TIME Cancer

Double Mastectomies Are On the Rise, But They Don’t Result in Fewer Deaths

More women have opted for double mastectomies than in the past but new research questions their effectiveness

New research shows that double mastectomies are increasingly used to treat cancer in a single breast, and it doesn’t always result in fewer deaths.

In a new paper published in the journal JAMA, a team of researchers looked at data from a cancer registry in California and found that double mastectomies for early-stage breast cancer increased significantly from 1998 to 2011. When the researchers compared the mortality rates of 189,734 patients who underwent either double/bilateral mastectomies, unilateral mastectomies or breast conserving surgery plus radiation, they found that double mastectomies were not associated with a lower risk of death compared to surgery plus radiation. Unilateral mastectomy had the highest mortality rate.

The researchers also found that double mastectomies increased the most among women who were under age 40 when they were diagnosed. Though the researchers can’t confirm, they suspect that the numbers may be due to the women’s relatively high likelihood of carrying genetic mutations like BRCA1 and BRCA2, as well as the greater likelihood that they have younger children and therefore want to extend their lives for as long as possible. The researchers call this “an emotional rather than evidence-based decision.”

“The increase in bilateral mastectomy use despite the absence of supporting evidence has puzzled clinicians and health policy makers,” the study authors write. “Although fear of cancer recurrence may prompt the decision for bilateral mastectomy, such fear usually exceeds the estimated risk.”

Given the rising numbers and growing concern about over-treatment, the researchers say physicians should really stop and consider how to respond to a patient’s request for double mastectomy, given that it’s an incredibly invasive procedure.

TIME psychology

Behind My Uncle’s Schizophrenia

What it's like to serve as a translator and tour guide for a veteran battling mental illness

My 69-year-old uncle Henry gazed into the jaws of the Natural History Museum’s biggest celebrity, Thomas the T. Rex, who was frozen in a silent roar.

I asked Henry, “How do you define danger?”

Henry answered, “Everything.”

I made a mental note. Later, I added the entry to the unique dictionary Henry and I are creating together. We call it a “thicktionary.” It documents the language of his mental illness. Other entries include Chicano, which means Americano, and alligator, which means you want to make friends with them but they have their own defensive mechanisms.

Henry, my oldest paternal uncle, has lived a life that’s constantly taken him in and out of danger – a life that has made me consider about what danger really means.

Even in my earliest memories of Henry, I feared the words that might come out of his mouth.

“Real estate on the moon,” he once started to say during a Christmas dinner at my grandma’s house in Whittier. An aunt yelled, “Shut up!”

My throat tightened. I wished my uncle would vanish.

After dinner, a cousin pulled me aside to whisper, “When we were driving home a couple of weeks ago, my mom pulled over ’cause she saw police shoving a homeless man. She started crying because it was…” Her finger pointed in the direction of Henry, who was wearing the same clothes he’d worn last Christmas, which smelled as if he’d worn them every day since.

He disappeared early from that dinner, riding his bike into the evening. Before driving us the 150 miles home to Santa Maria, my father went looking for Henry in Norwalk, where he and Henry grew up. With us kids looking on in the car, he found Henry camped out in front of a Wienerschnitzel near his childhood home, his possessions bundled and bungeed to a 10-speed that looked as worn as he did. My father parked, walked to Henry, and handed a pile of McDonald’s gift certificates to a man whose intelligence had so impressed the Army in 1967 that they enrolled him in officer candidate school in Fort Sill, Oklahoma.

When Henry’s draft letter came, he went to basic training, then for training in field artillery, and then to Northern Vietnam. Henry says the most dangerous part of Vietnam was that, “your ammunition might go off too early. You could be eradicated in full respects.” He felt a great responsibility for other people’s lives.

After Henry returned from the battlefield, he briefly attended college using G.I. Bill money. Then, he started avoiding baths. He started asking my father and his sisters if they, too, could hear the voices of the people he’d killed or hurt in Vietnam. He put his Bronze Stars in a coffee tin, carried it to the backyard, and held a funeral for his medals.

