On medical progress and stage 4 breast cancer
By Gayle A. Sulik
Elizabeth Edwards died from stage 4 breast cancer (also known as metastatic breast cancer) on December 7th, 2010 at the age of 61. Ms. Edwards was a well-known public figure, notably the wife of former Senator John Edwards, and an accomplished lawyer, author, and health advocate. Her death inspired new discussions of Stage 4 breast cancer, finally shining a light on what has been a relatively invisible segment of the breast cancer community: the diagnosed who live from scan to scan, treatment to treatment, with the knowledge that neither medical progress nor positive attitude will likely keep them from dying from breast cancer.
Following Ms. Edwards’ breast cancer diagnosis in 2004, she quickly became a celebrity survivor. She expressed optimism about cure and continued to pursue an active personal and professional life. After learning in 2007 that she had a recurrence which had already spread to her bones, Ms. Edwards still looked for a “silver lining” despite the fact that her breast cancer was no longer considered to be curable. At that point, doctors called her breast cancer “treatable” – meaning that she would be in some kind of therapy for the rest of her life.
Ms. Edwards knew that she might not live to see her children grow up. Yet public discussions were hesitant to acknowledge this reality. I remember the PBS news report that featured clips from a press conference in which Edwards’ medical doctor, Lisa Carey of the University of North Carolina Breast Center, stated that many women with stage 4 breast cancer “do very well for a number of years.”
In the interview that followed with Dr. Julie Gralow of Fred Hutchinson Cancer Research Center, the discussion of prognosis was similarly vague. Dr. Gralow rightly revealed that doctors have “no crystal ball” to see the future and that average survival rates cannot be used to predict an individual’s life span. However, she also circumvented the prognosis issue by using phrases such as “years of survival” and living out “long lives.” We heard about “terrific new therapies,” “great treatments…that don’t cause a lot of symptoms,” and and a new “era of personalized cancer therapy.” Dr. Gralow stressed that Ms. Edwards gives hope to those who are fighting metastatic breast cancer and that “her biggest issue is that she has a couple of young kids to raise.”
Immediately following Ms. Edwards’ death, Dr. Barron Lerner wrote a warm, thoughtful, and informative essay in The New York Times about the lessons society can learn from Ms. Edwards, including the limits of current treatments and the dubiousness of the term “survivor” that, while empowering in some ways can be misleading in others. For the 49,000 new people each year who develop what amounts to be a