Fall is my favorite season of the year. I love the chill in the air and the beautiful colors. However, October is always a little overwhelming to me. It is breast cancer month and as a breast cancer doctor I am assailed by feelings of pride, sadness, trepidation and gratitude. I literally know hundreds and hundreds of women who have been diagnosed, bravely walked through treatment and are now living their lives to the fullest. I have seen women from their 20s to their 80s in every circumstance of life gather their resources and do whatever was necessary to overcome the beast. They then turn and lend a hand to the sister who is following behind. I am proud to share the same xx chromosome pattern that finds the fight to be there for yourself and family, makes you gather information and actively participate in treatment decisions rather than passively agree with the pundits and spurs action that may spare others from the disease.
I am so very grateful to my patients for teaching me what is important in life. The patient with breast cancer knows what is important to fight for: namely family, community, the future and self worth.
Sadly, some patients are not cured and die of breast cancer. There is never a survivor day or a fundraiser that I don’t see the husbands, siblings and children that have been left behind. They usually are doing well, following marching orders organized and dispatched by their departed love one. It is overwhelming when I think of all the truly gifted, funny sweet friends that I have found and lost due to this one disease. My understanding as to why medicine fails some women while curing others has improved over the years but is still woefully inadequate. I hope to live to see the day where the interaction of the cancer and the patient is understood and the right treatment is known for everyone.
It would be even better if we understood the cause of breast cancer and could prevent the disease. Breast cancer that is estrogen receptor positive has decreased in the United States when it was discovered that hormone replacement with a combination of estrogen and progesterone increased the risk for breast cancer. The prescriptions for these drugs abruptly dropped and a few years later the incidence of breast cancer dropped. Unfortunately, the incidence of breast cancer in China and India is on a trajectory that was present in the United States a few decades ago. Earlier menses, pregnancies at an older age, less breast feeding, increased body mass, changes in dietary patterns and increased consumption of alcohol particularly at a younger age may be the perfect storm that promotes breast cancer. I fear that worldwide, breast cancer will become an even bigger problem. I feel confident that the collective maternal power of the world will play a huge role in teaching the future generations about the essential role of exercise and the need for moderation in food and alcohol.
I am so very grateful to my patients for teaching me what is important in life. The patient with breast cancer knows what is important to fight for: namely family, community, the future and self worth. Often, if I am bogged down in the details of life which can seem important, a patient will say or do something that lets me refocus on the truly important things in life. I am also incredibly thankful that there is so much data that informs me how to best treat breast cancer. That is not the case with most cancers. The reason it is true of breast cancer is that thousands and thousands of women have participated in clinical trials that have informed us as to the best treatment of breast cancer. Breast cancer patients have left an invaluable legacy with their participation in research and the pressure they have exerted for better understanding of the disease.
So, I leave October and enter November with profound thanksgiving for the gifts of wisdom, bravery, humor, optimism and friendship I have received from my patients. Thank you to each and every one of you.