My aunt took Henry to the Veteran’s Administration Hospital in Long Beach. The VA doctor diagnosed him with schizophrenia. Mental health organizations often cite schizophrenia as one of the most debilitating mental illnesses. It manifests through disorganized thoughts and perceptions. It reconstitutes reality, and a person with schizophrenia might see, or, more often, hear things that others do not. The language of schizophrenic people is particularly compelling. A schizophrenic might speak in constant poetry. Metaphors and other abstractions mire their speech, making their intent a beautiful mystery. While the doctor did not explicitly state that Henry’s tour of duty triggered his decline, it’s hard to see how war didn’t at least worsen something that’s often at least partly genetic.

In the years after his diagnosis, Henry experienced bouts of homelessness, but as he aged, he returned more and more to his childhood home in Norwalk. This tract home sat unoccupied after my grandmother remarried. Henry stuffed the house full of treasures salvaged from dumpsters or exchanged for pennies at swap meets. My father and brother used to drive three to four hours from Santa Maria to visit Henry every month.

In 2012, during an historic summer heat wave, Henry’s neighbor phoned my father after seeing Henry collapse in his front yard. I lived 20 minutes away so my father asked me to meet the social workers he called about Henry.

I met two male social workers on nearby train tracks—tracks my father and Henry played on as children. The social workers lectured me on Henry’s civil rights, stressing that it was unlikely that they could do anything for him. I nodded, silently cried, and walked them to the driveway. The color disappeared from their faces when they saw my dehydrated uncle, looking like a castaway, crouched on a strip of soiled carpet. Grime, including his own feces and urine, caked his clothes and person. He held a pair of rusty, yet sharp, shears at arms length. He aimed these at the men.

The social worker standing nearest to Henry unhooked his phone from its holster. He dialed and said, “I’m going to need a bus and back up.”

An ambulance drove Henry to a Long Beach hospital. I followed behind the gurney as paramedics wheeled Henry into the psychiatric unit. There, I helped him bathe and change into a gown, and placed his clothes and belongings in a plastic bag.

After about four hours, a doctor came. He shook hands with Henry and introduced himself, and then my uncle issued one of the perfectly crisp proclamations he occasionally makes: Henry Gurba. United States Army. Second Lieutenant. Artillery. I served in Vietnam.”

Then, he mumbled, “You look like Shatner.”

“What?” asked the doctor.

“My uncle says you look like William Shatner,” I said. “He’s complimenting you. You’re charismatic. Like Captain Kirk.”

I had unofficially become Henry’s translator.

Mostly I glean what he means through deductive reasoning. For example, Henry once pointed to empty wall space above his bed, where his calendar had been hanging, and said, “My chickens flew away. Have you seen them?” Each calendar month features a large, glossy hen photo. Chickens mark Henry’s concept of time.

“We’ll find your calendar,” I promised. We did.

Decoding his intent is a matter of listening, and looking, and keeping track of the other relationships in his “thicktionary.” But Henry needs more than translation.

Getting him proper care has been a battle. When my father went to the VA Santa Maria Clinic to ask how he could get medical care for Henry, a representative insisted Henry had to go to a VA hospital to seek it. When my father protested that Henry’s mental illness made that complicated, the representative insisted that Henry’s “military training would make it easy for him to navigate the system.” But aside from the initial diagnosis, the VA has done nothing to attend to his psychological needs.

Henry doesn’t necessarily want care from the VA either—though we family members know he’s entitled to it. He doesn’t trust the army or anything related to it. He once told my father, “They tried to kill me once. I’m not going to give them a second chance.” The only time we experienced timely attention was after we phoned Congresswoman Grace Napolitano’s office. The VA has also failed to place Henry in one of its nursing facilities, even though we requested it about a year ago. Medi-Cal, health insurance for low-income Californians, covers Henry’s care at the residential nursing facility where he lives now.

But of the dangers Henry has faced, the worst is loneliness. That’s why Henry knows the name of every resident, doctor, clerk, administrator, nurse, and orderly at his nursing facility, and when he sees them, he smiles and greets them. They smile back and greet him.

I moved to within five minutes of Henry in Long Beach and visit him at least twice a week. I take him to the Santa Monica Pier, Chinatown, the tar pits, and the zoo—places that evoke childhood memories or that have animals.

