Despite a generally frenetic work, medical, and social schedule (last week something took me out of the house every single day!) and despite the start of a new Eng. 102 section, I’ve managed to make a fair amount of progress on each of the book projects in hand.
One of the appendices for the Boob Book, “How to Read a Scientific Paper,” is finished. With that and the introduction in hand, now all I need to do is write one reasonably substantial chapter and a prospectus, and I’ll be ready to start peddling the thing.
Which chapter remains to be seen. In the order of the draft chapter outline, the first chapter discusses DCIS vs. actual invasive cancer. The next goes into the considerations a woman needs to make when faced with the question of whether to do a lumpectomy (or repeated lumpectomies, which occur in about 48% of cases) or to elect a mastectomy.
However, in the chapter outline as it stands, the book does not go into the controversies over mammography and screening. This is pretty fierce stuff, and when you look hard at it, pretty disturbing. Because the push to screen all women — some circles would like to see girls having mammograms shortly after their first menstrual period — is so ubiquitously advertised, so harmful to so many women, and so controversial, I wonder if I should include some discussion of it.
I didn’t put that subject into the original draft outline because one of the book’s underlying assumptions is that the reader already has a diagnosis, and so the question of whether to subject herself to repeated mammograms is moot. The book is intended as a tool for women who have to cope with an existing diagnosis of DCIS or early-stage invasive breast cancer. So the whole pink ribbon flap is really beside the point.
What I’ve got as my first chapter is hardly the stuff of television documentaries. However, the chapter on reconstruction certainly is. If I skipped over the first several chapters and went straight to the one on deciding whether or not to have reconstruction, that would get an editor’s attention.
I have some seriously controversial things to say on the subject, which parallel Gayle Sulik’s observations about the money motives behind the pink ribbon movement. My line of thinking focuses on the profit centers that drive the pressure put on women to agree to implants and major surgery to create fake breasts.
It probably would make sense to do that: cut to the liveliest controversy. The table of contents will make the rest of the book’s direction clear.
There’s a lot of material here. I just need to get to work on it!
I wonder if the mammogram stuff would do well as another appendix? Just a thought.
I think it deserves a chapter. There’s quite a lot of controversy around the subject. I’m not about to rehash everything Barbara Ehrenreich and Gayle Sulik have already covered in spades, but I do think that when women are trying to make decisions for their own care, they should know what mammography can and can’t do, and that every time you have a mammogram, there’s a certain degree of risk involved.
On the other hand, there’s a degree of risk in declining to be screened on a regular basis. The latter depends on your age, your genetic background, your drinking and smoking habits, possibly the environments you’ve lived in, and (bizarrely enough) your socioeconomic status.
I agree with all that, I was just thinking of what you said about the underlying assumption of the book being that the reader already has a diagnosis. If you put it in an appendix, then you could cover the material without disrupting the flow of the book. On the other hand, you actually know your material and how you plan to organize it, so if you think it deserves a chapter it probably does.
The flow for the whole process that leads to a diagnosis and one type or another of treatment starts with mammography. Since that process sometimes can involve overtreatment stemming from false positive mammogram results, the first decision a woman needs to consider is getting a second opinion on the mammogram and biopsy — possibly even before allowing a biopsy to happen.
A great deal of hysteria surrounds the issues of breast anomalies. Women need to be aware of that and be prepared to cope with it.