Saturday, September 24, 2011

Scr$w F&ck Cancer

This TEDx talk, by Yael Cohen of the F-ck Cancer charity, made me pretty dang annoyed.

Yael's case seems air-tight at first. Here it is: her mom got cancer, and she learned that 90% of cancers are curable when caught early, so she launched a movement to help "cure" cancer by making us all find our cancers early. Sounds great, right?

Her narrative is pretty seductive. She says that people die from cancer because they're part of an apathetic generation (or generations). They often don't bother to look for cancer until it's too late. Yael uses the word "apathy" so many times, and so angrily, that you might figure it'd make a gal like me a touch sensitive about her later-stage cancer discovery.

And it does. So here's why her argument is wrong.

We can't stop all cancer in its tracks through early detection because (drumroll please)...

Cancer of the everywhere
Not to freak you all out, but did you can get cancer in just about every single part of your body? (I try not to say these things at parties.) I've met people with connective tissue, bone, kidney, blood, breast, ovarian, testicular, gut, muscle, uterine, and skin cancer, to name a few. You can't prevent every cancer because you can't check every single part of you all the time. This way lies madness, and in many cases it's simply impossible to check all of these places accurately, because of...

The trouble with cancer scans
Ok, so why don't we all just get total-body scans using those fancy machines at the cancer doctor's office? Welp, the best scans are insanely expensive, they blast you with enough cancer-causing radiation that frequent scanning would be counterproductive, and they tend to turn up a ridiculous number of of false positives. There is no way to scan specifically for cancer. There are just lots of ways to find cells that are dividing quickly, or forming a lump, which not all cancers do.

Mammograms, for example, catch lots of breast cancers, but they miss them, too, particularly in young women (who have denser breasts - yep, my breast was dense, poor little fellow). There's almost no way to catch many kinds of ovarian cancer until it's quite late-stage. The technology will get better, but it's not there yet.

Small lump = early detection?
But say your type of cancer is an easy-to-spot kind, and it's nothing but a small lump. Did you succeed in catching it "early"? Well, that's a matter of luck.

In my case, the fact that my lump was teeny (just a little wider than a penny) didn't mean that I caught it "early". My cancer had already spread to a bunch of nearby lymph nodes, pushing me to stage III. I've heard of women with .6cm tumors that have already spread to their bones. Smaller lumps are more likely to be curable, but that's not a guarantee.

Doctor error
Most of my young friends with cancer have a story that goes like this: "I went to the doctor and shared my concerns, but my doctor said I was too young for cancer." Cancer is definitely unlikely in young folks, and not all doctors know the signs. Sometimes a patient's best efforts don't lead to a correct diagnosis until it's too late.

A refined "cure"
So, sadly, as with many lectures of this nature -- lectures that seem so challenging and yet so obvious that you feel the satisfying sense of cutting through the "crap" to get to an epiphany -- this one's too good to be true. Yael's a passionate and brilliant speaker, and I'm sure she's a devoted daughter. But she's not a patient and she's not an oncologist.

A better, but less-catchy, way to reframe her speech is: early detection is possible in the case of some cancers. When caught early, many cancers are also much more curable. For example, breast cancer is 100% curable when caught at stage 0 (harder to scan for or check for), and it's 0% curable at stage 4 (when the cancer's very visible to scans). You're more likely to get a more curable cancer if your tumor's smaller or your cancer's more localized. It's not a guarantee, but it ups your likelihood.

So, go to the doctor. Get every single cancer screening that's reasonable and feasible for someone in your age group. If you find a lump or if something seems wrong, bug your doctor, and bug him/her again. Do the best you can; if you never see a doctor, there is no way your cancer could possibly get diagnosed at an early stage.

But if you're diagnosed with a later-stage cancer, for f&ck's sake, don't blame your own "apathy". And if your friend gets a later-stage cancer, for f&ck's sake don't call them "apathetic". It's not just insulting - it's deeply untrue.

One of my good friends is fighting a rare, metastatic cancer of the smooth muscle. She's a doctor, and very young; there is nothing she could have done to find her cancer early or to stop it. I want to hijack Yael's applause at the end of her talk and redirect it at my brave and strong f&cking friend.

(If you really want an adorably irreverent cancer charity, may I suggest Stupid Cancer instead? 100%-cancer-patient-approved)