after lumpectomy (in the 80% breast tissue left) would it be absolute that the same women, if she had chosen mastectomy (only 10% breast tissue) have the same recurrence? I would think not.If you take out the majority of breast tissue you have taken away a bigger chance that recurrence could occur. If I am mistaken about this, please explain.

  3. Determined says:

    I think there are some other reasons involved as well. If you go through radiation the skin is often damaged and reconstruction if a mastectomy is needed later is difficult. I have several friends that are dealing with this. So while we need to let science guide us abosolutely,there are other issues that women think about when it comes to their bodies.And ultimately it is their choice and they should not be made to feel badly for the choice they make or the reasons they are making them. If they can get a better outcome appearance wise that will help them with the dreaded term “new normal” they may chose that path.

  4. Been There, Done That says:

    As a survivor, I’ve had two occasions to talk with women who were newly diagnosed and considering options–well, sort of. In each case, they knew I’d had bilateral mastectomies, and assumed I would support their reflexive response “to just get it out of me”–to have their breast tissue removed immediately. I asked them to consider all of the options for treatment.

    I had chemo first, not surgery. That’s the protocol Dana Farber was following in 2009–chemo obliterated the tumor. I had time to decide on the mastectomies option and what it came down to is this: a decision weighed by me and my medical team. Since I had lobular invasive, sometimes called, “the mirror cancer,” one that has the reputation of reoccurring in the other breast, we decided to remove both and do reconstruction. My surgeon told me that she looks forward to the day when surgery is no longer necessary to treat breast cancer–but that option isn’t a reality yet.

    THESE DECISIONS ARE AN INVESTMENT–they should be carefully weighed and all options should be on the table.

    Thank you, Dr. Love, for some clear insight that goes beyond the pink haze.

  5. Been There, Done That says:

    As a survivor, I’ve had two occasions to talk with women who were newly diagnosed and considering options–well, sort of. In each case, they knew I’d had bilateral mastectomies, and assumed I would support their reflexive response “to just get it out of me”–to have their breast tissue removed immediately. I asked them to consider all of the options for treatment.

    I had chemo first, not surgery. That’s the protocol Dana Farber was following in 2009–chemo obliterated the tumor. I had time to decide on the mastectomies option and what it came down to is this: a decision weighed by me and my medical team. Since I had lobular invasive, sometimes called, “the mirror cancer,” one that has the reputation of reoccurring in the other breast, we decided to remove both and do reconstruction. My surgeon told me that she looks forward to the day when surgery is no longer necessary to treat breast cancer–but that option isn’t a reality yet.

    THESE DECISIONS ARE AN INVESTMENT–they should be carefully weighed and all options should be on the table.

    Thank you, Dr. Love, for some clear insight that goes beyond the pink haze.

  6. Rachael Smith says:

    I look forward to a day when other studies particularly on food/ environment are combined with traditional medicine in order to better understand how bc is not one single event. It is a result of earlier weakness in the body. What we put into our bodies from birth until now is relevant.

  7. Betty J. Young says:

    As a mother of a daughter going thru treatment, I find your information invaluable. You answer questions for me that I do not have the opportunity to ask. Also, I respect the dignity and privacy involved that she and her husband, and medical team share. Thank you.

