Pink is the new Blech

Yes, it's that time of year again when blatant consumerism wraps itself in pink and runs amok throughout the media and popular culture. It is certainly commendable to raise breast cancer awareness by selling pink platform shoes, pink handbags, pink Mix Masters. However, if the goal is to generate awareness, then why not donate ALL or at least a significant portion of the profits from the sales of the cotton-candy colored crap to breast cancer charities? If those who sell pink merchandise in the name of awareness retain the bulk of the profits from their sales, then it begins to look an awful lot like the name of the game is opportunism, and the goal of generating awareness begins to look a lot like an also-ran. My wish is that the companies that flood the market with pink throughout the month of October in the name of "breast cancer awareness" would realize that it is distasteful to boost their bottom line through the sale of pink items and would choose instead to direct all of the direct profits (i.e., dollars earned over costs) from their pink sales to breast cancer charities. Until that happens, I'm boycotting pink and grassrooting my efforts to increase awareness and accurate information about breast cancer to the people.

In that spirit, let me just clear up a few misunderstandings that were fed to millions of American women last night via the WOMAN-produced blockbuster television hit, Grey's Anatomy. Shame on you, Shonda Rhimes, creator and heart center of Grey's, for having the handsome Dr. Alex Karev characterize his patient's Stage II breast cancer as ADVANCED. Stage II breast cancer is EARLY STAGE. I repeat, Stage II breast cancer is EARLY STAGE breast cancer, whether or not the cancer has "metastasized" (and I shudder to use that word in this context, but it actually is the medically appropriate way to say that cancer has moved from one sight to another, even if it does not mean that distant organs are involved) to lymph nodes in the breast and armpit.

Since Grey's Anatomy failed in this regard, I think now would be a good time to briefly outline the stages of breast cancer, for anyone who might be interested:

Stage 0 - breast cancer that is entirely contained within itself, which is to say that it is non-invasive in nature, and not likely to spread or even to become Stage I. However, there have been cases where a Stage 0 patient ends up with with metastatic (i.e. Advanced) breast cancer.
My personal belief is that women who go from Stage O to Advanced breast cancer probably had an undiagnosed invasive cancer. And this is one reason why I believe so strongly in mastectomy after a breast cancer diagnosis. Who knows what is lurking in a diseased breast? Clean up the disease - get rid of the breast. That's just my opinion, of course.

Stage I - invasive breast cancer (cancer cells are breaking through to or invading neighboring normal tissue) in which the tumor measures up to two centimeters, AND there are no lymph nodes involved.

Stage II - invasive breast cancer in which the tumor measures at least two centimeters, but not more than five centimeters. In Stage IIB, the cancer has also spread to the lymph nodes under the arm on the same side as the breast cancer, but the lymph nodes are intact, have not yet stuck to one another or invaded into surrounding tissues. The patient in Grey's Anatomy last night was a Stage IIB patient. I was a Stage IIB patient, with two (or three, depending on whom you ask) positive lymph nodes under my arm.

Stage III - invasive breast cancer where the tumor is larger than five centimeters OR regardless of the size of the tumor, there is significant lymph node involvement where the nodes are stuck to one another or invading the tissue surrounding them. This is Stage IIIA. In Stage IIIB, the breast cancer, regardless of size, has invaded the skin, the muscle or the internal mammary lymph nodes. Stage IIIB refers to a rare form of breast cancer called Inflammatory Breast Cancer, where at least half the time, there is no actual tumor; instead, the cancer cells are ubiquitous to the breast, the skin and underlying muscle.

Stage IV - invasive breast cancer that has spread beyond the breast, armpit and internal mammary lymph nodes. Stage IV breast cancer is usually found in the lungs, liver, bone, or brain. Sometimes it is caught while the cancer is not detectable in these organs but is detactable in the mediastynal (mid chest) or supraclavicular (above the collar bone) lymph nodes. Stage IV is ADVANCED breast cancer and is the ONLY "ADVANCED" breast cancer.

