Like Jay, we initially thought it was DCIS and went with a lumpectomy to remove it. But unlike in Jay’s case, there was an invasive tumor in there as well and a second surgery was necessary. If she waited until 50, she’d likely be one of those unfortunate statistics we’re apparently better off with than without.

But Paulos does have a point. We are conditioned to be scared of breast cancer. There are other deadly cancers for which we aren’t routinely screened. And while we all know women who have suffered terribly from breast cancer, we don’t know those women who were overtreated. Why? Because most of those women were told that they had cancer when they really had a stage zero condition with a small chance (maybe 20%) of turning into an invasive cancer.

You asked me in an earlier comment if I’m a physician. I’m not. I’m a DCIS victim. Note that I didn’t say “breast cancer survivor.” If you want to see women treated condescendingly, stop by a breast center. The only way that I found out that my condition had a very small chance of turning into invasive cancer was by doing my own research. Everyone at the breast center treated me like an uneducated housewife who was terrified of her awful cancer. Yes, I had the surgery, and in a “made for TV” moment, I learned about the new guidelines the morning after my follow up appointment. First, I smiled for all of those women who won’t be subjected to overtreatment for a condition that is unlikely to harm them. Then I cried.

You can rail against the journalists for their attempt to explain science, but in the end the science is still very messy.

Here are some reasonable facts which I think aren’t too controversial now:

1) X-Rays cause cancer in some small percent of cases.
2) Horse based Estrogen causes breast cancer. Now that it is isn’t used much any more, the cancer rate should be falling – without any help from screening.
3) Mammograms have found a lot of cancers which fell somewhere in between benign and malignant. They didn’t know what to do with these cancers, and many were treated as regular cancer. This caused lots of pain for woman, and at the same time an increased “survival rate”. Since a cancer which was treated is considered a success, but a cancer never found is not.

Add all this up, and you can most any conclusion you like (depending on your disposition). Granted woman tend to want “control” which may be comforting, even if it leads to bad results.

All this leads to my main point. Science tends to have a “crying wolf” problem. It comes out with some course of action, which often times is wrong, sometimes tragically wrong. Scientists then comes out later with an opposite course of action, which people then dismiss because the first course is now wrong – which destroys the credibility of the scientists.

When I was a kid, when we ate dinner, we ate are bread with margarine. This was because butter had saturated fat which caused heart disease. This went on for 20 or 30 years. Then one day, saturated fat no longer caused heart disease, and trans-fats caused heart disease. The advice to eat margarine was not only ineffective, it actually caused heart disease (tragically wrong)! Now people won’t believe that trans-fats cause heart disease, because the heart (vascular really) scientists who figured it out were the ones who told us not to eat the butter.

I don’t blame the scientists, its a hit and miss affair. But from my perspective, its an argument for freedom of choice in the end. The scientists will send out the data and recommendations, and we will have to choose individually. The dynamic of having the scientists lead us is too damaging when the story (inevitably) changes. I think that’s also an argument against socialized medicine, but your views may differ.

James