  8. WH says:

    Wow! I don’t why this particular essay sparked a rant from me, but here goes, …
    As patients we are given a significant amount of information to digest in a very short amount of time. This is coupled with the constant stress of the diagnosis itself, and the continuous reminders that we need to be our own advocate and gather as much information in order to get our best and most informed care. On top of this we are quickly herded into the care-by-numbers cattle call that does not fully inform of us all probable side effects by minimizing their possibility. So, when we are diagnosed, scarred, irradiated, and unable to tolerate the required adjuvant protocols, OR contemplating the possibility of facing all that loveliness when handed a BRCA1 or 2 mutation, we do NOT need the additional judgment from professionals, family, and peers that tells us what we have done, what we can no longer tolerate and cannot continue, or what we plan to do is “wishful thinking.”
    Please do not marginalize our decision-making because we are the only ones who will be held accountable in the end and are the only ones who will suffer and die or survive at the hands of those who think they know better. It has been one year since my diagnosis and I have been as compliant as intellectually possible. I have been told how many possible things I have done in that past that could have contributed to my breast cancer. I have been told what I need to do to prevent future recurrence. I have dealt with the wide array of tests and the “least likely,” but very painful side-effects of even the tests. I have listened to professionals push their treatments and minimize possible side-effects (almost all of which I had the pleasure of experiencing, except death, more cancers, and hair loss). I have felt the absolute judgment of those same once-positive and pleasant professionals when I have rejected a treatment whose side-effects were so intolerable that I wanted to kill myself.
    I am no wimp. I am not afraid of pain. I have also read that the patient’s attitude is one of the main factors in successful treatment. My initial attitude was that I will do whatever I am told to do, I will get through this, I will get beyond this, and this will not define who I am. My attitude has not changed much, but now is that as long as the treatment isn’t killing me (or in the case of my last one, making me want to die) then I will do it. Because I wish to live! I wish to live a life where I am a whole person. I wish to live a life where I am cognizant and my usual upbeat, energetic, engaged self. I wish to live a life where I am a capable parent to my young children. I wish to live a life where I do not have fear an additional cancer/lymphoma caused by the very treatments meant to cure me. I wish to live my life on my terms.
    My prognosis is excellent, even with my rejection of a particular adjuvant therapy. I am so very lucky to have had the best possible care, to have the best possible support network, and to have the best possible life ahead of me. I absolutely believe in what this foundation stands for and agree that in addition to treatment, prevention of breast cancer, (and all cancers) is extremely important. Discounting my wishful thinking, however, smacks of a condescension that is telling me, yet again, I am not capable of making decisions about my own care, even though I am the one who ultimately has to deal with all outcomes as well as take responsibility for all decisions.
    There are no guarantees when it comes to cancer. No one can truthfully say that they are cancer free, because that is an impossible status to prove for any living person. All we can do is arm ourselves with as much knowledge as possible, tolerate as much treatment as possible, and then move on to the rest of our lives knowing what only real survivors know—that we are the only ones who truly have to live with our decisions and our outcomes. We are facing what no one wants to face. So let us chew our organic goji berries while we are standing on our heads in meditation and visualizing, hoping, praying, and wishing for as many tomorrows as possible. Cleansing breaths to all of you! -WH

  9. sabina says:

    If a woman truly believes in her mind and heart a mastectomy will prevent a re-occurrence, lets not forget it has been scientifically proven the power of the mind can override data and science.

    Regarding food – its our daily medicine – it is what we eat several times a day. It effects weight, mood, metabolism, frame of mind and the health of every cell in our body.

    I don’t see how you can say it does not make a difference.

  10. sharon2girls says:

    Dr. Love, I understand your point and I am all for ways to prevent this awful disease, but I do agree with a lot of the comments made already.

    I am a pre-survivor who made a choice a year ago to have a bi lateral prophylactic mastectomy for LCIS and Atypia Ductal Hyperplasia. I am well aware that LCIS and ADH does not mean that I would get breast cancer, but that I was at a significantly higher risk than the normal person. I also do not have a family history of breast cancer. However, for 5 years I continued to develop new clusters of micro calcification, first set being benign, but over the years new sets in one breasts kept developing, which resulted in several non surgical biopsy, over 500 mammograms and a surgical biopsy (wired guided) which left my left breast significantly deformed. Last year my mammogram revealed new calcification that were deemed suspicious in both breast. Surgery was recommended to remove of breast tissue which would have left my left breast basically with little tissue and now deformed the right breast. I decided that I needed to get off the roller coaster of each year wondering if I was going to continue the pattern of micro calcification and whether I had more LCIS and ADH (which was found to be significant in each breast after the mastectomy). To not be faced with surgery after surgery and worrying about my future, I am glad of my choice.

