1097
Subj : Re: Episode with No Plot
To   : alt.tv.er
From : npardue
Date : Sat Oct 08 2005 00:33:55

From Newsgroup: alt.tv.er


Sharon Three wrote:
> >
> > 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.

Thanks for the explanations.
>
> 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.

It wasn't entirely clear exactly what the woman was having done that
day.  Didn't look to me like she was having the actual surgery that
afternoon, just counseling/discussion with the oncologist. She was
being taken to oncology, not the OR.

But as for why she was having (or preparing to have) the mastectomy
rather than oophrectomy; presumably because she could still have kids
without breasts, but losing the ovaries would trash all her options.


>
>  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?
>
Again, I didn't get the sense that was what was being said.  SHE was
worried about not being able to find a man, but Abby was trying to
reassure her on that point.

Naomi


> 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

.

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