During our outings, Henry often talks to strangers and I watch, observing how once Henry’s words dip into the poetry of schizophrenia, listeners’ facial expressions shift. Their facial features conspire to say, “This dude is crazy.” They turn and walk away.

But my time with him has taught me that, with love—and by love, I don’t mean greeting-card sentiments but love founded on expansive curiosity— Henry can be understood. And one of the primary shifts in my understanding of Henry is that it’s easy to feel that he is a danger. It’s harder, but vastly more loving and real, to appreciate how for him, everything is dangerous.

Myriam Gurba is a teacher, artist, and writer. She wrote Dahlia Season, a novella and short story collection, and Wish You Were Me, a poetry collection. She writes an irregular arts and literature column at radarproductions.org. This piece first appeared at Zocalo Public Square.

 

TIME Cancer

Angelina Jolie’s Surgery May Have Doubled Genetic Testing Rates at One Clinic

Actress Angelina Jolie leaves Lancaster House after attending the G8 Foreign Minsters' conference on April 11, 2013 in London.
Actress Angelina Jolie leaves Lancaster House after attending the G8 Foreign Minsters' conference on April 11, 2013 in London. Oli Scarff—Getty Images

When Jolie announced her surgery to prevent cancer due to a genetic predisposition, she encouraged other women to get checked too, study says

In 2013, actress Angelina Jolie announced that she had undergone a preventive double mastectomy because she was a BRCA1 gene mutation carrier, which puts her at very high risk for breast and ovarian cancer. Jolie also had a family history of these cancers.

Soon after, TIME wrote a cover story–“The Angelina Effect“–looking at what impact her decision could have on women who carry the dangerous BRCA1 and BRCA2 genes and therefore may be at risk for breast and ovarian cancers. Now, a new study being presented at the 2014 Breast Cancer Symposium shows that the Angelina effect is indeed real.

The study authors did a retrospective review of records from a cancer center in Canada and discovered that in the six months following Jolie’s highly publicized surgeries, testing and counseling around genetic testing nearly doubled. The researchers compared the number of counseling sessions and testings in the six months before and after the announcement and found that the number of women referred to genetic counselors by physicians increased 90%, and the number of women who qualified for genetic testing increased 105%. The researchers say this led to a two-fold increase in identified BRCA1 and BRCA2 mutation carriers.

“After Angelina Jolie’s story was released, physicians were probably more proactive and referred more patients; at the same time, patients were more likely to request and seek genetic counseling,” said study author Dr. Jacques Raphael, a clinical fellow at Sunnybrook Odette Cancer Centre in Toronto, Canada, in a statement.

Estimates vary, but BRCA1 and BRCA2 gene mutations are said to increase a woman’s risk for breast cancer by well over 50%. Only about two to four of every 1,000 women carry the gene mutation (men can have it too) and it is more common among women with histories of ovarian and breast cancer in their families, as well as people of Ashkenazi Jewish descent.

Jolie isn’t the only celebrity with a known health “effect.” In 2000, TV personality Katie Couric underwent a colonoscopy on live television, which prompted a surge of 20% more colonoscopies across the U.S. (dubbed “The Katie Couric Effect.”) This recent study, although small, suggests that Jolie’s announcement and the resulting media coverage encouraged more women to opt into genetic testing–and that prominent figures like Jolie can impact how women approach their health in real, measurable ways.

TIME Barack Obama

Can Stress Make You Go Grey? (Even If You Are Not Barack Obama)

The President's hair may not be a marker of a tough time in office

Speaking at a Labor Day event Wisconsin Monday, President Obama tried to fire up Democrats to vote in the November’s midterm elections by reminding them of what he’d sacrificed on behalf of American workers—namely his youthful black hair.

“Every gray hair is worth it,” the President said.

As is evident in the timelapse video below, it’s clear that Obama is notably grayer than when he entered office and the change is extraordinary, but as any logician/annoying know-it-all-friend will remind you, correlation does not imply causation. But could Obama be right? Can job stress make you go gray?

The current evidence suggests that “stress does not cause people to have gray hair,” says Dr. Ken Anderson, founder of the Anderson Hair Sciences Center in Atlanta. In other words, parents who complain that their teenagers are turning their hair gray probably can’t blame their new hair color on the 16-year-old. “That’s called aging. That’s father time doing that to them,” Anderson said.