    So yes, we need to focus on the prevention, but I am grateful I had a choice in continuing my life without knowing I would not have to face the dilemma of the “what if”. I am grateful for the choice that many women do not get to make when faced with breast cancer. My goal is to continue to raise money and awareness of the strides made with this terrible disease, but women need to be able to make a choice about their path and not have to be judge if they decide to have a mastectomy for whatever reason they decide to make. I have met too many women in the last year that didn’t have a chance to make a choice and developed breast cancer or had their breast cancer come back and opted for a mastectomy.

    Choice and prevention go hand in hand. Your site is invaluable to us all, but I would hope women do realize they have a voice.

    Mastectomy is a very hard decision to make and is a very emotional decision and the surgery by any means is not easy.

  11. Rosie Benitez says:

    Sabina
    Your words moved me to tears. You are an amazing survivor that gave me strength with your words.

  12. Rosie Benitez says:

    WH
    Your words moved me to tears. You are an amazing survivor that gave me strength with your words.

  13. tobycat says:

    My concern with all of this is that women are getting very mixed messages. I know there is a real push for less invasive surgery and to save a women’s breasts, but I just feel there is way too many mixed messages given to women. I would cut off my arms and legs if it meant I could have more time with my children. I have done extensive research since my mastectomy and I have found surgeons on both sides of the coin. The bottom line that made my decision was that until you can tell me what caused me to get cancer, you really can’t tell me for certainty how it will act in my body. For all anyone knows, in some individuals mastectomy may save their lives.

  14. Dr Susan Love says:

    I am really glad to hear from all of you. I have been a breast cancer surgeon for over 30 years and I would never dismiss a woman’s choice.
    I am more concerned that, as outlined by WH, at a time when women are scared to death their doctors are not giving them all the information. There are several very large randomized controlled studies showing that the survival rates are the same whether you have mastectomy or lumpectomy and radiation. The local recurrences are usually left over cancer which can happen with mastectomy or lumpectomy and is less related to the amount of breast tissue…more which breast tissue. The different is in the new cancers or second primaries. It will be lower after bilateral mastectomies than lumpectomy. Luckily the chance of this is very small in non gene carriers about 2% after lumpectomy and radiation and about 5% in the other breast. The radiation reduces the risk significantly which is why we sometimes add it to mastectomy in high risk cases.

  15. mybella1 says:

    WH
    Rant on sister…As a Stage III, 3-yr survivor who nearly died from the chemo I was moved to tears by what you shared. Your thoughts were not only true, but powerful and my sentiments EXACTLY!
    As you so elliquintly stated:
    All we can do is arm ourselves with as much knowledge as possible, tolerate as much treatment as possible, and then move on to the rest of our lives knowing what only real survivors know—that we are the only ones who truly have to live with our decisions and our outcomes. We are facing what no one wants to face.
    Thank you!

  16. Alison says:

    WH – I wish you would submit your comments to a magazine because it sums up to a tee my and others’ frustrations in dealing with cancer treatment and the mixed messages out there. I went to two outstanding hospitals to get advice on treatment and they provided totally opposing opinions. One treated me like “Dead Woman Walking” (no intervention would really work) and the other wanted to cut, chemo, radiate and drug everything. I am sick of doctors who will either not commit themselves to providing their opinion – leaving all decisions up to me; or, the other doctors who are in the “it’s my way or the highway…” camp. I look at all the pink campaigns out there and I am sad – with all the money , time, press, etc. that has been thrown at this cause, we should be further along than this.

