This Is Not A Race, It’s A Journey

By Dr. Kathleen T. Ruddy

Breast cancer is not a race, it’s a journey.

Breast cancer is a disease for which there is neither one cause nor one cure.  It is the product of a long equation involving multiple factors that, over time, culminate in malignancy.   Furthermore, breast cancer is a problem for which there is no single solution.  So forget the idea of a “race for the cure”:  this is not the Space Program where we land on the moon, plant the flag, and return to Earth victorious.

Yes, finding cancer early helps improve survival for many women, but not all of them.  Some tumors, like inflammatory breast cancer (IBC), appear virtually overnight.  Aggressive breast cancers like IBC tend to recur no matter is done.  Triple-negative breast cancers are about as bad:  find it early, treat it aggressively, do everything by the book, and still it comes back and torments many patients to death.

After more than four decades (!) in this War On Cancer, after race upon race upon race for a cure, after one breakthrough followed by another, we still have new cases piled to the sky every year; and women with Stage IV metastatic disease fare no better than they did when Betty Ford was diagnosed with the disease.  Improved survival?  Absolutely, we have improved survival.  Mostly this is due to better chemotherapy and the introduction of targeted therapies.  But prevention is still bringing up the rear as far as funding is concerned – a distant straggler in the race – and 1.5 million new cases are added to the breast cancer registry every year.

Mammogram screening is the only effective way we have of finding breast cancer early; and it does improve survival.  But it is far from perfect.  Mammograms find many cancers that wouldn’t bother a soul if they were never unearthed, and they frequently lead to an array of additional diagnostic tests – and untold anxiety – that prove to be a waste of time and money when benign disease is found to be dressed up like wolf.  But mammography is the only effective screening method we have at the moment, and until we can better distinguish life-threatening from innocuous breast cancer, we are wise to stick with screening mammography as a matter of policy, even if the individual patient chooses to opt out and “take her chances.”  Rather than suggesting, as Dr. Welch does in his recent New England Journal of Medicine article, that we “look less aggressively” for breast cancer (and risk women’s lives in the process), I think working toward a more accurate screening method is the most practical, sane solution to the myriad flaws that mar mammography.

Breast cancer is not a disease for which a race for a cure makes sense, as has been marketed lo these many years.  It is a journey, and a slow one at that.  There is no single finish line.  No single cause.  No single cure.  No one drug, procedure, or vaccine (no matter how powerful or precise) that fits all cases, all causes.  The journey does not even take place along one road:  there are environmental factors, viruses, genes, hormones, diet, exercise, stress, alcohol, and cigarettes – to name a few – that line up on one side of the equation, and an endless array of drugs, surgeries, therapies, and diagnostic tests fighting on the other.  It’s a tangled map draped across a curved surface, and the whole thing is in constant motion.  Go ahead, try and pin it down:  many have tried, all have failed.

Breast cancer, like all cancers, will always be complicated, even if we find a magic bullet, a perfect screening test, and a thoroughly effective preventive vaccine.  The factors lined up on either side of the equation are just too numerous and deep to submit to a single “cure”, per se.  So stop with the nonsense about a race and a cure.

This is not a race, this is a journey.