whose only focus would be breast care. The concept included a same-day model in which patients with new problems could be seen within a day of their call to our center.
We opened our first breast center in 1988, originally called Breast Care Center of Orange, and since then we have diagnosed and treated thousands of women with cancer and tens of thousands of patients with other breast issues.
It soon became obvious that the breast center concept was saving lives. Women who followed early detection guidelines were typically diagnosed with small, curable cancers—though the situation was much different for women who did not follow the guidelines.
The majority of advanced malignancies that we cared for occurred in women who had never had a mammogram or had neglected to have one for years. The conclusion was obvious: Aggressive screening worked. The challenge was to figure out how to get more women to participate in our early detection efforts.
My initial approach was to help establish a nonprofit organization (the Be Aware Foundation) in 2004 with the goal of inspiring women to follow early detection guidelines. We presented classes on breast self-examination and created a video to help women learn how to do self-exam with confidence. We also created a website where women could sign up for monthly reminders to do self-exam and a yearly reminder to get a mammogram and clinical exam. I wrote frequent articles, sent out with the monthly email reminders, dealing with the evolving controversies in breast care.
Despite my best efforts, the campaign to get more women to follow early detection guidelines was being thwarted by forces beyond my control. Our own government was promoting watered-down screening guidelines. Well-respected nonprofit organizations that in the past were proponents of early detection were issuing their own weakened recommendations.
The media was having a great time reporting all this conflicting advice. As a result, public confusion mounted. The net result was that fewer women were following early detection guidelines and diagnostic delays were on the upswing.
I became increasingly frustrated that women were receiving so many mixed messages. It was that ongoing frustration, plus the desire to set the record straight, that prompted me to write this book. To me it was obvious that something must be done to fight back against the “experts” who were the source of so much confusion. I wanted to inspire women to follow early detection guidelines and demand optimal breast care.
That said, I did not want to write something encyclopedic . . . and I had no interest in being “fair and balanced.”
I wanted to compose a work that easily explains issues in the same manner I use in answering questions from my own patients. As I was wrestling with my approach, I had an appointment with a woman recently diagnosed with breast cancer. After I completed my lengthy explanation of treatment options, I was greeted by a long pause in which I could tell she was having problems processing our discussion.
She then looked me straight in the eye, and with a newfound confidence she said, “Just tell me what you would do if I were your wife.”
The advice I gave her that day was the same I would offer members of my own family—mother, wife, or daughter.
And then I thought further: While it’s relatively easy to advise my own patients, what about the millions of women who are desperate for information but don’t know where to find it?
I hope that this book—written from the point of view of not just a breast care surgeon, but also a husband and father—will be a helpful resource for those women and their families.
THE PLAN BEHIND THE BOOK
For the convenience of our readers who wish to find breast care information quickly and easily, this book is organized in a way that makes it easy to get answers to a wide spectrum of breast care issues. To help bring these topics to life, most chapters are illustrated with one or more personal stories of women who have experienced the issues we describe.
We begin with specific issues that may arise, and recommendations for treatment, for women (and men) according to their age. Subsequent chapters address common breast problems, then uncommon but perilous breast problems. This is followed by a brief exploration of the various controversies in breast care as well as a brief discussion on prevention. Further chapters provide guidelines for women who are newly diagnosed, including when you may need a second opinion. Finally, we describe surgical options and offer a discussion of breast reconstruction, before concluding with the importance of hope when it comes to winning the battle against breast cancer.
The Controversies That Drive This Book
THE QUESTION of what constitutes optimal breast care—noted briefly in the Introduction—is not just an idle subject that is open for debate; it is now one of the most contentious issues in all of medicine.
Despite incredible progress everywhere in diagnosing and treating breast cancer, guidelines for optimal breast care today are brimming with contradictions and misleading statements. There is a growing trend to cut back on early detection efforts, based partly on flawed scientific studies, but also, regrettably, on cost. While it’s true that medical costs are spiraling out of control, any procedural change that contributes to giving cancer a greater foothold will ultimately be more expensive for everyone.
Among the biggest controversies are the following:
Screening Mammography
Clearly the most outrageous controversy I’ve witnessed was promoted by the doctor who proclaimed on Fox News that mammograms can do more harm than good and stated that one in five cancers will disappear without treatment. The reasoning behind his fallacious statement and the proof of its nonsense will be demonstrated in chapters fifteen and sixteen.
Yet other controversies have made mammograms the subject of dangerous confusion. Traditionally, women have been told that they need to begin mammograms at age forty and continue yearly.
Now a government task force, the USPSTF (United States Preventive Services Task Force), offers new, reduced-mammogram guidelines that contradict reliable, proven standards (see chapter sixteen). The USPSTF recommends that mammogram screening start at age fifty, that it be repeated only every other year, and that it be discontinued after age seventy-four—even though none of the research has suggested that routine screening be discontinued at any age as long as a woman is in good health. None of the so-called “experts” on the USPSTF were physicians whose specialty was breast care.
Breast Density
For women whose mammograms show they have dense breasts, a second and different type of screening can detect tumors not seen on traditional mammograms. Yet, thanks to a mix of small additional cost and disbelief by so-called experts that this second screening is necessary, only a small fraction of the female population with dense breasts ever get the additional screening they need (see chapter fourteen).
Breast
