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Sunday, 10 August 2014

My cancer patients don't need bad science and self-blame, Mr Abetz | Ranjana Srivastava | Comment is free | theguardian.com

My cancer patients don't need bad science and self-blame, Mr Abetz | Ranjana Srivastava | Comment is free | theguardian.com



My cancer patients don't need bad science and self-blame, Mr Abetz




As
an oncologist, I feel frustrated on behalf of patients who harbour the
fear that they somehow brought the cancer upon themselves by having an
abortion



Doctor looking at mammograms
A doctor looking at mammograms. Photograph: Alamy







The incautious words of the Australian senator Eric Abetz linking abortion to breast cancer on a television show were still being digested when the calls began.

“Can I ask you something personal?” a patient asks.

“What’s the matter?”

“Do
you think you could talk to my mother-in-law? She can’t stop hinting
that my breast cancer is related to my previous abortion – it’s making
me upset and worried that she now won’t help.”


I listen in
disbelief as she continues, “I am sorry I hid it from you but I had an
abortion years ago when I lost my job, couldn’t afford rent, and felt
insecure about the future. I am not religious but it’s awful enough to
be considered a sinner without being told that the breast cancer is a
by-product of that decision.”


“Firstly, I don’t need to know about
your abortion”, I say, thinking furiously about how to salvage the
situation quickly. “Secondly, there is no plausible scientific evidence
to back this claim. We can discuss how to approach your family but
please be clear on one thing – although old reports exist, there is no
proven link between abortion and breast cancer.”


The prolonged silence prompts me to ask if she is still there.

“But
a senator said this”, she replies. “I mean, they have access to all
kinds of fact-checks and he was on national TV. Could it be that he
knows something doctors don’t?” I can almost hear the misgivings creep
into her tone.


It’s my turn to plead with her. “I am not
shielding you from the truth, in fact the opposite. I can show you
extensive and reputable research that quashes this theory. You have
reasons to be upset but this shouldn’t be one. Your abortion did not cause your breast cancer.”


“Okay”,
she says, leaving me in no doubt that my reassurance has done little to
assuage her distress. I feel frustrated not only on behalf of my
patient but countless other women who harbour the fear that they somehow
brought the cancer upon themselves.


The senator’s words are not
merely incautious; I believe they demonstrate a striking lack of
judgement as to how mere sound bites uttered by powerful people can
affect ordinary individuals who, like my patient, have neither the time
nor the wherewithal to conduct a meaningful study of the published
research and arrive at their own conclusion.


Elevating radical,
religiously driven ideology to the same platform as methodically
studied, scientific evidence and then claiming that distinguished
professional bodies such as the Australian Medical Association, the
American Cancer Society and the World Health Organisation can agree to
disagree is not merely careless; it is downright disingenuous. In my
experience, such words can cause immediate consternation and sow
longer-term doubts in the minds of patients.


Abortions and breast
cancer are both common to women. The Better Health Channel Victoria
states a 2005 estimate of between 70,000 and 80,000 abortions in
Australia annually. Cancer Australia estimates that in 2014, just over
15,000 women will be newly diagnosed with breast cancer. With improved
treatment, many will join the approximately 160,000 survivors. The
question at the front of every patient’s mind is what causes cancer.


While
there is a well-established association between smoking and cancer, it
remains frustrating but true for many cancers that their trigger is yet
undisclosed, waiting for research to illuminate us. Amidst the maelstrom
of emotions usually associated with a cancer diagnosis, who would want
to add shame, disgust and self-condemnation to the list? Yet, this is
precisely what the senator’s comments might achieve for many current
patients who are already vulnerable to the suggestion that something
other than a random genetic event triggered their cancer.


Every
day in my office, I hear men and women with cancer blame themselves.
Could it be the stress, they wonder, from their son’s messy divorce or
their grandchild’s drug addiction? Maybe it was their diet or exercise
which they let slip away. Perhaps it was the strong chemicals from the
factory next door or the pollutants in the local water supply. Now,
there will be abortion on the list, steering an already emotive
conversation into an unnecessary direction. I fear that it will nibble
away time from discussing other vital and relevant issues that would
actually help patients.


An even greater concern is the way in
which this false assertion will continue to creep stealthily into public
consciousness long after the media storm has dissipated. For this, one
only has to turn to the furore created by a publication in the Lancet
linking childhood vaccination to autism. The research was quickly
discredited, the paper was partially, then fully retracted, and finally,
the researcher was struck off the medical register in 2010. The full
dismantling took 12 years and the scientific community was throughout at
pains to disavow the fraudulent research. Yet, to this day, the issue
is a live one in mothers’ groups and on parenting blogs, clothed as a
dilemma for conscientious parents who invoke a global conspiracy theory
while dismissing their doctors’ evidence-based advice that childhood
immunisation saves lives. It takes enormous work to undo the results of a
false assertion.


Nulliparity, or the lack of any childbearing, is
understood to be associated with a slightly higher risk of breast
cancer. Nuns experience breast cancer more commonly than other groups of
women. However, nulliparity is not the same as abortion and the medical
community has worked diligently over the years to disprove the link
between abortion and breast cancer. Oncologists do not ask about
abortion when assessing risk factors for breast cancer. They do not
factor in a history of abortion in their cancer management plan. Their
practice won’t change as a result of the senator’s comments but a
woman’s extent of silent guilt may well do.


Later reports suggest
that the remarks were unfairly edited and the senator feels “sheepish”.
Unsurprisingly, medical bodies have reacted strongly and angrily to the
remarks. The acute anger has to do with the ridiculous content of the
claim but those of us who regularly counsel cancer patients also feel
dismayed by the undermining of medical integrity that went along with
it. We will have to work hard at reassuring women that abortion and
breast cancer are not linked.







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