What Are the Odds?

It's easy to play the statistics game when it comes to health. Some play it like skateboarding, grinding through the dangerous health risks and cheating death - and some succeed. Others play it for security, doing all the right things in some pact for guaranteed longevity - and for some it works.

I was an ovo-lacto vegetarian for nearly twenty years. I raised both of my children as vegetarians, with an eye to healthy nutrition and eschewing food fads and extreme notions. As a family, we ate nothing with a face. My cholesterol and triglyceride levels were always remarkably good, and we ate primarily low-fat foods and few desserts, since I was always watching my weight. I drank rarely and didn't use recreational drugs. I even used a non-toxic approach to termite assassination. I lived clean.

The year I got cancer I had just lost 30 pounds and had become an Elliptical Training Demon. I never felt stronger or healthier. I had no family history of breast cancer, and cancer appeared only on my father's side of the family history. At a fertile 51, I'm "young" in the breast cancer world, and that's how I felt: informed, bright, strong, vibrant, healthy, with a goal to lose the last 30 pounds in 2007, and then approach the next 50 years of my life with new strength and no chance of obesity-related illnesses.

I don't know what my odds of getting breast cancer were, but I'm pretty sure they were low. My first lesson in real-life statistics was this: if the statistics are against something and you get it, then it becomes 100% odds in your case. All the predictive aspects of statistics are then rendered meaningless. The radiologist hinted at this during my call-back ultrasound. I asked him what the chances were that what he was looking at was cancer. He said, giving you a number is meaningless. If you have it, it's 100%. Whoa.

But statistics became important again when I had to make a decision about my treatment. My circumstances were plugged into a computer model that spit out my chances in the form of bar-graphs, and I landed smack in the middle of the Gray Zone. With my lumpectomy and planned radiation and hormone treatments, the doctor was comfortable letting me weigh the benefits and risks of chemo and come to my own decision. Thanks, doc. He did point out that my tumor size (1.1 cm) bumped me up into the second size category, along with all the bigger ones up to 2.0 cm., so that my odds were probably skewed better than on the charts. According to my future in the form of bar graphs, doing chemo would give me a 6% higher chance of making it to ten years without a relapse.

I asked him lots of questions, but most of his answers were non-directive: It depends , No one knows, It's individual. He was not helpful. I agonized for nearly a week and as I approached our agreed-upon decision deadline, two unanswered questions burned in my mind as being critical to my deciding:
How bad is it to relapse?
Is my first shot factually my best shot?
Don't you think an oncologist presenting you with a life and death decision like this should have addressed these questions up front?

I asked, and I got: Relapse is horrible - once it happens there's a 95% chance you will not be cured. The radiological oncologist told me: The first shot is your best chance, so get as aggressive as possible. Easy, decision made.

I later realized that because the statistics he gave me necessarily tracked women for ten years, that meant the treatments and methods were ten-year-old technology. During a recheck with my excellent surgeon, he nearly clapped his hands with glee that I'd decided upon adding chemo to my treatment regimen. He was my first educator about breast cancer upon my receiving the biopsy result, and so his opinion matters to me. He told me that realistically, I probably will have a 99% chance of a cure now (higher than the 91% on the bar graph). That's one statistic I'm going to believe.