Treating breast cancer as a recurrent—not chronic—disease

By Barbara A. Brenner

As everyone familiar with breast cancer knows, there is no available cure for metastatic breast cancer (breast cancer that has spread beyond the breast to life-sustaining organs). In fact, metastatic breast cancer will kill a woman who has it unless something else kills her first.

The good news is that some treatments can extend the lives of some women with metastatic disease, by keeping metastatic breast cancer from advancing, at least for a period of time. These treatments are not without side effects, however. Some of those side effects are devastating.

One thing I find interesting at this moment is that advances in treatment have led the cancer industry to begin to talk of breast cancer as a “chronic disease.”

The term “chronic” appears to have many meanings. The use of the term in the context of breast cancer—metastatic or not—conveys an approach to, and an attitude about, the disease that points in the wrong direction.

Consider how Wikipedia defines “chronic” in the medical setting:

A chronic disease is a disease that is long lasting or recurrent. The term chronic describes the course of the disease, or its rate of onset and development. A chronic course is distinguished from a recurrent course; recurrent diseases relapse repeatedly, with periods of remission in between.

By this definition, metastatic breast cancer is recurrent, not chronic. While this might seem like an academic dispute, consider it from the point of view of a woman with metastatic breast cancer. Rita Arditti, a cancer activist and active member of the Women’s Community Cancer Project in Boston, and a woman living with metastatic breast cancer, has this to say on the subject:

Cancer is a progressive disease regardless of “personal management” of the disease. In the case of diabetes, lifestyle changes (diet, exercise) are crucial because many times they can allow the patient to avoid insulin or other treatments. Apparently, heart disease is in the same boat: lifestyle changes are crucial and, in many cases, have been able to control the disease.

What are the lifestyle changes I can make that would put me in that boat? In fact, the whole issue of patient compliance is key for people with chronic illness. For cancer patients, I guess compliance means showing up for chemo or taking your pills.

The other important point is that the treatments for cancer are, in some cases, worse than the disease and that secondary cancers are often a result of the treatment of the first cancer. Injecting insulin daily is no fun, but the side effects of some cancer therapies are frankly horrendous, and the uncertainty of their effectiveness adds to the burden.

It is one thing is to take insulin or some other treatment that is known to help. But cancer patients often receive treatment with only the “hope” that it will improve their cancer outcome, which may mean months of bad side effects for nothing. That adds a big stress factor to the whole picture. Uncertainty is all over the place with cancer, regardless of attitude, because we know so little and can do practically nothing to improve the situation. Not having any control is in itself terribly debilitating.

If a “chronic” disease is one that the public believes can be successfully managed by the person who is ill—without serious side effects from the treatments—clearly metastatic breast cancer is not a chronic disease. If metastatic breast cancer is ever to actually become a chronic disease, we will need far more progress in the treatment and improved quality of life for those who take these treatments.

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“…clearly metastatic breast cancer is not a chronic disease.”

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Breast cancer is also sometimes referred to as a chronic disease, because the risk of recurrence never completely disappears. Women with early stage disease are followed in medical care for long periods of time. (Sometimes for as long as they live, even though they may well live a long life and die without a breast cancer recurrence.) In this context, the push to view breast cancer as a chronic disease seems to be an effort by the cancer establishment to convince the public that we can manage it successfully, and therefore we need not be concerned by the fact that there are still millions of women diagnosed with breast cancer every year.

Urging the public to accept the notion of early breast cancer as a chronic disease undermines the demand for true breast cancer prevention. After all, if you can manage an illness once it occurs, why should you be concerned about keeping people from getting it?

How we think and talk about breast cancer and other cancers clearly has implications for how we address the disease. We all need to move beyond accepting the notion of breast cancer as a chronic disease if we are to have any hope of truly ending the epidemic.

More on BCA’s views on cancer policy issues can be found at here.

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