Principles of Medical Ethics 

Before You Donate

Think very seriously before donating to any breastcancer organization, or fundraising program until you read their Annual Report to see who their top contributors are, and if they have a product that appears frequently in the message the organization sends to the public. That would be unethical and its illegal. The same applies to a request that the public buys products, but does not receive a "donor receipt" for tax-deductible purpose. Read any and all food labels that breastcancer "non-profits" are promoting to raise money. Some organizations tell the public to help them raise money by asking you to visit their websites, but that only gives them "hits" to increase their sponsors.

Another tip, "signing" an online Petition is not acceptable, so don't fall for such antics. An ethical non-profit, or professional will not request your visit to their website, nor use "cookies" placed on your computer when you visit their site.

Purchase the Breastcancer Postage Stamp, the Post Office will always give you your charitable deduction receipt. Its a valid form of fund raising.

It is projected that close to 300,000 women will be newly diagnosed with breast cancer in 1999. 300,000 of us maimed and emotionally shattered. Approximately 45,000 will die. 1:9 women will get breast cancer but with the new information regarding DCIS, I believe the figure is closer to 1:4-5 based on our current available technology, and physicians enforcing their own codes of ethical conduct. Those not prepared to perform up to date procedures must refer their patients to those who can, and/or obtain the training it takes to perform, for example the Sentinel Lymph Node Dissection, or be enforced by their associations, county medical boards, and their patients.  Any delay in diagnosis is going to harm the patient, no matter how it is viewed (emotional health is largely ignored by our society when it comes to questionable diagnoses). Someone must take this responsibility, responsibly.

 

The breast is composed of a system of ducts.  Imagine an orange with its several sections. Each section could be imagined as a breast duct, into which the mother's breast fluid lets down into upon stimulation: release of syntocinon (a hormone), which goes into its magic action when the baby cries, even another baby cries, or if the mother even thinks of her infant! This and childbirth are the longest clinical trials in history and perpetuate the marvel of human development.

Back as far as the 1960s, Paul Gyorgy, M.D., at Case Western Reserve in Cleveland (who was one of my personal mentors) had definite findings, some proved the value of human fluid fed to infants, and others created a real 'stir' among seriously interested researchers. He led in the research on the components of breast fluids fed to an human infant vs cows milk fed to a human infant. The most startling experience for me, at that time, was that here were many components in this human fluid which were unidentified and evidenced best on a colored, vertical graph, as very high or very low components, compared to other known components.  However, in cows milk (human formula), the results were the opposite! At time, the graphs looked inverted!

That which was high in a woman's breast fluid, was extremely low, or nonexistent in cow's milk, and vice versa. The "knowns" we could deal with, and had a starting place, but the unknowns presented grave concerns among those of us who were involved in the knowledge of this research. Dr. Gyorgy's understanding of the human breast, and its anatomy appears to have been long forgotten. However, during that time, I found that D.O.s (Doctors of Osteopathy) were much more intellectually curious when presented with these facts, and the theses, as well.

How we ever came to believe that ductal carcinoma could not spread (termed "in situ (*staying in one place), apparently arose from the same subjective observations that a woman labored more effectively on her back than she did on her side (because on her back she was in more pain and the more agony she presented was thought to equal the strength of the contractions. Many times, attending a woman in labor, on her side, I was told there was no way I could feel the strength of her contractions if "she is on her back." As a matter of fact, the woman's psychological response to those around her told me more about her progress AND her dilation, than anything else. I never needed to do a pelvic examination: the woman 'told' me. But, if one would slip their palm under her abdomen while she was on her side, the contraction's intensity could be perceived. This is where the M.D. schools evidence their lack of requiring common sense.

HOW DOES THIS RELATE TO BREAST CANCER?  The thesis upon which DCIS is predicated cannot be valid because there is no anatomical mapping of the ductal system of the breast.  I have read recently that Dr. Love is currently working on such an important aspect of treatment and surgery for breast cancer, generally. In 1999, we knew that DCIS can spread to the lymph. I was the patient. Stanford University studied their next twelve patients, and had four positive for "mets" to the lymph. Thus, DCIS is an oxymoron. A women either has cancer or she does not.

Micrometastasis!  What is it (often referred to as "micromets")?   How can we be checked for it if we are told we have ductal carcinoma in situ (in one place)? It is also referred to as 'pre- cancerous,' and  commonly referred to as "DCIS"? We have always been told that it does not spread! I am providing no medical information on this web site but I shall attempt to tell you what I was told and how it was explained to me.  New pathology techniques are now available, and the Sentinel node biopsy was the beginning. Then, new pathology techniques used when an individual's lymph nodes are examined by the pathologist, after surgery. Now the pathologist can, and hopefully will, use cytokeratin staining on the cells removed from the lymph node, which will evidence the micro cells that have moved into the lymphatic system.

There is rationale for purchasing only the Breast Cancer US Postage Stamps which benefit NIH!

More and more breast surgeons are learning about this right now, in early 1999, and are learning rapidly at breast surgery/breast cancer conferences. General surgeons will take longer, unless they attend those conferences, and stay current with the literature.

