here’s what I know so far, so far

IMG_4099This photo is just here to remind me how full the moon was, back when I started thinking about writing this post.  It took more than the usual dose of pondering, to figure out what I wanted to say.

And so, here I am, in the calm after the storm of my bad news mammogram detour of 2012-13.  I’ve got a full head of hair, both darker and grayer than before, but hey, it all came back.  And I remain enormously grateful for the care I received, and for the family and friends who warmed my heart with good cheer along the way.  Sure, I’ve got some health issues I’m dealing with these days, but as one of my docs noted last week, my joint aches and pains aren’t even vaguely malignant.  And this I know for sure: compared to what I was worrying about last winter, my medical concerns today are strictly garden variety.

And yet…there’s this thing that happens, when you’ve faced a cancer scare.  Inevitably, some noteworthy study hits the news cycle, about what you just went through.  And trust me, it’s not anywhere near as much fun as reading the Sunday travel section about vacation spots you’ve already visited.  No, the stories that bubble up to the top of the media pages these days about cancer care (no stories about cures, I’m sad to report, and few stories about prevention, beyond “Eat more kale”) tend to make a person who’s been down that road question…well, everything.

Starting with the detection piece.  I’ve told practically every woman I know to insist on getting 3D mammograms.  It was a 3D image that found my tiny lump and sent me down my treatment path.  The mantra was repeated as well-documented fact: early detection is key.  Finding breast cancer early and catching it before it spreads is the name of the game. A slam-dunk no-brainer, it seemed.

Except that one recurring tidbit of “new” news left me wondering if early detection was truly the key to everything.   Does knowing sooner actually save lives, or have medical practices simply ramped up the success rate by “curing” us of non-lethal lumps? Why haven’t the odds of survival from the really scary breast cancers, the ones that metastasize and invade other body parts, improved significantly, with early diagnoses?  How many years will it be before that spot on a film image can be positively identified as an ornery, take-no-prisoners tumor gone rogue, versus one that’s just bobbing around in the shallow end of the cancer pool, never to reach its malignant potential?  When will we be more usefully informed, beyond what we know today?

IMG_4323This photo I’ve inserted purely for visual joy.  Though, now that I think about it, an image like this one might provide a useful lesson in perspective.

“Here’s What I Know So Far” is the name of this blog.  It started out as a subject line for the emails I had, back and forth, early on, with my beloved.  Between the mammogram and the biopsies and the surgery and various tests, the definition of What I Know So Far became a bulging file folder of data.  I learned, for example, that from a cohort of four sisters and a mother, one’s family circle can collectively go 4 for 5 in the breast cancer derby, but can still all come up blissfully negative on the tests for scary genetic mutations that drive women to harvest their eggs and offload their reproductive plumbing.  It’s the sort of information that starts out as a “phew!” and ends up leaving a person (that would be me) wondering, “Well then, why?”  What were we all exposed to, back in the day? Was it the DDT sprayed on the blueberries that we scarfed from the side of the road?  Was there something in the lime dust that settled all over our neighborhood, from the kilns down the street?  Too many Diet Pepsis drunk out of plastic bottles, too much aerosol cheese? Was it the glue vapors hanging in the air, back when my brothers made model airplanes, or the second hand smoke from my parents’ cigarettes? How will I ever know?

Bottom line: there’s nothing to be done about the facts you don’t have.  You can only go on what you know so far, however imperfect the current information may be.

I got the mammogram callback, I got the tests, I got the surgery.  While I was lying on the operating table getting lumpectomied, my surgeon biopsied some cells from my sentinel node, site of the presumed next stop for any breast cancer cells with a wanderlust component.  Alas, my little breast lump had already dispatched some of its friends to my armpit.  And with that, “In situ” were words that didn’t apply.  We were not being overly cautious, and I was not about to be over-treated.  We had a situation here.

So, as I sit here typing, what do I do with the realization, the weird relief, that nothing I’ve done seems to have been uncalled for?  My plan of attack was based on the best information available.  I didn’t get a radical mastectomy, like my mother did 35 years ago, back when the known facts of breast cancer were even fewer and farther between.  But I also didn’t spend much time pondering a wait-and-see option, or checking out alternative treatments.   What I banked on, and am relieved by, is the knowledge that the surgical, oncological and radiological plan that was set into motion to rid my body of cancer was a combination of the best options available.  With what my doctors knew at the time.

With what we all knew so far.

The tasks that lie ahead for researchers are the same ones they’ve been tackling for decades: that is, how best (how most safely, how least invasively) to rid the human body of any sort of cancer, and how to prevent cancers from spreading to other organs and body parts.  Oh, and while you’re at it, dream big, and see what you can do to prevent cancer from striking in the first place.

No small feats.  But also, no room for make-believe success stories.

As for what I went through, there will be better testing down the road, including screenings to determine when and how often women need mammograms, based on one’s genetic makeup and family history.  There will be further fine-tuning, to upgrade best courses of treatment, dosages and delivery methods.  All these improvements will make the trauma of a lousy mammogram result just a little more tolerable, and a whole lot more successful, bit by bit.

In the meantime, my friends, here’s my continued, if somewhat revised, entreaty: Have these conversations with your docs.  Get answers to the questions: Am I at risk? Should I get that baseline examination? Don’t throw out the baby with the bathwater on mammograms, and don’t let years go by before you schedule the one you were due for six months ago.  Accept the fact that there’s no perfect information. But find out what you can, and do right by your health, with what there is to know. So far, anyway.

IMG_4324Chuck Close, from far enough back to see the whole.

Sometimes you have to stand back to see the big picture, and to figure out what you know.

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