No family history of breast cancer – you’re fat, you’ll get it anyway.

A reader writes:
I’ve been fat nearly my entire life. At my adult height (5’9″) I have ranged in weight from 180lbs to 300lbs, at the time of this story I was 280lbs.

During a routine breast exam at a yearly check-up, the gynecologist felt a lump. She assured me that in my age group it would most likely be a cyst or some such, but the standard of care was to refer me to a specialist. I chose a breast specialist and I had regular appointments with her over the course of a year. She said the lump was just some extra cartilage, but she wanted to keep an eye on it to make sure. She never mentioned my weight until the last time I saw her a few months ago.

I had just had an ultrasound done on both breasts, and was wearing a stupid shrug-like gown that barely covered anything. She briefly said my ultrasound was fine, and nothing had changed from the first appointment. She then asked me what kind of exercise I did. I enthusiastically stated I had just started lifting free-weights and swimming. She nodded and didn’t really care or seem to think that was good enough. At first, I welcomed a discussion about my weight, because it was something I had never talked to a doctor about, and I wanted to. I quickly realized that she was not really interested in helping me.

She started by saying “If you ever get serious about weight loss, call me.” This confirmed my suspicion that my current exercise program was no good to her. She then launched into a lecture for about 45 minutes about my weight, while I sat there with my breasts hanging out of the gown. After she talked for a little bit, I tried to let her know I don’t take my weight lightly. I told her I had problems with my weight my whole life, and that my parents were obese, and that I am really trying hard. She said “We used to think there was a genetic factor, but now we know that is not true. It’s simple, it is all about calories in vs. calories out.” Wait a minute, she had JUST gotten done telling me that, for her, it doesn’t matter what she eats or exercises her weight stays the same, and she was wearing pants from ten years ago. But genetics don’t matter and it is all about calories in vs. calories out?

She then told me all about her fat friends. The ones who need seat-belt extenders on airplanes and through their experiences she really understood the struggle of weight-loss. She kept trying to get my to sign up for this program that I had never heard of before that she runs out of her office. I googled it when I got home and discovered it was a sub-set of medifast where you eat 1200 calories or less a day and exercise an hour (or more) every day.

I was livid. She had told me all about how obesity increases the risk for breast cancer, and she had treated obese patients my age (28) for breast cancer. I have NO history of breast (or prostate) cancer in my family. I am healthy in every way. I have no diabetes, high blood pressure, or anything. She basically tried to scare me to death with threats of breast cancer into paying her for an extreme weight-loss program.

Thankfully, I have found a registered dietician at my school who teaches intuitive eating, of which HAES can be a part though we haven’t discussed that yet. She has been wonderful in helping me control my overeating. I am a fat person who does have disordered eating, but that doesn’t mean that is all I am. My previous experience with the specialist really hurt my self-esteem and derailed my exercise efforts. Thanks to support from my wonderful dietician and a loving fiance I am going to take up rock climbing and get back to weight-lifting. My RD also let me know it is okay that I hate cardio! I can do what feels fun to me and just makes my body feel good without worrying about running on a treadmill to burn a certain number of calories.

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  1. Grr. This makes me SO angry.

    I’m a cancer registrar (meaning, I gather and collate information on cancer cases), and I can tell you now – breast cancer in women of your age is rare – 40-60 is a more typical age group, that’s why screening mammograms start at that sort of age. And when it does develop in young women, it’s almost always in families with a strong genetic risk. In fact, among pre-menopausal women, being fatter is known to reduce your breast cancer risk. And even while there’s thought to be an increased risk for fatter women post-menopausally, there’s no proof that weight loss reduces this risk – assuming that long-term weight loss is even possible, which is doubtful. There’s known to be a similar, if not greater, risk with HRT – it’s down to estrogen, which influences the growth of some types of breast cancer (usually the more easily treatable ones) – yet nobody’s urging women not to go on HRT for that reason.

    All that said, risk factors are just that – risk, not certainty. Women of all shapes and sizes get breast cancer, and the majority of them have no risk factors at all. And, as your gynecologist said, the majority of abnormalities at your age are likely to be cysts or other benign irregularities. She was right to get you checked out, but the specialist’s behaviour was beyond offensive, and you’d absolutely be justified in complaining if you can (don’t know what the system is where you are, but are health practitioners even allowed to sell commercial products like that?).

    Bottom line: blaming and shaming patients for any disease, or possibility of disease, is never helpful or acceptable. I’m so sorry this happened to you, and glad you’ve found someone to help you look after your health in a non-shaming way.

  2. How horrible! So glad you didn’t get sucked into that crappy diet plan! After my experience (which I will submit shortly) I felt awful…not necessarily about me, but just thinking about the women that my doctor DID succeed in scaring into pursuing unhealthy eating/exercise habits to conform to her definition of healthy.
    And I don’t like cardio, either. A Marine Veteran, my body FIGHTS running and all other attempts at high-intensity cardio. (I had knee problems in the Marines, and I still have problems with a medial meniscus tear – I had surgery to remove the one I sustained in the USMC, and when I was recovering, BAM! it happened again…so I decided, no more surgery for meniscus tears). Now, weight lifting…I’ll meet you there. I can just LOOK INTO the weight room and gain muscle mass. Like a boss! 😉

  3. redheademerald is right. Quite a bit of research shows that fat women are at LESS risk for breast cancer before menopause. The situation changes after menopause; we are more at risk then. But at your age, she was wrong that being heavy increased your risk for breast cancer.

    The key clue here is that she ran a wt loss program out of her office. You were nothing more than a potential revenue stream for her, and she saw this lump scare as a way to frighten you into her revenue stream.

    Beware the hard sell. It usually masks some sort of monetary motivation.

  4. That was completely unethical. She tried to use her authority to pressure you into buying something dangerous and ineffective. She even lied to you about what’s known about build and heredity. She deserves at least a warning from whoever licenses doctors.


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