When I was informed of the experimental Sentinel Node Biopsy, it was by a physician friend whom I valued highly. I knew I wanted to have that node examination because of my family history of cancer, the site of my cells in groups (two), and the type of cell found in my biopsy. The fact, too, that the tell-tale calcifications were on my last two annual mammograms and grew a great deal in size and morphology (shape) in one year didn't encourage me that I had a typical DCIS.

Also, I knew of too many women who had had "lumpectomies," or partial mastectomies, without node examination, and certainly without the new pathology staining techniques, who were found to be riddled with metastatic cancer within 4-10 years.

I have been blessed with a fascination for biology, and drove my professors' crazy eons ago when I would ask question after question, and often be told, "You don't have to learn that." When I was a peri-natal instructor, I read every related journal published each month, as well as followed closely the progress of cellular biology. Therefore, I didn't trust cells that were performing in an archaic manner (not communicating with the other cells around them!) when I was told I had "just DCIS."  I lost my confidence in the intellectual ability of that physician immediately.

An internationally known pathologist told me during the early days of deciding how to treat this 'micromets; "Perhaps I can explain a bit what is happening. You see, to find positive nodes in cases of DCIS is rare (back in 1998), and it is more infrequent to find micrometastasis by special ancillary techniques such as immunohistochemistry (note: the staining procedure done by pathologists on your lymph node tissues so they may be more easily seen). On the other hand, these are tools that we will be using more frequently in the future, so most likely we will find more cases and hopefully we will be able to define better guidelines as how to treat patients as yourself. Meanwhile, you must bear with us, and our ignorance."

How this kindly, highly educated, renown pathologist could even think any of us would consider pathologist 'ignorant,' even due to the lack of new techniques, was hard for me to accept. At the National Institutes of Health, she has performed the second opinion on all of my pathology from surgeries the last four years.

That made me decide I had done the right thing by getting to know all the members of my Team, and seeking counsel from NIH Pathology in Bethesda, Maryland, via the Internet.

Since that time August, 1998, my surgeon has informed me of reports from Stanford, and University of Miami, on their identification of micromets in DCIS node examinations which were done by performing the Sentinel node dissection (or biopsy), often called "SND."  That is a highly experimental test, just as the Tamoxafin trials are, right now (but most women don't know it). Dye is injected into the tumor during the surgery to remove the tumor or the breast, and the dye goes to the Sentinel node. It is excised, and examined by the pathologist. This type of staining usually takes 24 hours. The prior staining took about 8-12 so it missed the fact that a cancer had spread into the woman's lymph system (like blood stream).

The problem then was that there was no information to explain how malignant cells could enter the lymph nodes.  Ah ha! Now there are answers—one most basic: the biopsy procedure!  I'm was certain that question would not last long, I had my own ideas. I certainly am not a scientist, however, I, as you, do have a brain with a considerable number of cellular biology credits under my "belt" and 8 hour labs/week. Hence, I am urging women to be sure an experienced breast surgeon is involved before a biopsy is performed! However, under FDA regulations, a breast surgeon may not perform a stereotactic or mammatome biopsy, unless a breast radiologist is present. But, I have seen it done—indeed, it was performed on me.

Many of the best oncologists believe "micrometastasis" must be viewed the same as any metastasis (growth of the cancer beyond its original location such as to the lymph nodes, liver, spleen, bone, etc.). Aggressively. I was fortunate to have been led to an oncologist who sought out two other opinions and I met with those physicians, too. I agreed with their recommendation of aggressive chemotherapy, because radiation could NOT be targeted in a large enough area. It was considered, however, at one time to irradiate the axillary area (armpit). I did not want radiation.

Women must be informed of the options before them. They have a right to have physicians who are well informed.  Informed consent means that the woman/patient thoroughly understands what is to be done to her, why, what might occur if something goes wrong, how long it will take, how much it costs (not counting insurance coverage but the truth, the whole truth), and every thing the physician knows about her potential post operative recovery and experience.  Everything!  Even though it may not happen. It is important that the doctor waits until there is a loving advocate present with the woman, from her own family, or friends, or a volunteer who has been well trained!

Patients have a right to meet and discuss their case, their bodies with anyone who is paid by the patient or their insurance company.  

That, if for no other reason, saves money! And, more importantly - Lives!

"So, what do I want to ask my breast surgeon and my pathologists?"

"Are you able to perform a sentinel node biopsy (one surgeon told me he'd do it)  "…sure...throwing some blue dye in there, but. . ." So be sure you have a surgeon who is an experienced breast surgeon, and just known to your other physicians.

"Patient outcome is in direct proportion to the number of surgical procedures a surgeon has performed on a breast," a well-known surgeon told me. If I was unable to find one in an area I lived in, I would meet with the pathologists and the surgeon together, and obtain assurances that this would be done, and the appropriate staining techniques would be performed, and a second opinion would be obtained by sending the slides and tissue blocks off to a reputable research center, or NIH. Discuss this with a board-certified oncologist in your area, or two of them. If you cannot locate a breast surgeon, contact the National Cancer Institute, or National Institutes of Health (see Resources) and ask for referrals in your region.

And, at all times, check out your physicians status with your State Board of Medical Examiners, and the ABMS (see Resources), and the local newspaper. Please remember, unless your doctors advise you that time is a critical factor, slow is faster! Take your time. Find an advocate to help sustain you and if you cannot find one there are many examples on this site of how to find one.  Or, e-mail me.

           reviewed 07/22/07