That was the question asked from the audience and since I was the lone panelist whose field was breast cancer, the crowd looked to me for an answer.
I usually resist contributing to anything that smacks of male versus female. When people ask me if female doctors are better than male, I say not necessarily, I’ve met some lousy female docs and incredible male docs. Or when I’m challenged about working in a place where99% of the staff are women and am asked “Isn’t is a lot harder to work with bunch of women than men?” I reply, I honestly don’t know, it’s been so long since I worked in a primarily male environment.
But would there have been a different outcome if breast cancer had been a man’s disease…that question begs a deeper, more thoughtful answer.
I had to consider another disease and how it has been handled. Heart Disease, the number one killer of women is a prime example of the disparities in research. Women are twice as likely as men to die from their first heart attack. But for too many years, too little research was done on women. It wasn’t until the early 1990s that the Office of Research on Women’s Health (ORWH) was established after a lot of women members of Congress along with some very miffed female lawyers started asking the right questions. They demanded a study on medical research expenditures in the late 1980s which showed substantial discrepancies. Women were missing from clinical trials and were only 5 percent of NIH’s budget.
It took years and a lot of females voicing their concerns before the allocation of dollars changed and research confirmed the hard cold fact: the symptoms for a woman having a heart attack are very different than in men. Even so, thousands of women died of that first heart attack before that fact became common knowledge and the first responders and doctors had the right information. Simply put, a woman can be in the middle of a heart attack and not complain of pain in her chest or radiating down her left arm. Those are symptoms for men, not women. The woman having a heart attack is fatigued and nauseous; most often thinks she’s battling a sudden onset of a bad case of the flu. And, even today, if she does survive, she’s less likely to be put on beta blockers or aspirin therapy after a heart attack, a step common for men.
In the breast cancer world, attitudes have undergone a huge transformation--mainly for the good; some of that change is due to research but most is due to women being advocates for what’s right.
Another act of Congress was needed to implement the two stage biopsy procedure, the simple act of waking up a woman after she had undergone general anesthesia for a biopsy and allow her the chance to decide on her own mastectomy. A lot of women went to sleep believing the lump was benign and woke up without a breast. No preparation, no treatment plan. Being allowed to make her own decision wasn’t an option until Rose Kushner pushed the Breast Cancer Patients’ Bill of Rights and the Informed Decision Law.
There was a time when it was common for a woman to be chided when she asked about how soon she could have reconstruction. She’d often hear that she shouldn’t be so vain, and should be glad to be alive. Privately, I’ve heard more than one physician talk about how a woman needs to go without for a few months and be flat chested so she’ll be grateful when the mound is finally created.
Not all doctors were or are so cavalier, but the truth is females didn’t enter medicine in mass until the early 2000’s and their presence ultimately impacted ‘patient sensitivity’ and communication issues. Today Medical Schools proudly note that half of all enrollees are women, and with 32% percent of all physicians in practice being female, yet still less than 9% of surgeons are female.
But attitudes, good and bad, are fostered in lots of ways. In many medical teaching institutions, the first organ to be amputated by surgical residents in training is the breast and cadavers don’t really care about cosmetic outcomes.
For the living breathing woman, outcomes do matter and reconstruction wasn’t always an option. For yearsinsurance companies balked at it being a necessary procedure—calling it ‘elective.’ Again it took an act of Congress to get that done with the Women's Health and Cancer Rights Act of 1998 requiring group health plans, insurance companies that paid for mastectomy also pay for reconstruction. Surgery to provide symmetry in the opposite, non-diseased breast was included under that act, but not widely known or applied until much later. How ironic when implants for men undergoing testicle surgery were first introduced in the 1940’s and almost always covered by insurance.
But back to reconstruction, the truth is that in those early years, why would any physician encourage having a procedure like reconstruction that was insanely costly and in many cases the results weren’talways optimal.
Of course when insurance coverage became standard and reimbursements to physicians became reasonable, the number of surgeries increased and today results are pretty darn good.
So back to the question: Would it have been different if breast cancer had been a man’s disease? Probably.
Would a cure already be found? Naw.
To those researchers working day and night searching for a cure, cancer is cancer, it doesn’t matter, male or female. The naysayers continue to complain that there isn’t enough collaboration among the researchers—but how could there be when the first scientist to make the ‘discovery” will be able to demand more funding for their project?
Still, in the end, the Universe has a way of sending the best ideas and the new discoveries out to multiple folks at the same time. Those ideas speed through the ethers just looking for that one mind that is willing to step out, take the risk and grab it.
That mind could be male…or female.
From my favorite philosopher and author
About Ideas and Discoveries
“It is a well-known established fact throughout the many-dimensional worlds of the multiverse that most really great discoveries are owed to one brief moment of inspiration. There's a lot of spadework first, of course, but what clinches the whole thing is the sight of, say, a falling apple or a boiling kettle or the water slipping over the edge of the bath. Something goes click inside the observer's head and then everything falls into place. The shape of DNA, it is popularly said, owes its discovery to the chance sight of a spiral staircase when the scientist’s mind was just at the right receptive temperature. Had he used the elevator, the whole science of genetics might have been a good deal different.
This is thought of as somehow wonderful. It isn't. It is tragic. Little particles of inspiration sleet through the universe all the time traveling through the densest matter in the same way that a neutrino passes through a candyfloss haystack, and most of them miss.
Even worse, most of the ones that hit the exact cerebral target, hit the wrong one.”