Still, the science on the matter isn’t settled. A 2013 study on mice, published in Nature Medicine, suggests that stress or injury to the skin around the hair follicle can cause a depletion of melanocyte stem cells—which are responsible for hair’s color—resulting in gray strands.

What we do know is that a change in hair color is most often the natural result of a reduction in melanin—the pigment that adds color to your hair—which occurs naturally over time. The odds of your hair turning gray increase by between 10% and 20% every decade past age 30. Other factors that can cause your hair to change pigment, or lose pigment, include pollutants, chemical exposure, some medications and even climate.

If the president is losing his hair, it could be due to job-related stress, but even then it would have to be an extraordinary situation. “Stress can cause hair loss, but not the kind of stress that we have every day,” he said. “It’s the kind of stress like your wife of 50 years dies…that kind of stress can really raise the stress hormones in the body and cause hair loss.”

Obama ain’t the only one.

TIME psychology

Hooray for the Mundane! Ordinary Memories Are the Best

Life's peak experiences sometimes pale in comparison to the routine business of living, a new study shows. That "what is ordinary now becomes more extraordinary in the future" can have some positive implications for our state of mind

Never mind those dreamy recollections of your fab trip to Rome or that perfect night out last Valentine’s Day. Want a memory with some real sizzle? How about that time last week you went out for a tuna sandwich with the guy in the next cubicle? Or that trip to the supermarket on Sunday? Hot stuff, eh?

Actually, yes. Ordinary memories, it turns out, may be a lot less ordinary than they seem—or at least a lot more memorable—according to a nifty new study published in the journal Psychological Science. And that can have some positive implications for our state of mind.

It’s not entirely surprising that the experiences we often think should have the greatest impact on us sometimes don’t. For one thing, we tend to expect too much of them. The first time you stand in the Colosseum or stare up at the Eiffel Tower is a gobsmacker alright, but while those moments nicely enhance your life, they typically don’t change them. What’s more, in the weeks and years that follow, we tend to re-run the memory loop of the experience over and over and over again. Like a song you hear too much, it finally becomes too familiar. To test how much we underestimate—yet genuinely appreciate—the appeal of our more mundane experiences, a group of researchers at Harvard University’s school of business devised a multi-part study.

In the first part, 106 undergraduate volunteers were asked to compile an online, nine-item time capsule that included such unremarkable items as an inside joke they share with somebody, a list of three songs they were currently listening to, a recent status update on Facebook, an excerpt from a final class paper and a few recollections of a recent social event. They sealed the virtual capsule at the beginning of summer and were asked to predict how interested they’d be, on a scale of 1 to 7, in rereading each item when they reopened it a few months later, and how surprised they thought they’d be by the details of the contents.

After the students did get that opportunity at the beginning of the fall semester, they used the same 1 to 7 scale to rate how meaningful and interesting they found the items. On item after item, the interest, curiosity and surprise they felt was significantly higher than what they had anticipated three months earlier.

In the second part of the study, a different pool of participants did something similar, but this time wrote about a recent conversation they had, rated it on whether it was an ordinary or extraordinary one (what they had for dinner the night before, say, compared to the news of a new romantic interest), and predicted again how interested they thought they’d be about reading the description a few months down the line. Here too, they wound up lowballing those predictions—finding themselves much more interested than they predicted they’d be. And significantly, the more mundane the conversation they described was, the wider the gap between their anticipated interest in it and their actual interest when they re-read the description.

The third part of the study replicated the second, but this time used only volunteers who did have a romantic partner, and asked them to describe and anticipate their later interest in an ordinary evening the two of them had spent on or before Feb. 8, 2013, and the one they’d spent one week later, on Feb. 14. Here too, the Valentine date did less well than the subjects expected compared to the surprise and pleasure they felt in reading about the routine date.

“What is ordinary now becomes more extraordinary in the future,” said lead researcher Ting Zhang, in a statement that accompanied the study’s release. “People find a lot of joy in rediscovering a music playlist from three months ago or an old joke with a neighbor, even if those things did not seem particularly meaningful in the moment.”

