Subj : Re: Episode with No Plot
To   : alt.tv.er
From : Sharon Three
Date : Fri Oct 07 2005 19:46:33

From Newsgroup: alt.tv.er


>
> I didn't care for the plot with the breast-cancer gal at all.  Maybe
> Doc Sharon can fill me in on the details of her problem, but I don't
> get why Abby was pressuring her to have this surgery now?  The woman
> still looks pretty young.  Wouldn't 'watchful waiting' (frequent breast
> exams and mammograms, and u/s scans of the ovaries) be a reasonable
> safe route to take for the next 5-10 years; at least long enough to
> allow her to fulfill her dream of marriage/kids. And Shaina was curious
> about the "90%" risk reduction that Abby quoted her.  "If she has a
> mastectomy she won't have any breasts," my brilliant daughet said, "So
> how would she have even a 10% chance of getting breast cancer?"

Because when a subcutaneous mastectomy is done, there are always some cells 
left behind which could become cancerous. Also, because they are prone to 
getting breast cancer at a young age, some of those who are getting 
prophylactic mastectomies will already have previously undiscovered breast 
cancer found at the time of their surgery.

As for Abby insisting that the lady be admitted immediately for mastectomy 
directly from the ER, well, that was just the usual ER stupidity.  Among 
other things, it is essentially impossible to get BRCA testing done (the 
test that was positive) without undergoing extensive counselling both before 
and after the test which is done by pros in the field.  The idea that this 
lady didn't know what her options were when it came to prevention or that 
mastectomy was her best or only option is just stupid.  There are multiple 
other options for these women including tamoxifen, close observation with 
mammograms and ultrasound and/or mastectomy. For that matter, if she was 
going to have surgery, an oophorectomy might have been a better choice.

 Abby's insistence that there was only one option and she had to pursue it 
immediately reminded me of the way she railroaded that woman into having an 
abortion she later regretted a few seasons back.  Most oncologic surgeons 
would require at least one outpatient visit for consultation as well as 
psychologic evaluation and extensive counselling for anyone considering such 
drastic surgery, especially, as Abby said, it is not foolproof.

The idea that a woman who had had a mastectomy might as well give up any 
hope of ever finding a man who would have her was also repugnant to me. 
TPTB sure don't have much faith in men, do they?

BTW, anyone who has BRCA 1 should be more worried about the 40% risk of 
ovarian cancer which is much more deadly than breast which stupid Abby 
didn't seem to know maybe because it isn't Ovarian Cancer Awareness Month. 
Anyway, many specialists would recommend that a woman with BRCA1 have her 
children as young as possible (partially because it is preventative for both 
breast and ovarian cancer) and then have her ovaries removed which would not 
only markedly reduce her chances of ovarian cancer but also breast cancer.

BRCA1 is one of several 'breast cancer genes' that have been discovered. It 
is most frequently seen in Ashkenazi Jews (same folks at risk for Tay 
Sachs).  About 1% of them have it.

More on BRCA1.
http://www.breastcenter.com/patient/brca.html?OVRAW=BRCA%201&OVKEY=brca%201&OVMTC=standard


Doc Sharon

.