Its odd how much we hear about breast cancer detection, when the real question is how well we can treat it. All the focus on screening has overshadowed a more important story: Breast cancer treatment has improved over the last 50 years. Breast cancer surgery has gotten a whole lot more sane. Radical mastectomy is largely gone, and more women are given a choice between simple mastectomy and breast-conserving surgery.
But arguably the biggest improvement involves adjuvant therapy, the chemotherapy and hormonal therapy that follows surgery. After summarizing 194 randomized trials, the international collaboration of Early Breast Cancer Trialists concluded that the addition of adjuvant therapy cuts the breast cancer death rate in half. That's huge.
6. Too much disease awareness may not be good for your health.
Breast Cancer Awareness Month serves as a prototype for "disease awareness" campaigns. Too often these morph into campaigns to find things wrong with healthy people. Our medical care system is extremely capable in this regard. We can detect miniscule abnormalities in the body's anatomy and its chemical milieu. And, as if that's not enough, we increasingly change the rules to narrow the definition of "normal": Lower blood pressures have become hypertension, lower blood sugars have become diabetes.
Many interests are served by this behavior. But that may not include yours. That's because health means more than the absence of abnormality. Health is also about how people feel; it's also a state of mind. And it's hard to feel good when things are constantly being found wrong. Pursuing health, ironically, may require that we not pay too much attention to it.
H. Gilbert Welch is a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice and an author of "Overdiagnosed: Making People Sick in the Pursuit of Health."
