Rosseau's Brainstorm: Detecting Cancer

One of the country’s top neurosurgeons wants to give women who have had breast cancer a chance to know their future. Is she doing them a favor?

By Laurence Gonzales

When I asked her about this, she described what she called the third career. The first career is school, the long years of training that made it possible for her to be where she is now — at the height of her second career. Not long ago this would have been it for a lifetime but, she says, "We live in a time when we hope to be fortunate enough to have a few extra years and a little extra cash to do something past 60 or 65, to do something meaningful and not just live on a golf course." Rosseau is married to an orthopedic surgeon; her children are 12 and 10 now, so she plans to continue with her second career for at least 10 more years. But she has already started laying the groundwork for the third act. In the mid-1980s, she began taking working vacations in developing countries on three continents, assisting in the training of brain surgeons. "I love that," she says. "That’s where I’m headed."

Too Much Information?

My friend Jeanne is a professional photographer in Portland, Oregon; she recently had an exhibit called "The Circle Project: Images on Breast Cancer." It shows not the patients themselves but life-size portraits of their friends and families. I ask Jeanne, whose cancer had not spread into the lymph nodes, if she would want to have her brain scanned, or for that matter, her liver, lungs, and bones. She sighs and pauses, then says, "I keep thinking ignorance is bliss. It’s strange. You’d think my response would be an automatic yes, but it’s not. It’s tied to my experience of doctors always wanting to do something to you. My head says, ‘Yeah, that’s a great idea.’ Obviously you want to get the message as soon as you possibly can. But my visceral response is ‘Leave me alone.’" Sounding weary from the experience of being so recently saved by the inescapable brutality of the medical arts, she says, "I don’t know. I don’t want to know. The anxiety is just too hard to deal with."

"There’s a great big caveat in everything I’ve said," she adds. "And that is the knowledge of the stats in my case. There’s an 85 percent chance that it will not recur, and that’s a pretty large number. But if it had already recurred, you’d better believe that I’d be in there every three months getting scanned."

"I worry about this," writes longtime breast cancer activist Susan Love, MD, in response to an e-mail describing Rosseau’s trial. "It is possible that some women have asymptomatic brain metastasis and that the surgery will not change anything. Anyone who has brain metastases from breast cancer has metastases elsewhere in her body and is not curable. The best you can do is reduce symptoms. Therefore you want to only diagnose women with symptoms. Screening for brain metastases will not do this."

"I hope she’s right," says Maria Carolina Hinestrosa of Rosseau’s attempt to isolate and treat the women most at risk. "Brain metastasis is one of the most terrifying aspects of the progression of breast cancer. But I’m skeptical. Would this be a wise use of resources, to screen people repeatedly for something that hasn’t shown symptoms?" This was tried, she notes, and by the mid-1990s, shown to be ineffective. "So having a whole population of people screened [just] increases healthcare costs and anxiety."

Whether or not her technological one-two punch ultimately increases lifespan, Rosseau believes it’s important to give women the option to assess their situation. "Certainly your long-term survival numbers are going to be affected by the fact that you’ve had a breast cancer metastasis to the brain," she says. "But your quality of life is going to be much better if it’s detected at a one-centimeter size rather than if it becomes five centimeters and you can’t walk." She hopes that by doing this small pilot program, she’ll generate enough interest for a manufacturer of diagnostic equipment to pay for a study that will look at much larger group of women.

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