You did not cause your cancer

Unfortunately, many people with cancer also struggle with guilt. What did I do to bring this on? Was it my diet or not getting enough exercise or not controlling my stress or my sexual activity in my youth? Of all our possible emotions, guilt must be among the most soul sapping and useless. Here is the truth about all these questions (and any others that you are asking yourself): We know of a few lifestyle choices that can increase the risk of developing cancer. These include smoking, too much alcohol, working around asbestos and probably some other industrial exposures. We also know, absolutely know with certainty, that none of these habits guarantee cancer, and that the overwhelming number of cancers have no known cause. It is nothing that you did and nothing that you didn't do to bring on the cancer diagnosis.

As an aside, the only people who can truly point at the likely root of their cancers are those who carry a genetic mutation. When I sit with a group of women who have breast cancer, there is sometimes a strange almost-envy of those who have a BRCA mutation as they can identify the cause of their diagnosis. Everyone else has to learn to live with uncertainty and a question that will never be answered.

I have heard all kinds of quirky suggestions of why cancer developed. One woman with breast cancer was convinced it was because her 80-pound dog had stepped on her breast. Another, more sadly, struggled because her sadistic father always told her that she would die of cancer. Others wonder whether it was because of limited green vegetables in their diets or lack of regular exercise or poor anger management. It was none of those things. No one, not even the world's very best cancer researchers, understands why cancer happens. Our bodies are programmed to keep us well, and it actually takes a perfect storm of errors for a cell to become malignant.

Some years ago, I worked with a delightful woman who had Stage IV lung cancer. She had smoked for a few years in her 20s, but had given it up decades earlier. Nevertheless, those long-ago cigarettes haunted her, and she was tortured by self-criticism and guilt. Those feelings were finally relieved when a woman in our support group made a suggestion for a perfect response when someone asked her if she had smoked. The answer: Only after sex. This made us all laugh and immediately cleared out the guilty feelings.

There are many theories about environmental causes and lots of good reasons to worry about pollution and contaminated water. There is much less reason to worry about dry cleaning our clothes or wearing underwire bras or wrapping our left-overs in plastic or heating things in the microwave in plastic containers. As far as I can understand it, the best explanation is that something in the environment finds vulnerability in a cell and begins a complex malignant process. No one can tell us exactly how or why or when.

There have been a number of books that propose psychological reasons for cancer. Remember the best seller some decades ago that asked: Why did you need this cancer? The hypothesis that cancer was psychologically necessary to heal a hurt or fill a chasm makes me furious. Any suggestion that the diagnosis is a bio psychosocial response to an unresolved issue or an unfortunate childhood or another human problem is ridiculous and wrong and can be hurtful.

It is very hard to accept that cancer is just plain bad luck and that *%#* happens. That, however, is the truth. Any time and energy wasted on trying to seek out the cause is lost time and energy that could be much better directed. I appreciate that we all would like to know how and why this happened so that we could avoid its happening again. If someone could promise me that my two breast cancers were the result of not eating enough cauliflower, you can be sure that vegetable would be on my plate several times a day. Cancer is often a disease of aging; as we live longer, we are more likely to develop some kinds of cancer. This is an unfortunate companion to longer lives, but I am confident that none of us want to return to the days before antibiotics or when many women died in childbirth.

If you are still looking for the reason for your diagnosis, please try to let it go. Think instead of how best to live your life going forward, focusing both on health and happiness.