One in three people will be
diagnosed with some form of
cancer during their lifetime. One
in eight women will be diagnosed
with breast cancer, the second-leading
cause of cancer death in women (lung
cancer being the first). The chance that
a woman will die from breast cancer is
about one in 39 (about 2.6%). Thankfully,
over the last five to 10 years, the death
rate has declined, in part due to better
treatments and also due to improved rates
of screening. There are currently more
than 3.8 million breast cancer survivors in
the United States. This number includes
women still being treated, as well as those
who have completed treatment. These
statistics mean that all of us are likely to
encounter cancer patients both personally
2 DALLAS MEDICAL JOURNAL • October 2021
PRESIDENT’S PAGE
What Should I Say?
DCMS 2021 President
Beth Kassanoff-Piper, MD, FACP
and professionally, no matter our specialty.
I am in a unique position to write about
cancer. I am a breast cancer survivor, a
primary care physician who diagnoses and
manages cancer patients, and a friend
to many cancer patients. I also have an
incurable, although manageable, cancer
(I have chronic myeloid leukemia). We all
bring our own personal experiences to the
relationships we have with our patients
when we see them in their most vulnerable
moments. They rely on us to be professional
and always have their best interests
in mind. Yet, they also need us to be
compassionate and supportive. While we
don’t all have a personal cancer history to
draw from when forging a bond with our patients,
we all want to foster that supportive
relationship.
I, of course, am an advocate for routine
breast cancer screening and encourage my
patients to stay up to date with their mammograms.
A patient a few years ago said
to me, “I’ll go because you want me to go,
but I’ve always known that I’ll never get
breast cancer.” I was briefly stunned but
recovered quickly enough to thank her for
agreeing to screening and to say a quick
prayer that she was right. Everyone thinks
it won’t happen to them, until it does.
Our cancer patients are scared. Scared
of dying, of surgery, of chemotherapy. We
are afraid of being disabled and being
unable to care for a husband, parents, and
children. We’re scared of missing out on
seeing our kids grow up. On a deeply personal
level, patients are scared of feeling
bad, of looking like a cancer patient, and
scared of losing part of what makes them
a woman. There are so many thoughts
swirling around in the head of a cancer patient
when difficult choices must be made
relatively quickly, while a patient is still in
shock from the diagnosis.
How do we as physicians navigate difficult
psychological issues surrounding
cancer? How do we, as human beings, approach
the topics with our friends or family
members? How do we help them in their
struggle? Clinicians, as well as patients,
find it very difficult to talk about cancer.
After my diagnosis, I often found myself
having to comfort others when telling them
I had cancer. I also had to develop a thick
skin, because people, including some
doctors, don’t know what to say to cancer
patients. There are some things no one
should say to a breast cancer patient, such
as, “They are just breasts” or “Hey, you get
a free breast lift,” or “You’ve had your kids,
you don’t need them anymore.” Losing
one or both breasts is both physically and
emotionally painful. Breasts are a huge
part of our femininity, and the loss can
impact self-image, intimacy, and relationships
with others. And to those who think
they understand because they have had
augmentation, there is a huge difference
between augmentation and reconstruction,
which involves rebuilding a breast from
scratch using implants and/or chunks of
tissue from other parts of your body.
Even well-meaning comments such
as “stay positive” can have a negative
psychological impact. Being told you have
cancer starts a grieving process, and we
should honor and respect our patients’
feelings through this process. Never say
to anyone, “Hey, it’s not that bad. Smile!”
Sometimes it is that bad. And cancer
patients don’t need the added pressure