Dr. Peter Bach on “Avoiding the Breast Cancer ‘Warrior’ Trap”

I clearly remember struggling with if/what I should write about Amy Robach of ABC News and her on-air and online statements about her own breast cancer diagnosis and treatment – and what it might mean for other women. I finally decided, and published “There’s another side to the Amy Robach breast cancer story,” becoming one of the first writers to raise questions about Ms. Robach’s public statements.  That was in November, 2013.

Just two weeks ago – 9 months later – Dr. Peter Bach of Memorial Sloan Kettering Cancer Center wrote “Avoiding the Breast Cancer ‘Warrior’ Trap” on the New York magazine website. He described Ms. Robach’s public statements as “both wrong and hurtful.”  Excerpts:

I should know. I’m a doctor at a cancer hospital, so I’ve taken care of many patients who have breast cancer. I run a group that does health-care-policy work, so I know how patients with cancer get treated. I have led cancer guideline panels and advised organizations that set the standards for cancer screening and overall care. And my wife died of breast cancer a few years ago. 

Every inch the network TV star with four-inch heels, runway model legs, a Mentos smile, and a light southern lilt wrapping broadcaster’s diction, Robach was off track right from the start. A mammogram saved her life, she told us. But that is not something she could possibly know. 

Decades of research show that most women, if they get proper treatment, are going to have the outcome they’re going to have, whether their cancer is found by mammogram or another means. Mammograms will shift a few to a better outcome. Some experts say about one in five deaths from breast cancer are stopped by mammograms. But others say it’s closer to zero.

It’s a solid article:  a doctor’s perspective, an evidence-based perspective, but, more than that, a cancer widow’s perspective.  He not only questioned her “Get screened” advice.

• He wrote that she “trampled” over the rich debate, oversimplifyng with an easier message than the “complex tradeoffs of the actual disease.”
• He stated his surprise “that these arguments were being made by  a journalist whose job should be to appreciate and explain nuance, not look away from it.”
• He wrote that Robach’s “I kicked cancer’s butt!” statement may leave other women feeling that “They must be dying for their lack of fortitude.”

The article led to a healthy discussion in the online comments left by readers.

• One questioned “Why anyone would counter Robach’s (and others’) alluding to themselves as warriors.”
• Another responded that “A lot of cancer patients take exception to the whole warrior/fighting metaphor.”
• One wrote: “I have been trying to get this same message across for years, so thank you for doing it succinctly.  As a woman living with metastatic cancer, (liver) I hear the warrior terminology constantly.  I don’t believe we are warriors or saints – we are sick. “
• One wrote:
  

  “Thank you Peter for this article which I’m sitting here crying after reading. As a recent “survivor” of ovarian cancer I’m scared & struggling to make a new normal. Any sense of being a warrior woman is subsumed by dealing with early menopause & sterility (I was diagnosed with cancer while we were trying to get pregnant) from having both ovaries removed.

  Though I feel thankful to be alive every day, I’m yet to feel like a warrior woman. I’m so sorry for your loss but my heartfelt thanks for beginning to expose the reality behind dealing with cancer, whatever the outcome.”

And Dr. Bach’s piece lit up Twitter with overwhelmingly positive comments – from what I saw.

I struggled – 9 months ago – with what to write because I did not want to question Ms. Robach’s decisions nor to be insensitive to what she was going through.  But I wrote then, as I still firmly believe now:

“the national television platform is still influential – and is used, in my opinion, unethically when it delivers an advocacy, opinion-based message on what should be a highly-individualized, evidence-based, shared decision-making discussion between patient and doctor.

Please don’t write to me accusing me of being anti-screening.  That will only show that you didn’t read this piece.  This is not anti-screening.  This is about discussing the known tradeoffs between potential benefits and potential harms in mammography.  And it’s about journalists sticking to facts, not offering opinions, advice, or their own personal stories in ways that are meant to influence others’ decisions or even in ways that might potentially have that impact.”

My thanks to Dr. Bach for keeping the discussion alive.

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