Where Science Meets Health Literacy: One Doctor, One Patient, and 40 Years of Progress
For readers who know me well, you know I often wrestle with having too many good ideas at once. October is no exception. It marks both Breast Cancer Awareness Month and Health Literacy Month. Rather than picking just one, I am linking them together—because clinical progress only fulfills its promise when patients have the health literacy to act on it.
A 40-Year Evolution in Breast Cancer Care
In 1977, while attending Albany Medical College, I met my lifelong friend Dr. Scott Kurtzman. I was heading toward geriatrics, while Scott pursued surgery. When we reconnected this past spring, we recalled how breast cancer was presented in our medical school textbooks: frequently caught late, diffuse, and carrying a five-year survival rate of barely 50–60%.
Dr. Kurtzman, now a world-renowned leader in breast surgical oncology, pointed out how dramatically the paradigm has changed. Thanks to aggressive screening and personalized treatment, breast cancer caught early in its localized state now carries a 99% five-year survival rate, with overall five-year survival exceeding 91%.
Broad Trends in Modern Oncology
This progress reflects a broader revolution in cancer management over the last 20 years:
- Plummeting Mortality: Overall cancer deaths are down over 30% from their 1991 peak.
- Precision Medicine: Immunotherapies and targeted gene treatments have replaced old-style blanket chemotherapy for many conditions.
- Advanced Diagnostics: Early detection tools—including 3D mammography, genetic profiling, and low-dose imaging—catch abnormalities long before symptoms appear.
Where Science Meets Health Literacy: A Patient’s Journey
Navigating these medical advancements requires health literacy—the ability to understand health choices and make informed decisions alongside your care team.
Few patients illustrated this better than a woman who underwent a successful mastectomy at age 75. She remained under my care for decades. At age 92, still driving and living independently, a routine physical exam revealed a local recurrence.
Determining the right path for a nonagenarian requires careful clinical judgment and clear communication. Together with her surgeon, we evaluated her overall health, tumor behavior, and personal goals. Building on years of mutual trust, we agreed on a limited surgical resection.
Her recovery was flawless—a result of her resilient spirit, family support, and informed trust in her care team.
She honored a personal promise to me by retiring from driving at 95, relocated to an independent living community at 98, and invited me to sit at her table for her 100th birthday celebration.
As I sat with her on that milestone day, I reflected on our shared journey. Her story highlights four decades of medical innovation, but more importantly, it underscores why health literacy matters: when patients understand their health, stay up to date on screenings, and actively partner with their doctors, extraordinary outcomes are possible.
To a Long and Healthy Life,
David Bernstein, MD