  17. Arizona says:

    Dr. Love, I respect your research and your expertise. I have from the time I carried your book everywhere with me (along with others) to help me along the way. I do, however, agree with my fellow survivors. It, ultimately, is our decision. Now. If the insurance company is willing to provide me with a mastectomy over a lumpectomy or vise versa, your information is IMHO strictly advice based upon research and experience. Unfortunately, your (and others’) research and experience does not mean that I am going to be happy with my physician’s decision.

    I was diagnosed late March 1987. No, I do not remember the exact day because I was on an emotional roller coaster due to having the diagnosis at the same time I was separating from my now divorced from husband. I postponed surgery for two weeks to get moved into my new abode all the while the surgeon was rushing me. This surgeon did not provide me with all of my options. Had he done so, I probably would have elected mastecomy on the affected side with reconstruction. Unfortunately, I did not know this until I returned for the lymp node dissection because the surgeon did not do both lumpectomy and dissection at the same time. I then had to fight to get reduction on the unaffected side! Why? Because I was told it was elective surgery. Elective? It wasn’t elective that half my breast was gone!

    Following my “nondecisions” I decided I would not do chemo therapy. I had both ductual carcinoma insitu and lobular carcinoma insitu (two tumors attached together). However, 6 months prior I had a total hip replacement which used a hollow prosthesis requiring my bone marrow to grow in and hold it. Even though I told the oncologist my concerns, he still sent me to a mental health social worker who told me I was passively committing suicide by not doing chemo. That was 24 years ago!

    Still I have asymmetry due to weight gain in the “reduced” breast. However, I would do everything I did the same way except I would have elected the mastectomy with reconstruction. Why? Because on the first mammogram following treatment, they located another “growth” which caused me to lose sleep for 3 full-weeks – as I was told it was benign and the surgeon would watch the growth. I decided to have that lump removed!! I did, however, do tamoxifen and arimedex. I continue to participate in the cancer community.

    I do not know if this is a rant. I know that it is not a rave. My sisters are right. We have to live with our decisions regardless what the research says at the time. What I do believe is that across this nation, surgeons must give us ALL of our options and not make decisions for us so that we can make the very best decision for our own self!

  18. Determined says:

    I am not sure many surgeons give the women they are talking into a lumpectomy with radiation the full issues of reconstructive difficulties. It is most of all about life. But there is also the issue of body image. I don’t want to have radiated skin that will not take to reconstruction easily. Just like they don’t go into much about the loss of sensation with a mastectomy. This is truly an area women grieve that have had a mastectomy. But clearly radiated skin is very difficult to reconstruct if a mastectomy is needed later. Much easier to have a good outcome with mastectomy and reconstruction without radiation.

  19. Nancy says:

    Forgive me if others already addressed this comment from Tobycat: “If you take out the majority of breast tissue you have taken away a bigger chance that recurrence could occur. If I am mistaken about this, please explain.” I think Dr. Love would explain, “If you remove the 90% of the breast tissue, the remaining 10% is still at 100% risk of breast cancer.” Dr. Love? Nancy Ryan

  20. Karen says:

    I have stage IV HER+ inflammatory breast cancer – diagnosed 6 years ago. I have wanted to have the other breast removed & the oncologist talked me out of it. Thank you Dr. Susan Love for your blog! It helps to satisfy my “what if they’re wrong” feelings. I have already beat the odds. Between Herceptin & the use of Tahitian Noni Juice & God’s will for me – I AM STILL HERE! No more wishful thinking for my future – at least in the way of choosing the most aggressive treatments. I will continue to study and read all I can get my hands on so that if a hard decision must be made, it will be a well informed one based on the science & not on wishful thinking.

  21. Amanda says:

    I just posted about this (in way less scientific and informative way) last night! I couldn’t agree more. Cutting edge research is what is going to beat this disease!

  22. Rochel Metzinger says:

    Hi there! This is my 1st comment here so I just wanted to give a quick shout out and say I truly enjoy reading through your articles. Can you recommend any other blogs/websites/forums that go over the same subjects? Thanks!

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