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.
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.
1. Some, but not all, oncologists (surgical, medical, and radiation)
are aware of the most recent studies and changing theories.
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).
2. Recent studies show improved survival for many, but not all, sub-groups
when radiation is used after mastectomy.
3. Increased survival for women (or men) receiving post-mastectomy radiotherapy
suggests a hypothesis or theory for the course that breast cancer takes
which may contradict the theory that some doctors hold.
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
Back to Post-Mastectomy Radiotherapy Index.