A Visit to Cancerland
Breast Cancer Action sent me this article, Welcome to Cancerland (also available as a PDF), a while back... possibly years back. I found it in a box of Truckee stuff, recognized Barbara Ehrenreich's name, and sat down to read it.
Much of what I read I already knew, but Barbara really puts it together. I found her insights about the infantilization of breast cancer and the positive-only focus on survivorhood particularly interesting, and although I knew that chemotherapy extends the average patient's life by only days or weeks, I didn't really understand the story behind that statistic. It's summed up in this paragraph:
Even if foolproof methods for early detection existed, they would, at the present time, serve only as portals to treatments offering dubious protection and considerable collateral damage. Some women diagnosed with breast cancer will live long enough to die of something else, and some of these lucky ones will indeed owe their longevity to a combination of surgery, chemotherapy, radiation, and/or anti-estrogen drugs such as tamoxifen. Others, though, would have lived untreated or with surgical excision alone, either because their cancers were slow-growing or because their bodies' own defenses were successful. Still others will die of the disease no matter what heroic, cell-destroying therapies are applied. The trouble is, we do not have the means to distinguish between these three groups. So for many of the thousands of women who are diagnosed each year, Plotkin notes, "the sole effect of early detection has been to stretch out the time in which the woman bears the knowledge of her condition." These women do not live longer than they might have without any medical intervention, but more of the time they do live is overshadowed with the threat of death and wasted in debilitating treatments.
It's a long but fascinating article, highly recommended. (Breast Cancer Action's Policy on Breast Cancer Screening and "Early Detection" has more information on the value of early detection and is shorter, if you just want the facts without the editorial insights.) I'd meant to mention it here before, but I got caught up in other things. It came to mind again today because of a NY Times article about the approval of a new drug for colorectal cancer ("F.D.A. Approves Cancer Drug From Genentech" -- free subscription required to view article), which contained this paragraph:
The drug, approved for patients with colorectal cancer that has spread to other organs, is far from a cure. But in a clinical trial in which it was used with chemotherapy, people who received the drug lived a median of 20.3 months, almost five months longer than those who received only chemotherapy.
Five months longer, at a total cost of $89,320 for the new drug alone ($4,400 x 20.3 months). This doesn't include the costs of chemotherapy (which include vomiting, hair loss, exhaustion, loss of libido, and other side effects, in addition to dollars). I'm just saying.