We could use a similar example today, not for breast cancer, but for the problem of babies born at the so called border of viability, about 23 to 24 weeks gestation. What to do with these babies - resuscitate them, not resuscitate them - is a big issue in neonatology yet is rarely discussed in society. I'm not wishing an extremely preterm birth on anyone, but if, say, the President or Vice-President had a child or grandchild born at 23 weeks gestation it could put the issue squarely into the public eye.
I have written about decision making regarding resuscitation of these kids before. Given their low rate of survival (30% for 23 weekers, 57% for 24 weekers) and the high rate of impairments in the survivors ( greater than 50%), is it justified to spend so much money on them? Does society want us to do everything we can for all of these babies? On the other hand, is it acceptable to simply let these kids die without trying? Maybe society would simply say that it's up to the parents, but shouldn't the public at least address it? My personal opinion, as I have mentioned before, is that we are not only justified in resuscitating these kids, we might be practicing age discrimination if we do not, because critically ill adults and older children with the above outcome statistics would without question be resuscitated.
I don't think, though, that we are likely to see society weigh in on the issue, for two reasons. One reason is that most people are not even aware of this issue, and of those that are many are only superficially so. The other reason is that it's a very tough issue, and most people would just as soon avoid discussing it if possible. Even some parents about to have an extremely premature baby try to opt out of decision making, doing whatever we suggest or seem to suggest.
So unless John Edwards or Barack Obama has a child, or John McCain a grandchild, born at 23 weeks gestation we are like to keep resuscitating these kids, paying perhaps a million dollars for medical care in survivors, and it will almost all be under the public's radar screen. We know about heart disease; we know about cancer; we even know a little bit about sickle cell disease. But extreme prematurity is an ethical issue ignored by the public, and it is likely to remain so for a long time.