Opinion: Options during cancer are yours only

Talk about it

There’s a lot of good to be said for medical research, but sometimes the recommendations of new studies make me wonder how things can change so suddenly.

I wondered that last week when a new federal report on breast-cancer screening upended 30 years’ worth of recommendations about selfexams and annual mammograms. Women 49 and younger and with no factors that put them in a high-risk category apparently don’t need a mammogram until they reach 50, and then they only need one every other year, the new report said.

I’m no expert on breast cancer, and I’m certainly not trained in either medical practice or medical research. I’ve lived for more than five years, though, with a woman whose breast cancer was detected through the early screening. Her treatment was successful and her prognosis remains excellent.

I wouldn’t for a minute suggest she wouldn’t be here today if she hadn’t been having regular mammograms. Breast cancer is tricky, though, and the literature I’ve read and personal stories I’ve heard convince me that if my wife’s cancer had been discovered at a later stage, her treatment would have been more complicated and her survival odds less optimistic.

She and I are kind of nuts on early detection. I had just turned 51 when I was diagnosed with prostate cancer. It’s an old story, but I never tire of hearing it.

At age 50, nearly 51, I had my first PSA, which is a screening test that can detect prostate cancer. My reading was 4.1, which was a measly one-tenth of a point higher than the 4.0 that was considered within normal limits. My family doctor, B.O. Lindbloom, said it was probably nothing, but he suggested I see a urologist, just to be sure.

The specialist in Rapid City examined me and agreed the PSA reading was probably no big deal. He suggested a biopsy, just to establish a baseline for future exams. I thought it was a waste of time, but I agreed. What I learned was that, for me, the baseline was a malignant tumor in the prostate, and a fairly aggressive one at that. I had surgery in March of 1995.

In the days and nights immediately following the biopsy results, I read every book and Google article I could find on prostate cancer. The lab reports after my surgery showed that the tumor was growing into the lining of the prostate. I can’t prove this, but I believe if I’d waited a year to repeat the PSA, which was one of my options, the cancer would have gone beyond the prostate. I might still be alive, probably would be. But I’d have had a much more complicated set of treatment options.

With two real-life examples of cancer and treatment in our house, we tend to read closely any new literature or studies. Studies such as the one recently issued on breast cancer tend to be pretty general in nature. They probably apply to most situations, and they are probably good medicine. As near as I can tell, they are backed by some of the best minds in the business.

Even so, when I was diagnosed with prostate cancer, I was the one who might die, not my family doctor, not the urologist, not the surgeon. I had more riding on it than anyone else. The same was true for Nancy with breast cancer. She had the most riding on her treatment decisions, regardless of how much anyone else might care about her outcome.

I guess that simply means that whenever a study comes out that changes conventional wisdom in some medical area, it’s up to each of us to figure out what it means for us. If you are the one diagnosed with the cancer, you’re the one who cares most about the outcome. Whether you buy the recommendations of a new study, go along with the old, conventional wisdom or take a flier on your own is your responsibility.

It’s your life.

Terry Woster’s column appears Wednesdays and Saturdays in The Daily Republic.

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