Breast cancer: a false emergency?
The first message I want to convey to women is this: breast cancer is not a surgical emergency, it is a psychological emergency. This is fundamental information that is rarely explained to women. When you are told that you have breast cancer, in reality, it has already been present for several years.
It is impossible to detect cancer that has just appeared on palpation or mammography. Thus, it is estimated that at the average age of onset of breast cancer, around fifty in France, the standard cancer detected during mammography or palpation began to form three or four years. There are of course exceptions, such as breast cancer whose biopsy shows a very strong proliferation. But these cases are very exceptional. Leukemia is a cancer emergency because the tumor is prone to very strong proliferation, but classic breast cancer is not. Breast cancer kills – too much – but less than we imagine and, above all, not right away.
The announcement of breast cancer
However, the announcement of breast cancer often has the effect of a bomb. It’s the thunderclap. The sense of absolute urgency is very strong. Many women then say to themselves: “Quick, I have to have it removed right away. “ Result: very often, they will consult not the best surgeon, but the one who can take them the fastest.
An American surgeon friend always told me: “If a doctor can see you the next day and operate on you the day after, don’t go. This means that he is not overbooked, which is not normal for a competent professional. “I totally agree with that! I guarantee you that if one day I have cancer, I will take my time to find and see the best specialist.
Do you have to make decisions quickly, following the diagnosis of breast cancer?
In this hyper-specialized profession of breast cancer care, good professionals are overbooked. It does not matter, because there is no urgency. In a month, nothing will happen, you have time to take your time. I will surely make some of them scream, but it is a reality. If a woman comes to consult me at the end of June telling me that she is going on vacation on July 10 and that she must absolutely have an operation before she leaves, I answer her that she can, if she wishes, go on vacation and that I will operate upon his return. Of course, if the biopsy of his tumor shows that it is little or not aggressive. If she had had her mammogram in September, we would be at exactly the same point. For a poorly proliferating cancer to increase by one millimeter and be visible on the x-ray, it takes months.
Colleagues call me regularly to refer women who have just been diagnosed with breast cancer, telling me that they need an appointment “right away”.
When I tell them it’s not an emergency, they tell me that the patient in question is very distressed. But why is she in this state? The fact that they call me in front of her with an urgent tone surely has something to do with it… Perhaps if they spoke to her in a more calm and reassuring way, this patient would be more serene. “I will give you the contact details of a specialist, you can call him calmly and you will have an appointment within two weeks. In the meantime, my secretary will transfer your file so that he has all the necessary information. The result will be the same, but we will have saved so much anxiety and haste!
It is absolutely necessary to convey this information to patients, but also to doctors, in particular to young doctors: breast cancer is not an urgent disease at one month, with rare exceptions. In almost all cases, it is a very slow disease that develops over months and years.