Post-Mastectomy Radiotherapy (Intro)

Date: Fri, 15 Nov 1996 22:36:45 -0800 (PST)
From: jbonine <jbonine@OREGON.UOREGON.EDU>
To: Breast Cancer Discussion List <BREAST-CANCER@morgan.ucs.mun.ca>
Cc: JBONINE <JBONINE@OREGON.UOREGON.EDU>
Subject: Post-Mastectomy Radiotherapy (Intro)

Friday, 15 Nov 1996

Dear B-C List Colleagues,

** When should radiation therapy be used after a mastectomy? **

THE NEED TO THINK ABOUT ALL THIS

Many or perhaps most of us believe that a person with breast cancer (and her or his friends or family when the person agrees) should not only receive doctors' recommendations, but, if they wish, thorough explanations of recommendations and even insight into the theories underlying the doctors' preferred therapies.

Not everyone is necessarily a candidate for radiotherapy after mastectomy, and someone who might not be a candidate with one doctor would be with another (and vice versa). I believe that whether radiotherapy is recommended after mastectomy is partly a matter of the doctor's level of knowledge, partly a matter of what category one is in and how evidence from trials and studies suggest can be helpful for that category (always considering risks as well), and partly a matter of which theories the doctors prefer.

Perhaps we can be better-informed patients or patients' friends and advocates if we try to understand the thinking processes that the doctors are going through, and the evidence that they do (or do not) consider when they make recommendations.

SUMMARY

Let me start by summarizing my current conclusions about this issue. I hasten to add that reading, listening, and arguing (some of it off the list in private e-mail) has modified my conclusions in the recent past and may well do so in the near future. One reason for posting this message is to improve or modify my understanding as you pick away at what I write. In discussing post-mastectomy radiotherapy, I will discuss these three items in reverse order, by first discussing the competing theories held by different oncologists of the "natural history" of breast cancer, then discussing the new evidence, and finally discussing whether some cancer doctors are unaware of the new evidence (or perhaps are aware, but find the evidence to contradict the theories that they strongly believe, and thus minimize that evidence).

The next message will be a discussion of theory, based largely on an interesting article by a University of Chicago professor who has thought long and hard about how to explain the data that he is seeing.

John
 
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