As an oncologist, the focus of my job is looking after women with cancer. Being aggressive in the management of this disease was the one constant underlying principle during my training.
I was taught to always be wary and suspicious of everything. If the clinical suspicion was there, then you were obliged to prove its existence. Don’t trust an equivocal scan, rely only on biopsy confirmation, and if abnormal symptoms persisted, look elsewhere and check and check again.
When this eventually revealed a confirmed diagnosis of cancer, then it was all about how quickly and efficiently you were able to offer the appropriate treatment and give someone the best chance of a cure.
Even after treatment was complete, an intensive follow-up would commence which went on for several years and at every visit, it was crucial to be actively looking out for any worrying signs of disease recurrence, when the cancer might once again rear its ugly head.
At the end of the day, cancer management is all about being aggressive, and less so about being conservative. There is nothing like a “wait and see” approach as it is all geared toward preserving life in those with a serious health condition.
As many oncologists may admit, a healthy paranoia in this respect is a by-product of dealing with cancer. But for the many women that I see everyday who come to me for benign or non-cancer related issues, it can become a bit challenging.
Dealing with cancer day in and day out does make me occasionally forget that the majority of women who visit a doctor in fact do not have cancer. Many, including myself, are often guilty of being overly aggressive with tests, scans and even treatment as they may think that every woman who walks through the door might have something sinister until proven otherwise.
It is well known that symptoms of benign disease as well as cancer are often the same. For instance, uterine fibroids and uterine cancer both present with similar complaints, and indeed some women have both.
However, fibroids are significantly more commonplace especially in our population, but while many doctors would immediately consider the ordinary fibroid as the culprit, an oncologist may think of cancer first as the primary diagnosis.
Could this lady be the odd one that does not just have the routine fibroid but something more worrying? At the very least, I am duly obliged to rule it out.
This does not always sit well with my patients. After all they came for a problem that should be easy to sort out. They don’t necessarily want to be told that they should do x, y, and z in the event they fall into that small population of women with a malignancy. Or certainly, at surgery, they don’t want to remove x, y, and z just to prevent cancer later on in life when all seems completely fine at the moment.
Fortunately, for the majority of these things, there are accepted guidelines to follow on how to appropriately manage various conditions.
Many a time however, it may be a judgement call on whether to be conservative or aggressive depending on various factors such as age and family history. Although this is done after a thorough discussion with a patient, I am usually inclined to be on the surgically and medically more aggressive side of the fence.
Seeing so many people with cancer, including the all the worst-case scenarios and the ones that were sadly missed for months before finally arriving at a dismal diagnosis has undoubtedly made me suspicious of everything.
But what does the medical literature say about aggressive care? Some studies actually indicate that in the long run it may be more cost effective, while for surgery, there have been shown to be improved outcomes with those undergoing operations in hospitals known to have a more aggressive treatment style.
On the other hand, there are instances when aggressive care is not in the best interest of the patient. It is all a balance between risk and benefit, and this is not always easy to explain or understand.
However, it is our job as health professionals, oncologists or not, to be open and honest about these occasional complexities that may arise while offering medical care.
In addition to attempting to follow standard practice, there must consistently be detailed discussions with everyone involved and include all explanations on why a particular course of action is recommended.