By The Numbers

We’re not equipped to handle large numbers. Ask a kid to estimate how many strands of spaghetti there are in the box and you’ll hear “a million.” Somewhere along the line, we learn to get better at guessing, but we’re still faking it.

We don’t get it. That’s why the lottery works, and why what happens in Vegas goes into someone else’s bank account.

Epidemiologists and oncologists do a lot of work by the numbers.  If you are a woman, they say you have a 1:8 chance of being diagnosed with breast cancer sometime in your life. You get cancer. You have, they say, a 10% chance of getting better spontaneously. If you have the kind of cancer I had, you have a 10% chance of being alive in two years. When you start talking about treatment options, a lot of doctors will use numbers and percentages to communicate with you.

“I know how to treat this cancer. Of my patients like you, 25% have what they call a complete response, where after they finish chemotherapy, there is no trace of the tumor. Those patients do very well indeed,” one doctor said.

“What happens to the other 75%,” asked Chris.

“Let’s focus on the 25%.”

I’d gone from a 10% to a 25%. Still fail. I moved on.

“Do you have any other questions?” asked Dr Walters, the oncologist at MD Anderson who I eventually chose to be the man who would treat my disease.

“How serious is my disease?”

“Serious.”

Chris asked about percentages.

“It’s hard to say,” said Dr Walters. “No one has a crystal ball. Maybe 40%? It depends on how you respond to the chemotherapy. Your odds might be closer to 60% just by virtue of your being treated here. It’s hard to pull numbers on a case by case basis.”

“What about the ten percent figure I read about?”

“Stay off the internet, and that has more to do with disparity of health care. Your being here, at this stage of your disease, puts you of that category.”

“I really don’t have a choice, do I?”

“It’s up to you. You can do nothing and hope your cancer will spontaneously go away. That happens sometimes, and we have patients who choose to hope for that. But it’s very rare, and your disease is already quite advanced. Or you can do our regimen and hope that you’re in the group of patients for whom it works.”

40%. I was still failing, but within spitting distance of a D minus, a passing grade. Maybe already there if life graded me on a curve.

After I finished chemotherapy and had surgery, my lymph nodes, which had been chock full of cancer, came up clean. That shot my odds up to 78%. I’d pulled my grade up to a C, and when you compare my case just to women whose cancer was exactly like mine, the numbers looked even better.

“The longer you go without a recurrence, the greater your odds that one won’t happen,” Dr Walters told me the last time I saw him. I don’t see him any more. I see Kathy, a nurse-practitioner in his practice, and we don’t talk about my odds of not dying. We talk about the things I need to do to cope with the lasting side effects of chemotherapy.

In a few weeks, I’ll pass the three year mark for being cancer-free. They’ll move me to the long-term survivor category and only make me come back for checkups every year.

I’m getting an A!

Except I think it’s still pass-fail.