One way to correct this imbalance—to take more pleasure in the day-to-day, nothing-special business of living—is merely to try to be more cognizant of those moments as they go by. Another, say Zhang and her colleagues, is to document them more, either by writing them down or, in the social media era, by sharing them. But there are limits.

“[T]he 5,000 pictures from one’s ‘extraordinary’ wedding may be excessive,” the researchers write. The same is true, they warn, about photo-documenting every plate of food that’s set in front of you rather than just getting down to the pleasurable business of eating it—a practice that they say is leading to “an unhealthy narcissism” growing society-wide. Recording our lives for the biopics that are constantly playing out in our heads is fine, but sometimes that has to give way simply to living those lives.

TIME Diet/Nutrition

What’s The Best Diet For Weight Loss: Low-Carb or Low-Fat?

They're equally good, study says

If your goal is to lose a few pounds, there’s a crowded library of best-selling programs to get you there. But which one is best? A new analysis published in JAMA shows that you might not have to worry about that so much, at least when it comes to two of the more popular diet regimens, low-carb and low-fat. No matter which one you choose, you can’t really go wrong.

After analyzing data from about 50 clinical trials involving 7,300 overweight or obese dieters, researchers found that any low-carbohydrate or low-fat diet resulted in significant weight loss. No single program contributed to a dramatically larger drop in pounds: people cutting back on carbs lost 19.2 pounds on average after a six-month follow-up, while low-fat dieters lost 17.6 pounds.

After a year follow-up, some of those pounds crept back for people on both diets, but still resulted in a 16-pound drop for people on low-carb or low-fat diets.

The authors say that these results should help people to find the diet that’s most likely to work for them, rather than forcing them to make drastic changes in their eating habits, which studies have shown aren’t effective in helping people to change what they eat and keep pounds off. “Our findings suggest that patients may choose, among those associated with the largest weight loss, the diet that gives them the least challenges with adherence,” the researchers write in a press release. As long as you maintain your diet and drop calories, you’ll drop pounds, too.

It’s important to remember, however, that the study only looked at weight loss, and did not focus on other health markers, such as cholesterol or blood sugar levels. So the findings don’t address whether one diet trumps the other in protecting against heart disease or diabetes. But other studies did take such factors into account — new research released yesterday in Annals of Internal Medicine suggests that a low-carb diet might be better for the heart: people on that diet lost almost eight pounds more and had a lower risk for heart disease than those following a low-fat diet.

More comparisons of the popular diets are inevitable, but which diet you choose will likely depend on what you hope to accomplish — whether it’s losing a few pounds or lowering your risk of having a heart attack or developing diabetes. But as the latest results show, being realistic about what you can and can’t give up is a good place to start.

TIME Infectious Disease

How Ebola Might Cause a Food Shortage in West Africa

The United Nations warns of food shortages as Ebola tightens borders

+ READ ARTICLE

DAKAR, Senegal — Food in countries hit by Ebola is getting more expensive and will become scarcer because many farmers won’t be able to go to their fields, a U.N. food agency warned Tuesday.

The current Ebola outbreak in West Africa has killed more than 1,500 people and authorities have cordoned off entire towns in an effort to halt the virus’ spread. Surrounding countries have closed land borders, many airlines have suspended flights to and from the affected countries and seaports are seeing less traffic, restricting food imports to the hardest-hit countries. Those countries — Guinea, Liberia and Sierra Leone — all rely on grain from abroad to feed their people, according to the U.N. Food and Agriculture Organization.

The price of cassava root, a staple in many West African diets, has gone up 150 percent in one market in Liberia’s capital, Monrovia.

“Even prior to the Ebola outbreak, households in some of the affected areas were spending up to 80 percent of their incomes on food,” said Vincent Martin, who is coordinating the agency’s response to the crisis. “Now these latest price spikes are effectively putting food completely out of their reach.”

An estimated 1.3 million people in Guinea, Liberia and Sierra Leone will need help feeding themselves in coming months, said the U.N.

The situation looks likely to worsen because restrictions on movement are preventing laborers from getting to farms and the harvest of rice and corn is set to begin in a few weeks, the FAO said.

The World Health Organization is asking countries to lift border closures because they are preventing supplies from reaching people in desperate need. Ivory Coast decided Monday night to keep its borders with Guinea and Liberia closed but said it would open a humanitarian corridor to allow supplies in.

