Such a Thing as 'Cancer Free?'
"Cancer free" are words that we read and hear about, but are not likely to be words ever spoken directly to us by a doctor. Similar phrases are "remission" and "we got it all." The latter may begin right after cancer surgery, when the surgeon confidently declares success. The trouble with that one is that it is absolutely impossible to know if all the cancer is gone. Cells, too tiny to be seen, may have been left nearby or may already have moved to other parts of the body. No way to know for certain."Remission" is a little different as it is a legitimate word for some cancers. Leukemia, for example, can be called "in remission" if blood and bone marrow look free of cells. Again, that is not a promise that those cells will not reappear, but it is a fair call at the moment.
In Breast Cancer World, there is no such thing. We can never know with 100 percent certainty that there are not cells lurking somewhere in our bodies. If there are, we can only hope that they will permanantly stay dormant (as they often do). One of the goals of research is to understand why, sometimes after a long period of dormancy, sleeping cancer cells suddenly awaken and cause trouble. The famous five year mark is not a promise of anything with breast cancer. Yes, all the studies document five- and ten-year survival rates, but that is a matter of convenience as much as anything. They have to pick some kind of marker; I suppose it could just as easily be four years or eight years. This week, two women joined my weekly support group for women with metastatic breast cancer; one has just experienced a recurrence after 17 years, and the second has just recurred after 15 years. This bad news was a horrible shock for them both as, quite appropriately, cancer had faded from their days and they considered it part of their past.
What is real and what can we hope for? Obviously, we hope that the cancer will never recur, that we will all go on to live long and healthy lives (perhaps even treasuring them more because of the cancer) and die as old ladies from something else. The best that we can hope to hear from our doctors is something along the lines of "Everything seems just fine" or "I expect that you will stay well." The official term is "NED," which means No Evidence of Disease. Note that it does not say "No Disease," as that can never be proven or promised. Here is something reassuring: Each year you stay well, the odds improve that you will stay well. That is, the curves begin to go in the right direction, and you can breath a little easier.
Here is a good essay about this from the Chicago Tribune:
The meaning of 'cancer-free'
As researchers learn more about recurrence, the goal posts for long-term survival keep moving further out
By Barbara Sadick, Special to Tribune Newspapers
September 26, 2012
Sixteen years ago, right before her 42nd birthday, Jane Baker Segelken was diagnosed with breast cancer. The tumor was small, and she was told that if the cancer didn't return within five years after treatment, her chances for long-term survival were good.
When Segelken made it to five years, she was advised to look to the seven-year mark, but before that seven years was reached, the target became 10 years, reflecting newer findings of longer-term studies.
"From the beginning," says Segelken, "I knew I'd never be considered cured, and as I began to meet women who had recurrences at 15 or 20 years after diagnosis, I gave up the idea that if I had no recurrences in the first 10 years, I'd be cancer-free for the rest of my life."
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