Earlier this month in clinic a patient with a small, early-stage breast cancer posed a familiar series of questions: Am I cured? If my cancer is gone, why do I have to take this pill? When can I stop worrying? Do I celebrate at 5 years?
I wish these questions had straightforward answers. But they don’t. For that reason, I think very carefully about how I respond to each one. Chances are my answer may differ from your oncologist’s answers. Even so, my answers typically go something like this:
I believe your surgery cured your cancer. If you want to tattoo a date on your body or celebrate a date with your family and friends every year — that is the date I would choose. That, of course, isn’t the day that you may have found your cancer, or learned you might have cancer, or had a biopsy to determine if you did. But it is the date the surgery we believed would cure your cancer happened. If any of us on your breast cancer care team believed the surgery left some cancer cells behind, we would be recommending more surgery. Everything we do after surgery — chemotherapy, hormone therapy, targeted therapy, radiation — is insurance to lower the risk that the cancer will come back. That insurance is deeply rooted in science, clinical trials, and the lives of volunteers who participated in research that showed those therapies make it less likely that your cancer will come back in your breast or in your lung, liver, bones, or brain. But that cancer we are hoping to stop from coming back is microscopic. It is so small we can’t find it with routine scans or blood tests. One day, as research progresses, we may be able to. But since we can’t, to me, it feels cruel and inauthentic to tell patients that they can’t really celebrate until it’s been 5 years or 10 years since their surgery. There is nothing magical about year 5 or year 10. It’s just how we measure cancer treatment time. So, if saying “I am cured” resonates with you — use it. If it doesn’t, call yourself whatever you want! And if you don’t like using your date of surgery as a marker, pick what feels right to you! And who says you have to celebrate years? Celebrate weeks! Or months! Life is short, cancer treatment is hard. Celebrate! Carpe Diem! YOLO!