No one dies from "Early Stage" breast cancer. The breast is a non-essential gland in the human body. No one dies from breast cancer that has spread only to the lymph nodes in the collar bone. People die when their breast cancer progresses beyond Early Stage to Advanced Stage -when the cancer spreads to the brain, the liver, the lungs and other distant organs that ARE essential to human life. The spread of cancer to the bones is not, in itself, going to kill a patient. But it is a sign that the cancer is serious, spreading and is putting the life of the patient in danger.

So, Alex Karev's patient had Stage IIB breast cancer, which she found while breast feeding her baby. Unfortunately, this is not an uncommon occurrence amongst young women with breast cancer. Pregnancy is a time of cellular growth and decreased immunity. If one had a propensity to grow a breast cancer, pregnancy would be a really great time for the body to get going with it. Pregnancy is also a time of increased hormone levels. So, if a breast cancer has estrogen or progesterone as its growth factors, then pregnancy will really get it going. Nursing continues the hormone surgers and also can mask the palpability of a tumor.

Alex Karev's patient withdrew from her baby and exhibited all of the symptoms of a serious, profound, clinical depression. None of that is earth-shattering. It is not uncommon to withdraw from one's friends and family when diagnosed with a life-threatening illness. It is a psychological defense mechanism. When Dr. Miranda Bailey scratched the surface, it became apparent that the patient also harbored some anger towards her baby for contributing to the cancer and then a hefty helping of guilt for that anger. All of this is textbook, and I have to admit that the Grey's writers did a fine job here. It was also fine that Karev's patient expressed a fear of dying. Totally to be expected in a cancer patient.

The problem was that the writers/editors/whomever did not then allow the characters to accurately convey that the fear of dying from cancer has little to do with the stage of the cancer. Everyone who gets a cancer diagnosis is afraid that they will die from it. In some cases, the fear is more emotional than fact-based. In last night's Grey's Anatomy, the fear was far more emotional than fact-based.

Here's how the facts were stacked for Karev's patient: A Stage IIB breast cancer patient who receives NO treatment at ALL will have about a 60 percent chance of surviving the disease outright. Each treatment the patient has - surgery, chemo, radiation - adds to those chances by a certain percentage until with a full battery of appropriate treatments, a Stage IIB breast cancer patient is looking at a greater than 80 percent chance of surviving the disease. (These facts came to me from my own oncologist more than four years ago, so they may be slightly outdated, but if anything they are more bleak than they would be today).

Did anyone tell Karev's patient that she was going to lick this thing? Uh, no. But all of my doctors did. Here are some of the things my doctors said to me in the first two months of my diagnosis and treatment:

• You will be fine...this will be a really hard time, but you will do what you have to do, and you will be FINE!
• It's not like it's an advanced form of the disease - that's a whole different disease entirely. You're early stage. You're looking at surgery and chemo and then moving on with your life.
• This is going to be an annoyance in your life, and then you will have your life back.
• You will be FINE.
• It's early stage. You will be FINE.

Get the picture?

And sure, maybe they might have been proven wrong. But to say that an 80-something percent chance of surviving a disease is a good prognosis is perfectly within reason and perfectly appropriate. And for the sake of the viewing public, it would have been a really, really good idea.

I know that if I were watching Grey's without having had breast cancer, I would be in a terrible mood today, worrying about breast cancer, seeing pink everywhere, worrying about breast cancer some more, remembering that on last night's show, a patient with a mere STAGE II cancer was not being given hope for a full recovery, seeing some more pink, reaching for some pink Pepto Bismal. It's downright irresponsible of Shonda and the Grey's gang to have put this storyline on as it was - exaggerated, overly melodramatic and gaping with holes.

I don't know why I watch Grey's other than to see what the hot, big-bodied, totally awesome Dr. Callie "Bonecracker" Torres will get into next.

Off I go. May the pink be with you, but not too much.

YC