Saturday, May 7, 2011

Am I cured yet?

This is a tough post to write, but I think it's pretty important.

People keep asking me when I'll know that the treatment worked and that I'm cured. It's a totally reasonable question, but it's also, unfortunately, impossible to answer.

Detecting cancer cells isn't an exact science. Mammograms don't catch all cancers, breast self-exams are useful but crude, and the mother of all scans - the PET/CT - can't detect the tiniest of tumors.

Treatment isn't perfect, either: the goal is to eliminate enough cancer cells so that the body can clean up the rest of it. Once breast cancer spreads to the rest of your body and takes hold, it's incurable. (Compare and contrast to Lance Armstrong's cancer, which was curable even though it had spread to his brain, lungs and bike helmet.) To read more about this stage, check out this extremely excellent article.

In the middle of the night, I sometimes ask myself, where's my tricorder?

There's a big misconception that once treatment is done, it's over. Here's the truth: once treatment is done, the waiting begins. Every ache and cough could mean that the cancer has spread. If I make it two years without the cancer spreading, that's great. If I make it another three years, that's really great. If I make it ten years, the odds are low that the cancer will spread. Hormone-positive breast cancer is never, ever declared cured.

I'm not going to detail my odds here. Though there's reason for optimism, they don't paint a full picture, and the more we learn about my cancer as we go, the fewer statistics there are for my unique situation. I'm at one of the best cancer centers in the country, and my cancer is somewhat slow-growing. Breast cancer is relatively treatable when compared with some other illnesses. These are comforting to me. But if I continue to be afraid for a long time, here's why.