Odds in Breast Cancer

Odds in Breast Cancer

If I told you that you had a one-in-eight chance of winning the lottery, you’d probably run
out and buy a ticket right now. Those are extremely good odds. Odds worth acting upon
for, say, betting on the Triple Crown, or the World Series or the lottery! So it is sobering to
think that the odds are very good that if you are a woman in the United States of America
you will get breast cancer. In fact the odds are one in eight that you will get breast cancer.

Once you are diagnosed with breast cancer, you suddenly realize that you could get
really interested in statistics like that or, as my friend Linda calls it, “medical math.” The
two most common risk factors for breast cancer are being female and getting older. So
once you are one of those one in eight, you become really interested in trying to understand
odds a little better. Because actually every decision you make once you are diagnosed is
predicated upon understanding the odds and acting upon that understanding. Understanding
the odds of attacking the cancer if you have a lumpectomy versus a mastectomy.

Understanding the odds of recurrence if you have chemotherapy followed by oral drugs
after your mastectomy or if you just have the mastectomy and nothing else. Once you start
the drugs and you start feeling the side effects, you begin thinking about what your odds
would be like if you stopped taking the drugs so you could get some relief from the side
effects. You are always thinking about the odds of the breast cancer coming back in five
years or ten years or fifteen years. Wow, that’s a lot of math to think about.

I have broken my own rule on trolling the Internet just to look at this question of odds.
The National Cancer Institute has a handy little calculator called a Breast Cancer Risk
Assessment Tool. According to that, my odds of getting breast cancer were 0.8 percent.

Well, that didn’t work out so well. I guess someone has to be in that 0.8 percent. Eightyfive
percent of breast cancers occur where there is no family history—okay, I think that
stat makes me feel a little better (see “G Is for Guilt”).

Once I was diagnosed, what other fascinating things could I glean from statistics?

There’s a chart for everything. A chart for survival rates—five, ten, and fifteen years—
based on the stage of your cancer. You can look up survival rates based on age. You can
examine your odds for survival depending on your race. The course of treatment to follow
is also dictated by odds. A pathology of your tumor can help assess the risk of recurrence
based on the treatment options and that pathology. What combination of treatments
reduces the chance of recurrence the most? The kind of test I took, the Oncotype DX test,
was supposed to help evaluate the chances of recurrence for me and my particular tumor
on a spectrum of risk from low to high. The course of treatment was obvious if you were
low risk or high risk. I, of course, was intermediate so had to figure out what treatment I
felt I should have, since the math wasn’t conclusive. I guess in that sense I’m a pretty runof-
the-mill breast cancer patient. I was never really good at this kind of math, and it can get
overwhelming.

However, the dirty little secret about breast cancer is that it is all about odds. It irks me
when people ask if I am “all clear” or if I am in “remission” or if I am “cured.” These are
words I have never heard uttered by my doctors. Not ever. Once a diagnosis is made, the
doctors remove the cancer they have found, including, they hope, any microscopic cells
that may be running around your body looking for another place to lodge. Then they work
on trying to lower the odds of its coming back. Let’s remember, there is no cure for cancer,
yet. This is also why I have a problem with the word survivor. I have survived, for now.

As the years progress, I am going to be checking the math I was so engaged in at the
beginning to see how I match up. Odds that I’ll be around to do that five years after being
diagnosed? Eighty-eight percent.