I suspect some of my thinking is not dissimilar from that of many women diagnosed with breast cancer. Even now, several months later and after two wide excision surgeries and a week of intensive radiotherapy, I still have moments when I wish I could enter a time capsule and jet back to the heady days before the end of October 2021 when I innocently went about my life without the spectre of breast cancer stalking like a mugger. A mugger, ever ready to hijack the life I thought was mine and leave me physically and emotionally scarred and changed forever.
When my mind goes to the ‘Why Me?’ question, my brain tries to shout back about the high prevalence of breast cancer, and the fact that the incidence increases as you age, and more so after the age of fifty. I’ve been trying to find the specific UK statistics; I think it is 1 in 8 women will develop breast cancer at some point in their lives. Obviously, the older you are, the more likely you are to be one of those positive results. So, the ‘why me?’ should have less emotional weight, shouldn’t it? Yet, I often start thinking about what I may or may not have done ‘to deserve this.’ Of course, this is a neurotic way of thinking. Nobody deserves cancer. But somewhere in my psyche lives that concept of sin and deserving punishment of some kind. It’s not a conscious process, but rather a devil that rears its ugly head from its subconscious slumber if something terrible happens. Could this be a consequence of my very early education in a Roman Catholic kindergarten and early school in Guyana? Could those nuns have instilled these deep feelings of sin and deserving punishment? (NB to self – discuss with my therapist!)
And terrible is what breast cancer is. It attacks my very sense of womanhood, sexuality and how I feel about myself. I was going to depersonalise that statement, but perhaps there are some women out there for whom this is not true.
First, there is the disease itself that I saw as an assassin of the person I thought I was. Quickly followed by the treatments to get rid of it. I know I’m one of the lucky ones, in that my cancer was discovered early. It was a small Stage 1 mucinous invasive carcinoma with surrounding DCIS that had not yet gone to my lymph nodes, a virtually zero proliferation score (1-2%), was HER2 negative, and Estrogen and Progesterone positive. I was told that these factors correlate with a good prognosis. So, why am I so agitated?
I did not have to have the mastectomy I so feared; and although I needed two operations to find a clear margin, my surgeon was successful. No chemo proposed, which I had been dreading. Instead, one week of intensive radiotherapy. I have refused to have the proposed five years of Aromatase Inhibitor (AI) therapy because on a cost/benefit analysis, it did not seem to me that the small risks of a reoccurrence of breast cancer could possibly outweigh the devastation to my Quality of Life (QOL) by AI, not to mention increased risk of serious bone thinning, a possible fatal heart attack or stroke. My risk of death from these causes appeared to be higher than death from breast cancer. These are my own conclusions based on my research and discussions on my specific cancer. I am not advocating this path for anyone else. We all take our own informed decisions and give informed consent – or otherwise.
At times that guilt thing kicks in again. This time, it’s me thinking about all those women whose cancer is much more advanced and less curable. Or when I hear of yet another relatively young woman who has died because of her breast cancer. Then I whip myself into a self-critical frenzy, asking myself what the hell do I have to complain about? So, I feel down. So, I feel excessively fatigued and
still in pain after radiotherapy. So, I feel unattractive and undesirable. So Bloody What, Susan! I am alive and with a good prognosis! Alas, my own reality cannot change that of others. I can only be myself – even if it appears self-centered and obsessive.
The Tyranny of Positive Thinking
I know people mean well when they tell me to stay positive and I’ll win the battle. I don’t understand why so many people feel the need to tell cancer patients, or indeed anybody suffering from serious illness, ‘just be positive.’
Perhaps one can deal with some of the treatments better if you are in a positive frame of mind. Maybe you can experience pain in a slightly less intense manner if your levels of cortisol are lower. But, and this is the big BUT, no amount of positivity is going to take the cancer away or prevent its reoccurrence. I could of course be wrong, but I am not aware of any evidence to this, that is based on science.
This brings me to my other rant, why is the terminology of war used when linked to cancer? The metaphor dates back as early as 500BC. Perhaps back then, it was perceived as a war that could be won by sheer will and determinism. But, most cancer patients and those who are now cancer-free do not appreciate these metaphors.
If it is a battle, it follows that there are winners and losers. What if we lose? Is it our fault? Did we not fight hard enough? Were we not sufficiently positive?
Scientists and oncologists have a much greater understanding of cancer now than they did even twenty years ago, thanks to advances in research. Breast cancer is one of the cancers that has seen some of the most promising and brilliant advances in early diagnosis, treatments, and outcomes. Survivability has increased astonishingly from the dread of 40 years ago. But this is not the result of a cancer patient’s positive thinking or winning a war/battle. This is the advancement of science and medicine.
Somewhere Over the Rainbow - go I
Hasta Pronto mis amigos!