Monday, June 20, 2011

Why me?

Early on in my breast cancer experience I went through a period of guilt. I think that everyone with cancer goes through this stage. I asked myself, what did I do wrong that gave me cancer?

So, here's what I found out.

Genetics: Well, my mom had breast cancer. She was much older than me when she got it (sorry, mom!); also, she was the only one in our entire extended family who got breast cancer. But the known breast cancer gene mutations bring a greater risk of breast cancer in younger women, which might explain my situation. So, I went through a full battery of genetic tests.

The results? Nope, I don't have any of the known genetic mutations.

Known risk factors: Okay, there are a slew of known and potential risk factors. Research into these risk factors is splashed across news sites every few weeks: all sorts of foods might cause breast cancer, caffeine might cause breast cancer, alcohol might cause breast cancer, medications might cause breast cancer, eating skittles while skydiving might cause breast cancer. With many of these risk factors, the link is tenuous, and it's often later found to be unsupported.

Some risk factors do withstand scientific scrutiny. Here's a handful of them. My risk rises if I'm black (which I'm not), if I smoke (nope), if I started my periods young (nope), if I'm obese (nope). It rises if I don't have kids (yup) and if I have dense breasts (yup). There are also all sorts of studies about diet and breast cancer, but they're so complex and nuanced that I gave up reading them. I've run across vegans, people who are lactose intolerant, and people from all sorts of dietary backgrounds who have cancer. Unraveling that link, if any, is going to be complex.

I was on the birth control pill shortly before my diagnosis, and I agonized about that for a long time. But I discovered that the link between the pill and breast cancer is ridiculously complicated. Also, if I count back to the time when the cancer may have started, I wasn't on the pill.

The results? Well, here's where I get on my soapbox.

Once, I came across an article called 'A clean-living young athlete with breast cancer asks: Why me?' There are some assumptions in that headline that really bother me. And after my research, I'm confident that the answer is this:

We don't know why young women get breast cancer. We may not ever know. And not knowing sucks. But no matter what risk factors a young woman may have, her odds of getting breast cancer are very low. Only about 5% of breast cancer happens in women under 40. Something like 0.03% of women my age get breast cancer.

So, whether you're a clean-cut young athlete, or somebody who doesn't run a lot of marathons; whether you've got kids or you don't; whether you eat only carrots or drink booze and eat cupcakes - you still probably won't get breast cancer young. The vast majority of young women who fall into a known risk category don't get breast cancer, and many people who get breast cancer don't fall into any risk category.

Here's the important bit: as far as we can tell, bad luck plays a big part in whether someone develops the complicated and mysterious cellular mutations that cause cancer. Life is about calculated risks, and the risk of getting breast cancer as a young woman is small.

I don't want to minimize the issue; breast cancer in young women is awful and it's something that needs more attention (a little self-promotion there). It's the second leading cause of cancer death in young women, robbing many wonderful gals of the future they deserve. Also, for reasons that we don't understand, the disease is more vicious in the young. We need money for research; we need to find out, for example, if environmental toxins are a key factor. Maybe all we need to do is stop the production of a few chemicals, and we can save hundreds of thousands of young women needless suffering.

But, back to personal responsibility: I'm not advocating destroying your body through rampant partying and misuse. A happy body leads to a happy brain. But assigning guilt and blame just doesn't make sense. This is something I struggle to internalize, but it's true. We women deal with enough needless guilt as it is.

In the case of this crime against my body, the thief is long gone and there are very few clues. I need to leave the evidence for the scientists and activists to sift through; my job is to pick up the pieces.