The world’s worst-ever Ebola outbreak has killed more than 1,500 people in Guinea, Liberia, Sierra Leone and Nigeria.

A separate Ebola outbreak has hit a remote part of Congo, in Central Africa, the traditional home of the disease. So far, 53 cases consistent with Ebola have been identified there of whom 31 have died, WHO said Tuesday.

TIME Infectious Disease

Another American Doctor Infected With Ebola, Charity Says

Another American missionary doctor has tested positive for Ebola, an aid group said Tuesday.

SIM USA said the doctor, who was not named, was treating obstetric patients at ELWA hospital in Monrovia and had not treated Ebola patients in the hospital’s isolation unit, which is separate from the main hospital. The charity said it was not yet known how the doctor was infected, but he immediately isolated himself when he showed symptoms.

The new case comes two weeks after Dr. Kent Brantly and his colleague Nancy Writebol, who worked for SIM, walked out of an Atlanta hospital virus-free after being infected and evacuated from Liberia…

Read the rest of the story from our partners at NBC News

TIME Infectious Disease

Window to Stop Ebola Outbreak Is ‘Closing Quickly,’ Official Warns

A burial team in protective clothing retrieves the body of an Ebola victim from an isolation ward in the West Point neighborhood of Monrovia, the capital of Liberia on Aug. 28, 2014.
A burial team in protective clothing retrieves the body of an Ebola victim from an isolation ward in the West Point neighborhood of Monrovia, the capital of Liberia on Aug. 28, 2014. Daniel Berehulak—The New York TImes/Redux

The CDC says more needs to be done to fight Ebola before it's too late

The window of opportunity to stop the Ebola outbreak in West Africa is “closing quickly,” a top health official said Tuesday.

“The number of cases is so large, the epidemic is so overwhelming and it requires an overwhelming response,” Tom Frieden, the director of the Centers for Disease Control and Prevention (CDC), told reporters Tuesday after returning to the U.S. Monday from a trip to the affected counties.

Despite the efforts of health workers from the affected countries and elsewhere, cases of Ebola will continue to increase, Frieden said. Moments after his remarks, an aid group announced that another American doctor fighting the outbreak in Liberia has been infected.

Groups like Doctors Without Borders that are treating patients are overwhelmed by the high number of cases, and have had to turn away infected people due to lack of space. Frieden said he saw patients lying on the ground in some West Africa clinics. He stressed that Ebola is a global problem, and that closing off affected countries like Guinea, Liberia and Sierra Leone—many airlines have stopped flying there—will only worsen the outbreak by cutting off access to needed supplies.

“Getting supplies and people in is a big challenge,” Frieden said. “The more the world isolates and stops contact with these countries, the harder it will be to stop the outbreak.”

TIME Cancer

British Parents Who Pulled Son from Cancer Ward Won’t Be Charged

Ashya King's Parents Extradition Hearing In Madrid
A policeman stands guard as a police van allegedly holding Brett and Naghemeh King, parents of five years old Ashya King arrives at the National Court on Sept. 1, 2014 in Madrid. Pablo Blazquez Dominguez—Getty Images

Police arrested Brett and Naghmeh King in Spain, where they had sought an alternative treatment for their 5-year-old son's brain tumor

British prosecutors will not press charges against a couple for taking their 5-year-old son from the cancer ward of a hospital without warning and flying to Spain to seek alternative treatment for his brain tumor.

The couple was arrested in Malaga, Spain over the weekend, where they were arranging to sell a home to fund an alternative treatment that they said could only be found outside the U.K., CNN reports. The withdrawal of their son from hospital sparked an international manhunt.

Brett and Naghmeh King said they felt they had no choice but to remove their son from treatment at University Hospital in the southern city of Southampton, after doctors there refused to agree to proton beam treatment that the parents argued was less invasive than chemotherapy. Their son, Ashya, suffers from a malignant brain tumor called medulloblastoma.

“We pleaded with them for proton beam treatment,” said Brett King in a video plea posted to YouTube:

The Kings have refused to return to Britain and have made a public plea to police to call off their search. British Prime Minister David Cameron announced his support for the couple on his Twitter account Tuesday:

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